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The '''colon''' | [[Image:Blausen_0603_LargeIntestine_Anatomy.png|thumb|right|Anatomy of the colon and rectum. (WC)]] | ||
The '''colon''' is section of the large bowel. This article also covers the '''rectum''' and '''cecum''' as both have a similar mucosa. | |||
An introduction to gastrointestinal pathology is found in the ''[[gastrointestinal pathology]]'' article. | It commonly comes to pathologists because there is a suspicion of [[colorectal cancer]] or a known history of [[inflammatory bowel disease]] (IBD). | ||
An introduction to gastrointestinal pathology is found in the ''[[gastrointestinal pathology]]'' article. The ''[[anus]]'' and ''[[ileocecal valve]]'' are dealt with in separate articles. | |||
Technically, the rectum and cecum are ''not'' part of the colon. Thus, inflammation of the rectum should be ''proctitis'' and inflammation of the cecum should be ''cecitis''. | |||
=Anatomy= | |||
*The [[rectum]] has several definition. These are discussed in the ''[[rectum]]'' article. | |||
*The large bowel may be submitted with segment names or with the distance to the anal verge. | |||
A conversion between named segments and distance - as per NCI of the United States:<ref>URL: [https://training.seer.cancer.gov/colorectal/anatomy/figure/figure1.html]https://training.seer.cancer.gov/colorectal/anatomy/figure/figure1.html]. Accessed on: 8 February 2018.</ref> | |||
{| class="wikitable sortable" | |||
!Named segment | |||
!Distance to anal verge (cm) | |||
|- | |||
|Anus | |||
|0-4 | |||
|- | |||
|[[Rectum]] | |||
|4-16 | |||
|- | |||
|Rectosigmoid | |||
|15-17 | |||
|- | |||
|Sigmoid | |||
|17-57 | |||
|- | |||
|Descending | |||
|57-82 | |||
|- | |||
|Transverse | |||
|82-132 | |||
|- | |||
|Ascending | |||
|132-147 | |||
|- | |||
|Cecum | |||
|150 | |||
|} | |||
=Common clinical problems= | =Common clinical problems= | ||
Line 7: | Line 46: | ||
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> | ||
*Neoplasia. | *Neoplasia. | ||
*Volvulus (cecal, sigmoid). | *[[Volvulus]] (cecal, sigmoid). | ||
*[[Diverticular disease]] + stricture formation. | *[[Diverticular disease]] + stricture formation. | ||
===Bleeding=== | ===Bleeding=== | ||
Mnemonic ''CHAND'':<ref>TN 2007 G29.</ref> | Mnemonic ''CHAND'':<ref>TN 2007 G29.</ref> | ||
*Colitis (radiation, infectious, ischemic, IBD (UC >CD), iatrogenic (anticoagulants)). | *Colitis ([[radiation colitis|radiation]], [[infectious colitis|infectious]], [[ischemic colitis|ischemic]], [[IBD]] (UC >CD), iatrogenic (anticoagulants)). | ||
*Hemorrhoids. | *[[Hemorrhoids]]. | ||
*Angiodysplasia. | *[[Angiodysplasia]]. | ||
*Neoplastic. | *Neoplastic. | ||
*[[Diverticular disease]]. | *[[Diverticular disease]]. | ||
Line 24: | Line 63: | ||
*Shigella. | *Shigella. | ||
Infectious colitis in the immunosuppressed: | [[Infectious colitis]] in the immunosuppressed: | ||
*[[Cytomegalovirus]] (CMV).<ref name=pmid7934809>{{cite journal |author=Golden MP, Hammer SM, Wanke CA, Albrecht MA |title=Cytomegalovirus vasculitis. Case reports and review of the literature |journal=Medicine (Baltimore) |volume=73 |issue=5 |pages=246–55 |year=1994 |month=September |pmid=7934809 |doi= |url=}}</ref> | *[[Cytomegalovirus]] (CMV).<ref name=pmid7934809>{{cite journal |author=Golden MP, Hammer SM, Wanke CA, Albrecht MA |title=Cytomegalovirus vasculitis. Case reports and review of the literature |journal=Medicine (Baltimore) |volume=73 |issue=5 |pages=246–55 |year=1994 |month=September |pmid=7934809 |doi= |url=}}</ref> | ||
