Difference between revisions of "Colon"

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(move stoma to top, subdivide)
(major re-arrange, subdivide/re-organize)
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***The proximal, anterior aspect of the rectum has serosa, i.e. it is not painted.
***The proximal, anterior aspect of the rectum has serosa, i.e. it is not painted.


=Specific entities=
=Common non-neoplastic disease=
==Inflammatory bowel disease==
{{main|Inflammatory bowel disease}}
 
The bread 'n butter of gastroenterology.  A detailed discussion of '''IBD''' is in the ''[[inflammatory bowel disease]]'' article.  It comes in two main flavours (Crohn's disease, ulcerative colitis).
 
===Microscopic===
Features helpful for the diagnosis of IBD - as based on a study:<ref name=pmid10048734>{{cite journal |author=Tanaka M, Riddell RH, Saito H, Soma Y, Hidaka H, Kudo H |title=Morphologic criteria applicable to biopsy specimens for effective distinction of inflammatory bowel disease from other forms of colitis and of Crohn's disease from ulcerative colitis |journal=Scand. J. Gastroenterol. |volume=34 |issue=1 |pages=55–67 |year=1999 |month=January |pmid=10048734 |doi= |url=}}</ref>
*Basal, i.e. crypt base, plasmacytosis with severe chronic inflammation,
*Crypt architectural abnormalities, and
*Distal Paneth cell metaplasia.
**Paneth cells should ''not'' be in the left colon<ref name=pmid11851832>{{cite journal |author=Tanaka M, Saito H, Kusumi T, ''et al'' |title=Spatial distribution and histogenesis of colorectal Paneth cell metaplasia in idiopathic inflammatory bowel disease |journal=J. Gastroenterol. Hepatol. |volume=16 |issue=12 |pages=1353–9 |year=2001 |month=December |pmid=11851832 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0815-9319&date=2001&volume=16&issue=12&spage=1353}}</ref> - if you see 'em think of IBD and other long-standing injurious processes.
**Some claim that (friendly right colonic) paneth cells and paneth cell metaplasia look quite different and can be distinguished.<ref name=pmid12655793>{{cite journal |author=Rubio CA, Nesi G |title=A simple method to demonstrate normal and metaplastic Paneth cells in tissue sections |journal=In Vivo |volume=17 |issue=1 |pages=67–71 |year=2003 |pmid=12655793 |doi= |url=}}</ref>
 
==Bowel ischemia==
==Bowel ischemia==
===General===
===General===
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*Radiation.
*Radiation.
*Toxins/drugs.
*Toxins/drugs.
==Angiodysplasia==
===General===
*Causes (lower) GI haemorrhage.
*Generally, not a problem pathologists see.
*May be associated with [[aortic stenosis]]; known as ''Heyde syndrome''.<ref name=pmid19652242>{{cite journal |author=Hui YT, Lam WM, Fong NM, Yuen PK, Lam JT |title=Heyde's syndrome: diagnosis and management by the novel single-balloon enteroscopy |journal=Hong Kong Med J |volume=15 |issue=4 |pages=301–3 |year=2009 |month=August |pmid=19652242 |doi= |url=http://www.hkmj.org/abstracts/v15n4/301.htm}}</ref>
Classic location:
*Cecum.
Epidemiology:
*Older people.
Etiology:
*Thought to be caused by the higher wall tension of cecum (due to larger diameter) and result from (intermittent) venous occlusion/focal dilation of vessels.<ref name=Ref_PBoD854>{{Ref PBoD|854}}</ref>
===Microscopic===
Features:<ref name=pmid3054852>{{Cite journal  | last1 = Hemingway | first1 = AP. | title = Angiodysplasia: current concepts. | journal = Postgrad Med J | volume = 64 | issue = 750 | pages = 259-63 | month = Apr | year = 1988 | doi =  | PMID = 3054852 }}</ref>
*Dilated vessels in mucosa and submucosa.


