Colon

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Author: Mikael Häggström [note 1]

Endoscopic biopsies   edit
Mostly:

This article also includes the rectum.

Presentations

Gross processing

More specific grossing is available for presentations above. For larger specimens (not biopsies):

  • Identify segment of colon if possible.
  • Measure length, average width and any significant variations thereof.
  • Optionally, measure the mesentery.
  • Inspect the serosa- look for any perforations, adhesions, fistulas and exudate
  • If perforation is present, try to probe it from the serosal surface
  • Open longitudinally
  • If the specimen is not fixed already, put it in formalin, preferably for a total of 48 hours.[1] Section attached fatty tissue for better fixation.
Multiple diverticula.
  • Semi-quantitate the number of diverticula – “numerous” or "multiple" if too many to count
  • Look for for any mucosal lesions. Note any evidence of inflammation, hemorrhage, abscess, perforation or fistula
  • Note the thickness of the wall.
  • If a cecal segment does not show an appendix, look in the history for a past appendectomy. If not, put more effort into finding it before reporting it as not found.
A mesenteric lymph node.
  • Note any obvious mesenteric lymph nodes. Further information: Lymph nodes
  • Sections to submit for microscopy:
  • 2 sections of any perforation(s), one section of any intact diverticulum, any mucosal lesions, any obvious lymph nodes.

Gross report

Example:

((A. Labeled - ___. The specimen is received in formalin and consists of))A. Labeled - [

- Check name and DOB - Confirm labeling with req ]. The specimen is received in formalin and consists of a segment of large intestine which measures __ cm in length and __ cm in average diameter. The serosal surface is tan and smooth.

  • ((The proximal surgical margin is inked blue and the distal surgical margin is inked green.))

or

  • The specimen is unoriented. ((The proximal and distal surgical margins are inked blue.))

((The mesenteric margin is inked red.)) The specimen is opened longitudinally to reveal a smooth mucosa. {{There are multiple diverticula measuring up to __ cm in depth. The rest of}} the mucosa is tan-pink with normal mucosal folds. The lumen is not dilated. The wall measures __ cm in thickness. Within the mesorectum there are __ possible lymph nodes measuring up to __ cm in greatest dimension. [[Sample 4-8 lymph nodes in case of diverticulitis]]  (Representative sections are submitted for microscopic examination in __ cassettes.)

Microscopic evaluation

Screening

In a general screening, look for:

  • Colitis, such as by neutrophilic infiltration

Common incidental findings

Microscopy report

Example report in an unremarkable biopsy:

(Colon, biopsy:)
Colonic mucosa without significant histopathologic changes.

In follow-ups of inflammatory bowel disease (IBD), add "Negative for colitis or dysplasia" if true.

Notes

  1. It is acceptable to not mention a subepithelial lymphoid aggregate at all.
  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Burroughs, S H (2000). "Examination of large intestine resection specimens ". Journal of Clinical Pathology 53 (5): 344–349. doi:10.1136/jcp.53.5.344. ISSN 00219746. 

Image sources