**May afflict patients with IBD and lead to colectomy... as IBD patients are put on immunosuppression.<ref name=pmid17026558>{{cite journal |author=Kandiel A, Lashner B |title=Cytomegalovirus colitis complicating inflammatory bowel disease |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2857–65 |year=2006 |month=December |pmid=17026558 |doi=10.1111/j.1572-0241.2006.00869.x |url=}}</ref> | **May afflict patients with IBD and lead to colectomy... as IBD patients are put on immunosuppression.<ref name=pmid17026558>{{cite journal |author=Kandiel A, Lashner B |title=Cytomegalovirus colitis complicating inflammatory bowel disease |journal=Am. J. Gastroenterol. |volume=101 |issue=12 |pages=2857–65 |year=2006 |month=December |pmid=17026558 |doi=10.1111/j.1572-0241.2006.00869.x |url=}}</ref> | ||
**Organ transplant recipients. | **Organ transplant recipients. | ||
**[[HIV|HIV/AIDS]]. | **[[HIV|HIV/AIDS]]. | ||
Images: | |||
<gallery> | |||
Image:CMV_colitis_-_high_mag_-_cropped.jpg | CMV colitis - high. mag. (WC/Nephron) | |||
Image:CMV_colitis_-_intermed_mag.jpg | CMV colitis - intermed. mag. (WC/Nephron) | |||
</gallery> | |||
=Grossing= | =Grossing= | ||
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# Subtotal colectomy - part of colon removed --or-- some of the rectum remains. | # Subtotal colectomy - part of colon removed --or-- some of the rectum remains. | ||
# Right hemicolectomy - right colon + distal ileum. | # Right hemicolectomy - right colon + distal ileum. | ||
# Lower anterior resection (LAR) - proximal rectum +/- sigmoid (for proximal rectal malignancies). | # [[Lower anterior resection]] (LAR) - proximal rectum +/- sigmoid (for proximal rectal malignancies). | ||
#* Specimens have should have intact mesorectum - ''total mesorectal excision'' (TME) - reduces local recurrence.<ref name=pmid8665198>{{Cite journal | last1 = Arbman | first1 = G. | last2 = Nilsson | first2 = E. | last3 = Hallböök | first3 = O. | last4 = Sjödahl | first4 = R. | title = Local recurrence following total mesorectal excision for rectal cancer. | journal = Br J Surg | volume = 83 | issue = 3 | pages = 375-9 | month = Mar | year = 1996 | doi = | PMID = 8665198 }}</ref> | #* Specimens have should have intact mesorectum - ''[[total mesorectal excision]]'' (TME) - reduces local recurrence.<ref name=pmid8665198>{{Cite journal | last1 = Arbman | first1 = G. | last2 = Nilsson | first2 = E. | last3 = Hallböök | first3 = O. | last4 = Sjödahl | first4 = R. | title = Local recurrence following total mesorectal excision for rectal cancer. | journal = Br J Surg | volume = 83 | issue = 3 | pages = 375-9 | month = Mar | year = 1996 | doi = | PMID = 8665198 }}</ref> | ||
# Abdominoperineal resection (APR) - anus + rectum - results in a permanent stoma (for distal rectal malignancies). | # [[Abdominoperineal resection]] (APR) - anus + rectum - results in a permanent [[stoma]] (for distal rectal malignancies). | ||
# [[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. | ||
#[[Doughnuts]] (also ''donuts'') from an end-to-end anastomosis stapler. | |||
#*Often accompany lower anterior resections. | |||
===Images=== | |||
<gallery> | |||
Image:Rectum - anterior view.jpg | APR specimen - anterior (WC) | |||
Image: Rectum - lateral view.jpg | APR specimen - lateral (WC) | |||
Image: Rectum - anterior and lateral - inked.jpg | APR specimen - inked (WC) | |||
</gallery> | |||
==Identifying the specimen== | ==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. | ||