==Diverticular disease==
==Diverticular disease==
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*[http://histology-group28.wikispaces.com/file/view/divertic.jpg/60992930/divertic.jpg DD (wikispaces.com)].<ref>URL: [http://histology-group28.wikispaces.com/DigestiveSystemProject http://histology-group28.wikispaces.com/DigestiveSystemProject]. Accessed on: 23 August 2011.</ref>
*[http://histology-group28.wikispaces.com/file/view/divertic.jpg/60992930/divertic.jpg DD (wikispaces.com)].<ref>URL: [http://histology-group28.wikispaces.com/DigestiveSystemProject http://histology-group28.wikispaces.com/DigestiveSystemProject]. Accessed on: 23 August 2011.</ref>


==Pseudomelanosis coli==
=Inflammatory=
*AKA ''melanosis coli''.<ref>URL: [http://www.medicinenet.com/melanosis_coli/article.htm http://www.medicinenet.com/melanosis_coli/article.htm]. Accessed on: 4 March 2011.</ref>
==Inflammatory bowel disease==
===General===
{{main|Inflammatory bowel disease}}
*''Not melanin'' as the name ''melanosis coli'' suggests; it is actually lipofuscin (in macrophages).<ref name=pmid18666316>{{cite journal |author=Freeman HJ |title="Melanosis" in the small and large intestine |journal=World J. Gastroenterol. |volume=14 |issue=27 |pages=4296-9 |year=2008 |month=July |pmid=18666316 |doi= |url=http://www.wjgnet.com/1007-9327/14/4296.asp}}</ref>
*Endoscopist may see brown pigmentation of mucosa and suspect the diagnosis.


====Epidemiology====
The bread 'n butter of gastroenterology. A detailed discussion of '''IBD''' is in the ''[[inflammatory bowel disease]]'' article. It comes in two main flavours (Crohn's disease, ulcerative colitis).
*Classically associated with anthracene containing laxative (e.g. Senokot) use and herbal remedies.<ref name=pmid18666316/>
 
===Gross===
*Brown pigmentation of the mucosa.  


Image:
*[http://commons.wikimedia.org/wiki/File:Melanosis_coli.jpg Melanosis coli - endoscopic image (WC)].
===Microscopic===
===Microscopic===
Features:
Features helpful for the diagnosis of IBD - as based on a study:<ref name=pmid10048734>{{cite journal |author=Tanaka M, Riddell RH, Saito H, Soma Y, Hidaka H, Kudo H |title=Morphologic criteria applicable to biopsy specimens for effective distinction of inflammatory bowel disease from other forms of colitis and of Crohn's disease from ulcerative colitis |journal=Scand. J. Gastroenterol. |volume=34 |issue=1 |pages=55–67 |year=1999 |month=January |pmid=10048734 |doi= |url=}}</ref>
*Brown granular pigment - in the lamina propria.
*Basal, i.e. crypt base, plasmacytosis with severe chronic inflammation,
**Typically more prominent in the cecum and proximal colon.<ref name=pmid18666316/>
*Crypt architectural abnormalities, and
 
*Distal Paneth cell metaplasia.
Images:
**Paneth cells should ''not'' be in the left colon<ref name=pmid11851832>{{cite journal |author=Tanaka M, Saito H, Kusumi T, ''et al'' |title=Spatial distribution and histogenesis of colorectal Paneth cell metaplasia in idiopathic inflammatory bowel disease |journal=J. Gastroenterol. Hepatol. |volume=16 |issue=12 |pages=1353–9 |year=2001 |month=December |pmid=11851832 |doi= |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0815-9319&date=2001&volume=16&issue=12&spage=1353}}</ref> - if you see 'em think of IBD and other long-standing injurious processes.
*[http://commons.wikimedia.org/wiki/File:Melanosis_coli_high_mag.jpg Melanosis coli - high mag. (WC)].
**Some claim that (friendly right colonic) paneth cells and paneth cell metaplasia look quite different and can be distinguished.<ref name=pmid12655793>{{cite journal |author=Rubio CA, Nesi G |title=A simple method to demonstrate normal and metaplastic Paneth cells in tissue sections |journal=In Vivo |volume=17 |issue=1 |pages=67–71 |year=2003 |pmid=12655793 |doi= |url=}}</ref>
*[http://commons.wikimedia.org/wiki/File:Melanosis_coli_low_mag.jpg Melanosis coli - low mag. (WC)].
 
