Colon

Author: Mikael Häggström

Endoscopic biopsies  

Mostly: Esophagus Gastroesophageal junction Stomach Gastric polyp Duodenum Colon Colorectal polyp

This article also includes the rectum.

Contents

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 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. 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:

• 

  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:

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

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

Main page

• Main page of Patholines