*Descending colon - has a bare area. | *Descending colon - has a bare area. | ||
*Rectum - has adventitia. ( | *Rectum - has adventitia. | ||
**Pathologists define it as starting where the adventitia starts/the serosal surface no longer completely surrounds the large intestine.<ref>{{Ref Lester3|339}}</ref> | |||
**Anatomists define it in relation to the third sacral vertebra.<ref>URL: [http://www.bartleby.com/107/249.html http://www.bartleby.com/107/249.html]. Accessed on: 19 October 2012.</ref> | |||
===Images=== | |||
<gallery> | |||
Image: Rectum - lateral view.jpg | Sigmoid and rectum. APR specimen. (WC) | |||
</gallery> | |||
==Lymph nodes== | ==Lymph nodes== | ||
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==Quirke method== | ==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> | *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== | ==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]]. | ||
*Radial margin/circumferential margin - should be painted. | *Radial margin/circumferential margin - should be painted. | ||
**Rectum starts/sigmoid ends @ place where serosa ends on the posterior aspect of the bowel. | **Rectum starts/sigmoid ends @ place where serosa ends on the posterior aspect of the bowel. | ||
***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. | ||
Note: | |||
*There are several definitions for the rectum.<ref name=pmid24130630>{{Cite journal | last1 = Kenig | first1 = J. | last2 = Richter | first2 = P. | title = Definition of the rectum and level of the peritoneal reflection - still a matter of debate? | journal = Wideochir Inne Tech Maloinwazyjne | volume = 8 | issue = 3 | pages = 183-6 | month = Sep | year = 2013 | doi = 10.5114/wiitm.2011.34205 | PMID = 24130630 }}</ref> | |||
**In a survey of surgeons: | |||
**67% defined it by an anatomical landmark | |||
***35% of all respondants considered the peritoneal reflection the proximal boundary of the rectum. | |||
**30% defined the proximal boundary as a distance from the anal verge. | |||
=Common non-neoplastic disease= | =Common non-neoplastic disease= | ||
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Most common (images): | Most common (images): | ||
<gallery> | |||
Image:Hyperplastic_polyp1.jpg | Hyperplastic polyp image - intermed. mag. (WC/Nephron) | |||
Image:Hyperplastic_polyp2.jpg | Hyperplastic polyp image - low mag. (WC/Nephron) | |||
</gallery> | |||
==Ischemic colitis== | ==Ischemic colitis== | ||
*[[AKA]] ''colonic ischemia''. | *[[AKA]] ''colonic ischemia''. | ||
*[[AKA]] ''ischemia of the colon''. | *[[AKA]] ''ischemia of the colon''. | ||
{{Main|Ischemic colitis}} | |||
==Diverticular disease== | ==Diverticular disease== | ||
{{Main|Diverticular disease}} | |||
==Pseudomembranous colitis== | ==Pseudomembranous colitis== | ||
{{Main|Pseudomembranous colitis}} | |||
==Volvulus== | |||
{{Main|Volvulus}} | |||
=Inflammatory diseases= | =Inflammatory diseases= | ||
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*Basal, i.e. crypt base, plasmacytosis with severe chronic inflammation, | *Basal, i.e. crypt base, plasmacytosis with severe chronic inflammation, | ||
*Crypt architectural abnormalities, and | *Crypt architectural abnormalities, and | ||
*Distal Paneth cell metaplasia. | *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. | **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> | **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> | ||
==Microscopic colitis== | ==Microscopic colitis== | ||
