A giant fibroepithelial polyp mimicking a subepithelial tumor

A rare congenital anal tag presenting as a perineal mass

“…Benign acrochorda / skin tags are also known as fibro-epithelial polyps or fibrous polyps 6,7 . They are considered to originate from anal papillae, projections at the muco-cutaneous junction of the upper anal canal 5 .…”

“…When these papillae become hypertrophied with considerable fibrous thickening, they may acquire a rounded and expanded tip to form fibro-epithelial anal polyps 5,9 . They are benign, skincoloured papules, mostly found at the dentate line, anal mucosa or in the perianal skin and are mostly idiopathic 6,7,10 . Anal tags are usually asymptomatic and thus often ignored 9,10 .…”

“…Histologically, these tags consist of myxoid or collagenous stroma covered by squamous epithelium, which usually is slightly hyperplastic and may be keratinized, which is that of the normal skin histology 6,7 . Several differential diagnoses exist for a perianal mass such as sacrococcygeal teratoma, rectal duplication cyst, perianal rhabdomyosarcoma, hamartomatous polyp and infantile perineal protrusion 1,2,3 .…”

“…They represent reactive hyperplasia in response to local irritation, infection or injury 3,5 . Tags are also found in the neck, axillary and inguinal areas 6,7 . In neonates, they are reported predominantly in the urethra, not in the anal region, and are believed to arise as a developmental error in the invagination process of the prostate 3 .…”