Notes:
*DDx of brown pigment:
**Lipofuscin - comes with age (can be demonstrated with a ''[[PAS stain]]''<ref name=pmid5463681 >{{cite journal |author=Kovi J, Leifer C |title=Lipofuscin pigment accumulation in spontaneous mammary carcinoma of A/Jax mouse |journal=J Natl Med Assoc |volume=62 |issue=4 |pages=287–90 |year=1970 |month=July |pmid=5463681 |pmc=2611776 |doi= |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2611776/pdf/jnma00512-0077.pdf}}</ref> or ''Kluver-Barrera stain''<ref>URL: [http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exkluvbarr.htm http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exkluvbarr.htm]. Accessed on: 5 May 2010.</ref>).
***Melanosis coli.
**Old haemorrhage, i.e. hemosiderin-laden macrophages (may be demonstrated with ''Prussian blue stain''<ref>URL: [http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exprussb.htm http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exprussb.htm]. Accessed on: 5 May 2010.</ref>).
**Melanin (from melanocytes) - rare in colon (may be demonstrated with a ''Fontana-Masson stain''<ref>URL: [http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exfontana.htm http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exfontana.htm]. Accessed on: 5 May 2010.</ref> -- though not so useful in the GI tract).
**Foreign material (e.g. tattoo pigment) - not seen in GI tract.
 
===Stains===
*Can be demonstrated with a [[PAS stain]].<ref name=pmid9283862>{{cite journal |author=Benavides SH, Morgante PE, Monserrat AJ, Zárate J, Porta EA |title=The pigment of melanosis coli: a lectin histochemical study |journal=Gastrointest. Endosc. |volume=46 |issue=2 |pages=131–8 |year=1997 |month=August |pmid=9283862 |doi= |url=}}</ref>


==Microscopic colitis==
==Microscopic colitis==
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**No crypt distortion.
**No crypt distortion.


=Infectious=
==Intestinal spirochetosis==
==Intestinal spirochetosis==
*[[AKA]] ''intestinal spirochetes''; more specifically ''colonic spirochetes'', ''colonic spirochetosis''.
*[[AKA]] ''intestinal spirochetes''; more specifically ''colonic spirochetes'', ''colonic spirochetosis''.
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*[http://commons.wikimedia.org/wiki/File:Hyperplastic_polyp2.jpg Hyperplastic polyp image - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Hyperplastic_polyp2.jpg Hyperplastic polyp image - low mag. (WC)].


==Colorectal Tumours==
=Rectal pathology=
{{main|Colorectal tumours}}
These are very common.  The are covered in a separate article entitled ''[[colorectal tumours]]''.
 