:''Microscopic colitis'' may refer to a microscopic manifestation of an unspecified disease process that can be apparent macroscopically. This section links to a pair of diseases (''lymphocytic colitis'' and ''collagenous colitis'') that are considered to only have microscopic manifestations and characteristic clinical presentation. | |||
{{Main|Lymphocytic colitis}} | |||
{{Main|Collagenous colitis}} | |||
==Diversion colitis== | |||
{{Main|Diversion colitis}} | |||
==Eosinophilic colitis== | |||
* | *Abbreviated ''EC''. | ||
{{Main|Eosinophilic colitis}} | |||
==== | =Infectious= | ||
* | ==Infectious colitis== | ||
* | :This section covers non-specific colitides that appear to have an infective etiology. | ||
===General=== | |||
*Common. | |||
*Diarrhea - typical symptom. | |||
===Gross=== | |||
*+/-Erythema on endoscopy. | |||
* | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
* | *Neutrophils predominant - '''key feature'''.<ref name=Ref_GLP324>{{Ref GLP|324}}</ref> | ||
* | **The neutrophils are often superficial - they go to were the bad guys are. | ||
* | *No architectural distortion - if acute. | ||
DDx: | |||
*[[Inflammatory bowel disease]] - lymphoplasmacytic infiltrate predominant,<ref name=Ref_GLP324>{{Ref GLP|324}}</ref> usually has chronic changes. | |||
* | *[[Ischemic colitis]]. | ||
* | *Medications - focal neutrophils. | ||
* | *[[Lymphocytic colitis]] - lymphocytes with a squiggly nucleus, may be confused with neutrophils. | ||
* | *Specific causes of infective colitis - with a distinctive morphology. | ||
** | **[[CMV colitis]] - esp. in the immunodeficient. | ||
** | **[[Pseudomembranous colitis]] - usu. due to ''C. difficle'', has characteristic gross & microscopic appearance. | ||
** | **[[Intestinal spirochetes]]. | ||
** | **[[Amebiasis]]. | ||
** | **[[Strongyloidiasis]]. | ||
**[[Cryptosporidiosis]]. | |||
===IHC=== | |||
*[ | Done if the patient is immunosuppressed, or there is clinical or morphological suspicion: | ||
*[ | *[[CMV]]. | ||
*HSV-1. | |||
*HSV-2. | |||
*[[EBV]] - may mimic IBD.<ref name=pmid21119609>{{Cite journal | last1 = Karlitz | first1 = JJ. | last2 = Li | first2 = ST. | last3 = Holman | first3 = RP. | last4 = Rice | first4 = MC. | title = EBV-associated colitis mimicking IBD in an immunocompetent individual. | journal = Nat Rev Gastroenterol Hepatol | volume = 8 | issue = 1 | pages = 50-4 | month = Jan | year = 2011 | doi = 10.1038/nrgastro.2010.192 | PMID = 21119609 }}</ref> | |||
===Sign out=== | |||
<pre> | |||
ASCENDING COLON, BIOPSY: | |||
- MILD ACTIVE COLITIS, SEE COMMENT. | |||
COMMENT: | |||
There is are no granulomas. The crypt architecture is normal. A benign lymphoid nodule is | |||
present. | |||
The differential diagnosis includes infective etiologies, early inflammatory | |||
bowel disease and ischemia. The histomorphology is more in keeping with an infective | |||
etiology as neutrophils are a predominant feature; however, clinical correlation is | |||
required. | |||
</pre> | |||
==Cytomegalovirus colitis== | |||
{{Main|CMV}} | |||
* | *Abbreviated ''CMV colitis''. | ||
{{Main|Cytomegalovirus colitis}} | |||
==Intestinal spirochetosis== | ==Intestinal spirochetosis== | ||
*[[AKA]] ''intestinal spirochetes''; more specifically ''colonic spirochetes'', ''colonic spirochetosis''. | *[[AKA]] ''intestinal spirochetes''; more specifically ''colonic spirochetes'', ''colonic spirochetosis''. | ||
{{Main|Intestinal spirochetosis}} | |||
==Amebiasis== | ==Amebiasis== | ||
