Anus & perianal area
Other nonneoplastic
Hypertrophied papillae

Topic Completed: 1 June 2014

Minor changes: 16 November 2020

Copyright: 2002-2021,, Inc.

PubMed Search: Hypertrophied papillae

Elliot Weisenberg, M.D.
Page views in 2020: 13,132
Page views in 2021 to date: 637
Cite this page: Weisenberg E. Hypertrophied papillae. website. Accessed January 17th, 2021.
Definition / general
  • Acquired projections of hyperplastic anal mucosa and submucosa
  • Known as anal tags, anal skin tags, anal fibroepithelial polyps
  • Very common in patients who undergo proctoscopic evaluation
  • Occur at base of anal columns
  • Protrude into anal canal, adjacent to anal ulcers
  • Reactive hyperplastic process of stromal connective tissue, either in isolation or secondary to nearby infectious / inflammatory process or mass lesion
  • Analogous to cutaneous skin tags
Clinical features
  • Ranges from subtle swelling at base of anal column to mass protruding into anal canal
  • May be associated with or thought to be hemorrhoids
  • May be adjacent to inflammation, abscess, tumor
  • Tend to enlarge over time
  • May be asymptomatic or associated with pain, discharge, itching, especially if longstanding
  • If pathology is isolated to hypertrophied papillae, resection is curative; otherwise, underlying pathology must be treated to relieve symptoms
  • Similarly to hemorrhoids, histopathologic evaluation is necessary to exclude accompanying lesions, such as low or high grade squamous intraepithelial lesions, invasive squamous cell carcinoma, rectal carcinoma, neuroendocrine tumors, melanoma, lymphoma, inflammatory bowel disease, nonspecific granulomas, herpes simplex virus infection, syphilis
Gross description
  • Polypoid, may resemble hemorrhoids
Microscopic (histologic) description
  • Usually thin squamous epithelium overlying an edematous to myxoid stroma with small, thin, branching vessels
  • Usually many mast cells
  • Secondary acute or chronic inflammatory cell infiltrate may be present
  • 80% have large, CD34+ stellate cells with fibroblastic or myofibroblastic differentiation that often show atypical nuclear features and multinucleation (Am J Surg Pathol 1998;22:70)
  • Lacks the hemorrhage, thick walled blood vessels and thrombosis present in hemorrhoids
Microscopic (histologic) images

Contributed by Elliot Weisenberg, M.D.
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Typical hypertrophied anal papillae

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Thin walled vessels

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Chronic inflammatory cell infiltrate

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Atypical stromal cells

Positive stains
  • CD34 stains atypical stromal cells
Electron microscopy description
  • Fibroblastic and myofibroblastic stromal cells
Differential diagnosis
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