==Solitary rectal ulcer==
==Solitary rectal ulcer==
===General===
===General===
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*[http://commons.wikimedia.org/wiki/File:Rectal_prolapse_-_low_mag.jpg Rectal prolapse - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Rectal_prolapse_-_low_mag.jpg Rectal prolapse - low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Rectal_prolapse_-_intermed_mag.jpg Rectal prolapse - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Rectal_prolapse_-_intermed_mag.jpg Rectal prolapse - intermed. mag. (WC)].
=Neoplastic=
==Colorectal Tumours==
{{main|Colorectal tumours}}
These are very common.  The are covered in a separate article entitled ''[[colorectal tumours]]''.
==Neuroendocrine tumour==
{{Main|Neuroendocrine neoplasms#GI tract}}
*[[AKA]] ''carcinoid''.
==Goblet cell carcinoid==
:Described in detail in the ''[[appendix]]'' article.
*AKA ''crypt cell carcinoma''.
*Biphasic tumour; features of ''carcinoid tumour'' and ''adenocarcinoma''.
=Other=
==Pseudomelanosis coli==
*AKA ''melanosis coli''.<ref>URL: [http://www.medicinenet.com/melanosis_coli/article.htm http://www.medicinenet.com/melanosis_coli/article.htm]. Accessed on: 4 March 2011.</ref>
===General===
*''Not melanin'' as the name ''melanosis coli'' suggests; it is actually lipofuscin (in macrophages).<ref name=pmid18666316>{{cite journal |author=Freeman HJ |title="Melanosis" in the small and large intestine |journal=World J. Gastroenterol. |volume=14 |issue=27 |pages=4296-9 |year=2008 |month=July |pmid=18666316 |doi= |url=http://www.wjgnet.com/1007-9327/14/4296.asp}}</ref>
*Endoscopist may see brown pigmentation of mucosa and suspect the diagnosis.
====Epidemiology====
*Classically associated with anthracene containing laxative (e.g. Senokot) use and herbal remedies.<ref name=pmid18666316/>
===Gross===
*Brown pigmentation of the mucosa.
Image:
*[http://commons.wikimedia.org/wiki/File:Melanosis_coli.jpg Melanosis coli - endoscopic image (WC)].
===Microscopic===
Features:
*Brown granular pigment - in the lamina propria.
**Typically more prominent in the cecum and proximal colon.<ref name=pmid18666316/>
Images:
*[http://commons.wikimedia.org/wiki/File:Melanosis_coli_high_mag.jpg Melanosis coli - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Melanosis_coli_low_mag.jpg Melanosis coli - low mag. (WC)].
Notes:
*DDx of brown pigment:
**Lipofuscin - comes with age (can be demonstrated with a ''[[PAS stain]]''<ref name=pmid5463681 >{{cite journal |author=Kovi J, Leifer C |title=Lipofuscin pigment accumulation in spontaneous mammary carcinoma of A/Jax mouse |journal=J Natl Med Assoc |volume=62 |issue=4 |pages=287–90 |year=1970 |month=July |pmid=5463681 |pmc=2611776 |doi= |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2611776/pdf/jnma00512-0077.pdf}}</ref> or ''Kluver-Barrera stain''<ref>URL: [http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exkluvbarr.htm http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exkluvbarr.htm]. Accessed on: 5 May 2010.</ref>).
***Melanosis coli.
**Old haemorrhage, i.e. hemosiderin-laden macrophages (may be demonstrated with ''Prussian blue stain''<ref>URL: [http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exprussb.htm http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exprussb.htm]. Accessed on: 5 May 2010.</ref>).
**Melanin (from melanocytes) - rare in colon (may be demonstrated with a ''Fontana-Masson stain''<ref>URL: [http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exfontana.htm http://education.vetmed.vt.edu/curriculum/VM8054/labs/Lab2/Examples/exfontana.htm]. Accessed on: 5 May 2010.</ref> -- though not so useful in the GI tract).
**Foreign material (e.g. tattoo pigment) - not seen in GI tract.
===Stains===
*Can be demonstrated with a [[PAS stain]].<ref name=pmid9283862>{{cite journal |author=Benavides SH, Morgante PE, Monserrat AJ, Zárate J, Porta EA |title=The pigment of melanosis coli: a lectin histochemical study |journal=Gastrointest. Endosc. |volume=46 |issue=2 |pages=131–8 |year=1997 |month=August |pmid=9283862 |doi= |url=}}</ref>
==Angiodysplasia==
===General===
*Causes (lower) GI haemorrhage.
*Generally, not a problem pathologists see.
*May be associated with [[aortic stenosis]]; known as ''Heyde syndrome''.<ref name=pmid19652242>{{cite journal |author=Hui YT, Lam WM, Fong NM, Yuen PK, Lam JT |title=Heyde's syndrome: diagnosis and management by the novel single-balloon enteroscopy |journal=Hong Kong Med J |volume=15 |issue=4 |pages=301–3 |year=2009 |month=August |pmid=19652242 |doi= |url=http://www.hkmj.org/abstracts/v15n4/301.htm}}</ref>
Classic location:
*Cecum.
Epidemiology:
*Older people.
Etiology:
*Thought to be caused by the higher wall tension of cecum (due to larger diameter) and result from (intermittent) venous occlusion/focal dilation of vessels.<ref name=Ref_PBoD854>{{Ref PBoD|854}}</ref>
===Microscopic===
Features:<ref name=pmid3054852>{{Cite journal  | last1 = Hemingway | first1 = AP. | title = Angiodysplasia: current concepts. | journal = Postgrad Med J | volume = 64 | issue = 750 | pages = 259-63 | month = Apr | year = 1988 | doi =  | PMID = 3054852 }}</ref>
*Dilated vessels in mucosa and submucosa.


