Difference between revisions of "Colon"
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(major re-arrange, subdivide/re-organize) |
(mv polyp section, tweak text, chg heading in grossing) |
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An introduction to gastrointestinal pathology is found in the ''[[gastrointestinal pathology]]'' article. | An introduction to gastrointestinal pathology is found in the ''[[gastrointestinal pathology]]'' article. | ||
= | =Common clinical problems= | ||
===Obstruction=== | ===Obstruction=== | ||
Top three (in adults):<ref>URL: [http://www.emedicine.com/EMERG/topic65.htm http://www.emedicine.com/EMERG/topic65.htm]. Accessed on: 28 June 2011.</ref> | Top three (in adults):<ref>URL: [http://www.emedicine.com/EMERG/topic65.htm http://www.emedicine.com/EMERG/topic65.htm]. Accessed on: 28 June 2011.</ref> | ||
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# [[Stoma]] - these are often done emergently and then get cut-out after the patient's condition has settled. | # [[Stoma]] - these are often done emergently and then get cut-out after the patient's condition has settled. | ||
==Identifying the specimen== | |||
*Transverse colon - has omentum. | *Transverse colon - has omentum. | ||
*Ascending colon - usu. comes with ileocecal valve and a bit of ileum. | *Ascending colon - usu. comes with ileocecal valve and a bit of ileum. | ||
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*Rectum - has adventitia. (???) | *Rectum - has adventitia. (???) | ||
==Lymph nodes== | |||
*One should get at least 12 [[lymph nodes]] if it is cancer.<ref name=pmid18780863>{{cite journal |author=Bilimoria KY, Bentrem DJ, Stewart AK, ''et al.'' |title=Lymph node evaluation as a colon cancer quality measure: a national hospital report card |journal=J. Natl. Cancer Inst. |volume=100 |issue=18 |pages=1310–7 |year=2008 |month=September |pmid=18780863 |doi=10.1093/jnci/djn293 |url=http://www.medscape.com/viewarticle/581463}}</ref> | *One should get at least 12 [[lymph nodes]] if it is cancer.<ref name=pmid18780863>{{cite journal |author=Bilimoria KY, Bentrem DJ, Stewart AK, ''et al.'' |title=Lymph node evaluation as a colon cancer quality measure: a national hospital report card |journal=J. Natl. Cancer Inst. |volume=100 |issue=18 |pages=1310–7 |year=2008 |month=September |pmid=18780863 |doi=10.1093/jnci/djn293 |url=http://www.medscape.com/viewarticle/581463}}</ref> | ||
==Quirke method== | |||
*Bowel is not opened - it is fixed... then sliced.<ref name=pmid18667357>{{cite journal |author=West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P |title=Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study |journal=Lancet Oncol. |volume=9 |issue=9 |pages=857–65 |year=2008 |month=September |pmid=18667357 |doi=10.1016/S1470-2045(08)70181-5 |url=}}</ref>, <ref name=pmid18541901>{{cite journal |author=West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P |title=Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer |journal=J. Clin. Oncol. |volume=26 |issue=21 |pages=3517–22 |year=2008 |month=July |pmid=18541901 |doi=10.1200/JCO.2007.14.5961 |url=}}</ref>. | *Bowel is not opened - it is fixed... then sliced.<ref name=pmid18667357>{{cite journal |author=West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P |title=Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study |journal=Lancet Oncol. |volume=9 |issue=9 |pages=857–65 |year=2008 |month=September |pmid=18667357 |doi=10.1016/S1470-2045(08)70181-5 |url=}}</ref>, <ref name=pmid18541901>{{cite journal |author=West NP, Finan PJ, Anderin C, Lindholm J, Holm T, Quirke P |title=Evidence of the oncologic superiority of cylindrical abdominoperineal excision for low rectal cancer |journal=J. Clin. Oncol. |volume=26 |issue=21 |pages=3517–22 |year=2008 |month=July |pmid=18541901 |doi=10.1200/JCO.2007.14.5961 |url=}}</ref>. | ||
==Standard method== | |||
*Bowel is prep'ed by opening it along the antimesenteric side. | *Bowel is prep'ed by opening it along the antimesenteric side. | ||
*Dimensions - length, circumference at both margins. | *Dimensions - length, circumference at both margins. | ||
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=Common non-neoplastic disease= | =Common non-neoplastic disease= | ||
==Colorectal polyps== | |||
{{main|Intestinal polyps}} | |||
Polyps are the bread & butter of [[GI pathology]]. They are very common. | |||
Main types: | |||
*Hyperplastic - most common, benign. | |||
*Adenomatous - quite common, pre-malignant. | |||
*[[Hamartomatous polyps|Hamartomatous]] - rare, weird & wonderful. | |||
*Inflammatory, [[AKA]] inflammatory pseudopolyps - associated with [[IBD]]. | |||
Most common (images): | |||
*[http://commons.wikimedia.org/wiki/File:Hyperplastic_polyp1.jpg Hyperplastic polyp image - intermed. mag. (WC)]. | |||
*[http://commons.wikimedia.org/wiki/File:Hyperplastic_polyp2.jpg Hyperplastic polyp image - low mag. (WC)]. | |||
==Bowel ischemia== | ==Bowel ischemia== | ||
===General=== | ===General=== | ||
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Pseudomembranes (microscopic):<ref name=Ref_PBoD837-8>{{Ref PBoD|837-8}}</ref> | Pseudomembranes (microscopic):<ref name=Ref_PBoD837-8>{{Ref PBoD|837-8}}</ref> | ||
*Loss of | *Loss of surface epithelium. | ||
*[[PMN]]s in lamina propria. | *[[PMN]]s in lamina propria. | ||
*+/-Capillary fibrin thrombi. | *+/-Capillary fibrin thrombi. | ||
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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> | ||
=Inflammatory= | =Inflammatory diseases= | ||
==Inflammatory bowel disease== | ==Inflammatory bowel disease== | ||
{{main|Inflammatory bowel disease}} | {{main|Inflammatory bowel disease}} | ||
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Features: | Features: | ||
*Lots of intraepithelial lymphocytes (>=20/100 lymphocytes/surface epithelial cells<ref name=pmid19109861>{{cite journal |author=Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S |title=Diagnosis and management of microscopic colitis |journal=World J. Gastroenterol. |volume=14 |issue=48 |pages=7280-8 |year=2008 |month=December |pmid=19109861 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref>) and | *Lots of intraepithelial lymphocytes (>=20/100 lymphocytes/surface epithelial cells<ref name=pmid19109861>{{cite journal |author=Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S |title=Diagnosis and management of microscopic colitis |journal=World J. Gastroenterol. |volume=14 |issue=48 |pages=7280-8 |year=2008 |month=December |pmid=19109861 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref>) and | ||
* | *Lymphocytes in the lamina propria. | ||
*NEGATIVES:<ref name=hopkins_cc_lc>[http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1 http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1]</ref> | *NEGATIVES:<ref name=hopkins_cc_lc>[http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1 http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1]</ref> | ||
**No PMNs. | **No PMNs. | ||
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*Uniform spherical nodules 2-4 micrometres in diameter, typical location - GI tract brush border. | *Uniform spherical nodules 2-4 micrometres in diameter, typical location - GI tract brush border. | ||
**Bluish staining of brush border '''key feature''' - low power. | **Bluish staining of brush border '''key feature''' - low power. | ||
=Rectal pathology= | =Rectal pathology= | ||
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*[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= | =Neoplastic disease= | ||
==Colorectal Tumours== | ==Colorectal Tumours== | ||
{{main|Colorectal tumours}} | {{main|Colorectal tumours}} | ||