*May also be | *May also be spelled ''amoebiasis''. | ||
{{Main|Amebiasis}} | |||
==Cryptosporidiosis== | ==Cryptosporidiosis== | ||
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=Rectal pathology= | =Rectal pathology= | ||
==Solitary rectal ulcer== | ==Solitary rectal ulcer== | ||
*[[AKA]] ''solitary ulcer syndrome of the rectum'', abbreviated ''SUS''. | |||
* | *[[AKA]] ''solitary rectal ulcer syndrome''. | ||
*Mucosal | *''[[Mucosal prolapse syndrome]]'' may be used as a synonym; however, it encompasses other entities.<ref name=pmid22697798>{{Cite journal | last1 = Abid | first1 = S. | last2 = Khawaja | first2 = A. | last3 = Bhimani | first3 = SA. | last4 = Ahmad | first4 = Z. | last5 = Hamid | first5 = S. | last6 = Jafri | first6 = W. | title = The clinical, endoscopic and histological spectrum of the solitary rectal ulcer syndrome: a single-center experience of 116 cases. | journal = BMC Gastroenterol | volume = 12 | issue = | pages = 72 | month = | year = 2012 | doi = 10.1186/1471-230X-12-72 | PMID = 22697798 }}</ref> | ||
{{Main|Solitary rectal ulcer}} | |||
==Rectal prolapse== | ==Rectal prolapse== | ||
{{Main|Rectal prolapse}} | |||
=Neoplastic disease= | =Neoplastic disease= | ||
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=Other= | =Other= | ||
==Colonic pseudo-obstruction== | |||
{{Main|Colonic pseudo-obstruction}} | |||
==Pseudomelanosis coli== | ==Pseudomelanosis coli== | ||
* | *[[AKA]] ''melanosis coli''. | ||
{{Main|Pseudomelanosis coli}} | |||
==Angiodysplasia== | ==Angiodysplasia== | ||
{{Main|Angiodysplasia}} | |||
==Drugs== | |||
* | {{Main|Drug toxicity}} | ||
===Sodium polystyrene sulfonate=== | |||
*AKA ''Kayexalate''. | |||
====General==== | |||
*Used to treat hyperkalemia - as may be seen in renal failure. | |||
====Microscopic==== | |||
Features:<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> | |||
===Microscopic=== | |||
Features | |||
*Purple blobs on H&E stain - look somewhat like [[calcium phosphate]]. | *Purple blobs on H&E stain - look somewhat like [[calcium phosphate]]. | ||
*Can cause focal [[necrosis]]. | *Can cause focal [[necrosis]]. | ||
Image | =====Image===== | ||
<gallery> | |||
Image:Cecal_adenocarcinoma.jpg | Adenocarcinoma and sodium polystyrene crystals (WC/Nephron) | |||
</gallery> | |||
==Graft-versus host disease== | ==Graft-versus host disease== | ||
{{Main|Graft-versus-host disease}} | {{Main|Graft-versus-host disease}} | ||
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==Chronic constipation== | ==Chronic constipation== | ||
This is occasionally an indication for colectomy. | :This section deals with ''chronic constipation'' that has no apparent cause. | ||
===General=== | |||
*This is occasionally an indication for [[colectomy]].<ref name=pmid21382578>{{Cite journal | last1 = Knowles | first1 = CH. | last2 = Farrugia | first2 = G. | title = Gastrointestinal neuromuscular pathology in chronic constipation. | journal = Best Pract Res Clin Gastroenterol | volume = 25 | issue = 1 | pages = 43-57 | month = Feb | year = 2011 | doi = 10.1016/j.bpg.2010.12.001 | PMID = 21382578 }} | |||
</ref> | |||
General differential diagnosis for constipation: | |||
*Tumour. | *Tumour. | ||
*Adhesions - due to previous surgery. | *Adhesions - due to previous surgery. | ||
*Neuropathy. | *Neuropathy.<ref name=pmid21382578/> | ||
*Congenital defect (Hirschsprung's disease). | **[[Parkinson disease]]. | ||
*Congenital defect ([[Hirschsprung's disease]]). | |||