==Mucosal prolapse syndrome==
==Mucosal prolapse syndrome==
*Similar to rectal prolapse???
*Similar to rectal prolapse. (???)


==Weird stuff==
==Drugs==
===Drugs===
Kayexalate (sodium polystyrene sulfonate):<ref name=pmid11342776>{{cite journal |author=Abraham SC, Bhagavan BS, Lee LA, Rashid A, Wu TT |title=Upper gastrointestinal tract injury in patients receiving kayexalate (sodium polystyrene sulfonate) in sorbitol: clinical, endoscopic, and histopathologic findings |journal=Am. J. Surg. Pathol. |volume=25 |issue=5 |pages=637-44 |year=2001 |month=May |pmid=11342776 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=25&issue=5&spage=637}}</ref>
Kayexalate (sodium polystyrene sulfonate):<ref name=pmid11342776>{{cite journal |author=Abraham SC, Bhagavan BS, Lee LA, Rashid A, Wu TT |title=Upper gastrointestinal tract injury in patients receiving kayexalate (sodium polystyrene sulfonate) in sorbitol: clinical, endoscopic, and histopathologic findings |journal=Am. J. Surg. Pathol. |volume=25 |issue=5 |pages=637-44 |year=2001 |month=May |pmid=11342776 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=25&issue=5&spage=637}}</ref>
*Used to treat hyperkalemia.
*Used to treat hyperkalemia.
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Image: [http://commons.wikimedia.org/wiki/File:Cecal_adenocarcinoma.jpg Sodium polystyrene crystals (WC)].
Image: [http://commons.wikimedia.org/wiki/File:Cecal_adenocarcinoma.jpg Sodium polystyrene crystals (WC)].


===Graft-versus host disease===
==Graft-versus host disease==
{{Main|Graft-versus-host disease}}
{{Main|Graft-versus-host disease}}
*Abbreviated as ''GVHD''.
*Abbreviated as ''GVHD''.
*Seen in the context of bone marrow transplants.
*Seen in the context of bone marrow transplants.


===Bowel transplant===
==Bowel transplant==
The histology of bowel transplant rejection is identical to GVHD - see ''[[GVHD]]''.
The histology of bowel transplant rejection is identical to GVHD - see ''[[GVHD]]''.


Line 429: Line 442:
*CD117 - to look for the ''interstitial cells of Cajal''.
*CD117 - to look for the ''interstitial cells of Cajal''.
*HU - neuronal marker.<ref name=pmid8586967>{{cite journal |author=Barami K, Iversen K, Furneaux H, Goldman SA |title=Hu protein as an early marker of neuronal phenotypic differentiation by subependymal zone cells of the adult songbird forebrain |journal=J. Neurobiol. |volume=28 |issue=1 |pages=82–101 |year=1995 |month=September |pmid=8586967 |doi=10.1002/neu.480280108 |url=}}</ref>
*HU - neuronal marker.<ref name=pmid8586967>{{cite journal |author=Barami K, Iversen K, Furneaux H, Goldman SA |title=Hu protein as an early marker of neuronal phenotypic differentiation by subependymal zone cells of the adult songbird forebrain |journal=J. Neurobiol. |volume=28 |issue=1 |pages=82–101 |year=1995 |month=September |pmid=8586967 |doi=10.1002/neu.480280108 |url=}}</ref>
==Neuroendocrine tumour==
{{Main|Neuroendocrine neoplasms#GI tract}}
*[[AKA]] ''carcinoid''.
==Goblet cell carcinoid==
:Described in detail in the ''[[appendix]]'' article.
*AKA ''crypt cell carcinoma''.
*Biphasic tumour; features of ''carcinoid tumour'' and ''adenocarcinoma''.


=See also=
=See also=
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