Fibroepithelial polyps of the anus are relatively common lesions, some of which are thought to arise from enlargement of anal papillae. Others are thought to arise from fibrosed haemorrhoids.
They are oedematous, flesh-coloured, sessile protrusions usually measuring 1–2 cm in length. Underlying constipation might be present. Fibroepithelial polyps of the anus may be associated with local inflammation such as fissure, fistula and irritant or allergic contact dermatitis. A variant associated with lichen sclerosus may also occur.
A fibroepithelial polyp of the anus has a myxoid and/or collagenous stroma covered by stratified squamous epithelium which may show some swollen cells with vacuolation near the surface. The stroma sometimes contains atypical cells showing fibroblastic and myofibroblastic differentiation. Hyalinized vascular changes may be present near the base of the polyps. There is an increase in CD34+ stromal cells.
Fibroepithelial polyps of the anus should not be mistaken for condylomas. They should also be distinguished from the much smaller transient infantile perianal pyramidal protrusion which occurs predominantly in young girls in the midline. Larger, fleshier, more oedematous skin tags should arouse the suspicion of Crohn’s disease. They can predate gastrointestinal disease by several years. Disturbance of the normal embryological development of the anus may rarely result in the appearance of one or more polypoid projections at the anus (anomalous anal papillae). These may be asymptomatic, but often become complicated by ulceration, faecal retention and constipation.
Fibroepithelial polyps of the anus might be treated successfully by topical steroid applications however, removal is the standard treatment when required.
This page was last updated in March 2016.