Difference between revisions of "Colon"

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{{Endoscopic biopsies}}
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This article also includes the rectum.
  
 
==Presentations==
 
==Presentations==
 
*[[Colorectal polyp]]
 
*[[Colorectal polyp]]
 
*[[Colon ischemia]]
 
*[[Colon ischemia]]
 +
*[[Colon for diverticulitis]]
 
*[[Intestine with tumor]]
 
*[[Intestine with tumor]]
:*[[Total mesorectal excision]]
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*[[Colitis]]
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*[[Hemorrhoids]]
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*[[Stoma]] and "donuts"
  
 
==Gross processing==
 
==Gross processing==
More specific grossing is available for presentations above.
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More specific grossing is available for presentations above. For larger specimens (not biopsies):
*Identify '''segment''' of colon
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*Identify '''segment''' of colon if possible.
*Measure '''length''' and variations in '''width'''
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*Measure '''length''', average '''width''' and any significant variations thereof.
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*Optionally, measure the '''mesentery'''.
 
*Inspect the '''serosa'''- look for any perforations, adhesions, fistulas and exudate
 
*Inspect the '''serosa'''- look for any perforations, adhesions, fistulas and exudate
 
:*If perforation is present, try to probe it from the serosal surface
 
:*If perforation is present, try to probe it from the serosal surface
 
*'''Open''' longitudinally
 
*'''Open''' longitudinally
*Semi-quantitate the number of '''diverticula''' – “numerous” if too many to count
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*If the specimen is not fixed already, put it in '''formalin''', preferably for a total of 48 hours.<ref name="Burroughs2000">{{cite journal|last1=Burroughs|first1=S H|title=Examination of large intestine resection specimens|journal=Journal of Clinical Pathology|volume=53|issue=5|year=2000|pages=344–349|issn=00219746|doi=10.1136/jcp.53.5.344}}</ref> Section attached fatty tissue for better fixation.
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[[File:Gross pathology of diverticulosis.jpg|thumb|220px|Multiple diverticula.]]
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*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
 
*Look for for any '''mucosal lesions'''. Note any evidence of inflammation, hemorrhage, abscess, perforation or fistula
*Note the '''thickness''' of the wall
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*Note the '''thickness''' of the wall.
*Optionally, measure the '''mesentery'''
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*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.
*Note any obvious mesenterial '''lymph nodes'''
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[[File:Gross pathology of a mesenteric lymph node.jpg|thumb|190px|A mesenteric lymph node.]]
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*Note any obvious mesenteric '''lymph nodes'''. {{Further|Lymph nodes}}
 
*'''Sections''' to submit for microscopy:  
 
*'''Sections''' to submit for microscopy:  
:*2 sections of any perforation(s), one section of intact diverticulum, any mucosal lesions, any obvious lymph nodes.  
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:*2 sections of any perforation(s), one section of any intact diverticulum, any mucosal lesions, any obvious lymph nodes.
:*If there is no perforation: 3 sections of diverticulum.
+
 
 +
==Microscopic evaluation==
 +
===Screening===
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In a general screening, look for:
 +
<gallery mode=packed>
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File:Tubular adenoma of the colon.jpg|Hyperplasia and/or atypia ([[colorectal polyp]] with [[tubular adenoma]] pictured)
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</gallery>
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*'''[[Colitis]]''', such as by neutrophilic infiltration
 +
 
 +
===Common incidental findings===
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<gallery mode=packed>
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File:Melanosis coli (4130655629).jpg|'''Melanosis coli''', lipofuscin-containing macrophages
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File:Histology of subepithelial lymphoid aggregate of the colon.jpg|thumb|'''Subepithelial lymphoid aggregate''', nonspecific, and generally reported as such.<ref group=notes>It is acceptable to not mention a subepithelial lymphoid aggregate at all.</ref>
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</gallery>
 +
 
 +
===Microscopy report===
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Example report in an unremarkable biopsy:
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{|class=wikitable
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| (Colon, biopsy:)<br>Colonic mucosa without significant histopathologic changes.
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|}
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In follow-ups of inflammatory bowel disease ('''IBD'''), add "Negative for colitis or dysplasia" if true.
 
{{Bottom}}
 
{{Bottom}}

Revision as of 20:46, 15 July 2021

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.

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