Talk:Colon

See also: Talk:Gastrointestinal tract polyps.

Normal 1

Microscopic description

A. The sections show normal small bowel mucosa with a benign lymphoid nodule.
B-G. The sections show normal colonic-type mucosa.

Final diagnosis

A-G. Terminal ileum, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum; biopsies (7x) - no pathologic diagnosis.

Normal 2

Microscopic description

A. The sections show normal small bowel mucosa with a benign lymphoid nodule.
B-G. The sections show normal colonic-type mucosa.

Final diagnosis

A. Terminal ileum, biopsy - no pathologic diagnosis.
B. Cecum, biopsy - no pathologic diagnosis.
C. Ascending colon, biopsy - no pathologic diagnosis.
D. Transverse colon, biopsy - no pathologic diagnosis.
E. Descending colon, biopsy - no pathologic diagnosis.
F. Sigmoid colon, biopsy - no pathologic diagnosis.
G. Rectum, biopsy - no pathologic diagnosis.

Rectal prolapse

Microscopic

The section shows benign fibromuscular hyperplasia of the lamina propria and submucosa. There is a mucosal erosion with reactive lymphoid hyperplasia characterized by germinal center formation. The germinal centers contain tingible-body macrophages.

Final diagnosis

A. Rectal polyp, biopsy - Benign fibromuscular hyperplasia and mucosal lymphoid hyperplasia with mucosal erosion.

Colitis

Microscopic

A. The sections show normal small bowel mucosa.
B. The sections show colonic-type mucosa with a mild lymphoplasmic inflammatory infiltrate and mild eosinophilia. There is no cryptitis and no crypt abscesses are identified. There is no architectural distortion. No granulomas are identified.
C. The sections show normal colonic-type mucosa.
D. The sections show colonic-type mucosa with a mild lymphoplasmic inflammatory infiltrate, mild eosinophilia and cryptitis. No crypt abscesses are identified. There is no architectural distortion. No granulomas are identified.
E. The sections show colonic-type mucosa with a mild lymphoplasmic inflammatory infiltrate, mild eosinophilia and cryptitis. Mild architectural distortion is present. No crypt abscesses are identified. No granulomas are identified.
F. The sections show granulation tissue and scant reactive colonic-type mucosa with abundant inflammatory cells, including, plasma cells, lymphocytes, neutrophils and eosinophils. Cryptitis, crypt destruction and crypt abscesses are present. No granulomas are identified. No dysplasia is identified.
G. The sections show colonic-type mucosa with a mild lymphoplasmic inflammatory infiltrate, mild eosinophilia and cryptitis. Mild-to-moderate architectural distortion is present. No crypt abscesses are identified. No granulomas are identified.
H. The sections show colonic-type mucosa with a mild lymphoplasmic inflammatory infiltrate, and mild eosinophilia. Mild-to-moderate architectural distortion is present. Many intraepithelial lymphocytes are present. No definite cryptitis is identified. No crypt abscesses are identified. No granulomas are identified.

Final diagnosis

A. Terminal ileum, biopsy - no pathology.
B. Cecum, biopsy - mild chronic colitis with mild eosinophilia.
C. Ascending colon, biopsy - no pathology.
D. Transverse colon, biopsy - mild focal active colitis with mild eosinophilia.
E. Descending colon, biopsy - mild active colitis with architectural changes.
F. Descending colon ("area of ulceration"), biopsy - severe active colitis with ulceration.
G. Sigmoid colon, biopsy - mild active colitis with architectural distortion.
H. Rectum, biopsy - mild chronic proctitis with possible mild acute proctitis.

Comment

The biopsies show features of chronicity and would be consistent with inflammatory bowel disease (IBD), a drug reaction, and chronic infection. There are no eosinophilic abscesses, as previously noted (see report for specimen S11-3965) and severe inflammation with ulceration. These findings make an eosinophilic enterocolitis unlikely. In the context of an IBD diagnosis, histologic features would favour ulcerative colitis over Crohn's disease.

Lymphocytic colitis

Final diagnosis

Rectosigmoid, biopsy: - Consistent with lymphocytic colitis, see comment.

Comment

The biopsy shows abundant intraepithelial lymphocytes with a preserved crypt architecture. No thick subepithelial band of collagen is present. No granulomas are identified. The main histomorphologic differential diagnoses include resolving infection and early inflammatory bowel disease.

Isolated crypt abscess

COLON, BIOPSY:
- ONE ISOLATED CRYPT ABSCESS, ON THE BACKGROUND OF COLONIC MUCOSA WITHOUT SIGNIFICANT
  PATHOLOGY, SEE COMMENT.
- NEGATIVE FOR LYMPHOCYTIC COLITIS AND NEGATIVE FOR COLLAGENOUS COLITIS.
- NEGATIVE FOR DYSPLASIA.

COMMENT:
The significance of the crypt abscess is unknown, as the background colon is not
significantly inflamed. A definite cryptitis elsewhere is not identified. Architectural
changes are not apparent. Clinical correlation is suggested.

Cecum

Polyps, Cecum, Polypectomy:
- Fragments of colorectal-type mucosa with cryptitis and crypt 
  abscesses, see note.
- NEGATIVE for dysplasia.

Note:
The possibility of an underlying inflammatory process involving the GI tract should be considered. The above findings should be correlated with the clinical findings and overall endoscopic impression.