Colon

Author: Mikael Häggström

This article also includes the rectum.

Presentations

• Colorectal polyp
• Colon ischemia
• Colon for diverticulitis
• Intestine with tumor
• Colitis
• Hemorrhoids
• Stoma and "donuts"

Gross processing

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

• Identify segment of colon
• Measure length and variations in width
• 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
• Semi-quantitate the number of diverticula – “numerous” 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
• Optionally, measure the mesentery
• Note any obvious mesenterial 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.

Microscopic evaluation

Screening

In a general screening, look for:

• 

  Hyperplasia and/or atypia (colorectal polyp with tubular adenoma pictured)

• Colitis, such as by neutrophilic infiltration

Common incidental findings

• 

  Melanosis coli, lipofuscin-containing macrophages

• 

  Subepithelial lymphoid aggregate, nonspecific, and generally reported as such.]]

Microscopy report

Example report in an unremarkable biopsy:

Colonic mucosa, negative for significant histopathologic changes.

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