*Myopathy.<ref name=pmid21382578/> | |||
*Medications/substance use. | *Medications/substance use. | ||
*Idiopathic. | *Idiopathic. | ||
Work-up if no tumour is identified:<ref>IAV. 15 December 2009.</ref> | ===Gross=== | ||
*No changes. | |||
===Microscopic=== | |||
Features: | |||
*Colon within normal limits. | |||
**Look for the Ganglion cells (submucosal plexus, myenteric plexus). | |||
**Look for interstitial cells of Cajal (with CD117) - typically most common around the myenteric plexus.<ref name=pmid17222246>{{Cite journal | last1 = Streutker | first1 = CJ. | last2 = Huizinga | first2 = JD. | last3 = Driman | first3 = DK. | last4 = Riddell | first4 = RH. | title = Interstitial cells of Cajal in health and disease. Part I: normal ICC structure and function with associated motility disorders. | journal = Histopathology | volume = 50 | issue = 2 | pages = 176-89 | month = Jan | year = 2007 | doi = 10.1111/j.1365-2559.2006.02493.x | PMID = 17222246 | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2559.2006.02493.x/pdf }}</ref> | |||
Negatives: | |||
*No significant vascular disease. | |||
*No fibrosis. | |||
*No loss of muscle. | |||
===Stains & IHC=== | |||
Work-up if no tumour is identified:<ref>IAV. 15 December 2009.</ref><ref name=pmid19360428/> | |||
*Routine H&E. | *Routine H&E. | ||
* | *Smooth muscle actin - confirm myocyte loss. | ||
*Gomori trichrome. | *Gomori trichrome - examine connective tissue. | ||
*CD117 - to look for the ''interstitial cells of Cajal''. | *CD117 - to look for the ''interstitial cells of Cajal''. | ||
**<50% the expected = abnormal.<ref name=pmid19360428/> | |||
***Normal numbers not defined. | |||
*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> | ||
===Sign out=== | |||
*A long list of things to report is contained the recommendation of a working group.<ref name=pmid19360428>{{Cite journal | last1 = Knowles | first1 = CH. | last2 = De Giorgio | first2 = R. | last3 = Kapur | first3 = RP. | last4 = Bruder | first4 = E. | last5 = Farrugia | first5 = G. | last6 = Geboes | first6 = K. | last7 = Gershon | first7 = MD. | last8 = Hutson | first8 = J. | last9 = Lindberg | first9 = G. | title = Gastrointestinal neuromuscular pathology: guidelines for histological techniques and reporting on behalf of the Gastro 2009 International Working Group. | journal = Acta Neuropathol | volume = 118 | issue = 2 | pages = 271-301 | month = Aug | year = 2009 | doi = 10.1007/s00401-009-0527-y | PMID = 19360428 }}</ref> | |||
**Most pathology practises do not report much. | |||
<pre> | |||
TERMINAL ILEUM, CECUM, COLON (ASCENDING, TRANSVERSE AND SIGMOID), COLECTOMY: | |||
- SMALL BOWEL, CECUM, AND COLON WITHIN NORMAL LIMITS. | |||
- FOUR LYMPH NODES NEGATIVE FOR MALIGNANCY ( 0 POSITIVE / 4 ). | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
Several stains were done: | |||
CD117: interstitial cells of Cajal present, no apparent decrease. | |||
SMA: no significant myocyte loss. | |||
Gomori trichrome: no abnormal fibrosis apparent. | |||
Tau: no abnormalities apparent. | |||
</pre> | |||
=See also= | =See also= | ||
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*[[Intestinal polyps]]. | *[[Intestinal polyps]]. | ||
*[[Small bowel]]. | *[[Small bowel]]. | ||
*[[Doughnuts]]. | |||
=References= | =References= | ||
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[[Category:Gastrointestinal pathology]] | [[Category:Gastrointestinal pathology]] | ||
[[Category:Colon|Colon]] |
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