Colon: Difference between revisions
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{{Top | <noinclude>{{Top | ||
|author1=[[User:Mikael Häggström|Mikael Häggström]] | |author1=[[User:Mikael Häggström|Mikael Häggström]] | ||
|author2= | |author2= | ||
}} | }} | ||
{{Endoscopic biopsies}} | |||
This article also includes the rectum. | This article also includes the rectum. | ||
| Line 9: | Line 10: | ||
*[[Colorectal polyp]] | *[[Colorectal polyp]] | ||
*[[Colon ischemia]] | *[[Colon ischemia]] | ||
*[[Colon for diverticulitis]] | |||
*[[Intestine with tumor]] | *[[Intestine with tumor]] | ||
*[[Colitis]] | *[[Colitis]] | ||
*[[Hemorrhoids]] | *[[Hemorrhoids]] | ||
*[[Stoma]] and "donuts" | *[[Stoma]] and "donuts" | ||
{{Comprehensiveness}} | |||
</noinclude> | |||
==Gross processing== | ==Gross processing== | ||
More specific grossing is available for presentations above. For larger specimens (not biopsies): | More specific grossing is available for presentations above. For larger specimens (not biopsies): | ||
*Identify '''segment''' of colon | *Identify '''segment''' of colon if possible. | ||
*Measure '''length''' and variations | *Measure '''length''', average '''width''' and any significant variations thereof. | ||
*Optionally, measure the '''mesentery'''. | |||
*Inspect the '''serosa'''- look for any perforations, adhesions, fistulas and exudate | *Inspect the '''serosa'''- look for any perforations, adhesions, fistulas and exudate | ||
:*If perforation is present, try to probe it from the serosal surface | :*If perforation is present, try to probe it from the serosal surface | ||
*'''Open''' longitudinally | *'''Open''' longitudinally | ||
*Semi-quantitate the number of '''diverticula''' – “numerous” if too many to count | *If the specimen is not fixed already, put it in '''formalin''', preferably for a total of 48 hours.<ref name="Burroughs2000">{{cite journal|last1=Burroughs|first1=S H|title=Examination of large intestine resection specimens|journal=Journal of Clinical Pathology|volume=53|issue=5|year=2000|pages=344–349|issn=00219746|doi=10.1136/jcp.53.5.344}}</ref> Section attached fatty tissue for better fixation. | ||
[[File:Gross pathology of diverticulosis.jpg|thumb|220px|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 | *Look for for any '''mucosal lesions'''. Note any evidence of inflammation, hemorrhage, abscess, perforation or fistula | ||
*Note the '''thickness''' of the wall | *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. | ||
*Note any obvious | [[File:Gross pathology of a mesenteric lymph node.jpg|thumb|190px|A mesenteric lymph node.]] | ||
*Note any obvious mesenteric '''lymph nodes'''. {{Further|Lymph nodes}} | |||
*'''Sections''' to submit for microscopy: | *'''Sections''' to submit for microscopy: | ||
:*2 sections of any perforation(s), one section of intact diverticulum, any mucosal lesions, any obvious lymph nodes. | :*2 sections of any perforation(s), one section of any intact diverticulum, any mucosal lesions, any obvious lymph nodes. | ||
:* | |||
===Gross report=== | |||
Example: | |||
{{Grossreport-begin}}A. Labeled - [ | |||
- Check name and DOB | |||
- Confirm labeling with req | |||
]. The specimen is received in formalin and consists of a segment of large intestine which measures __ cm in length and __ cm in average diameter. The serosal surface is tan and smooth. | |||
*{{Comprehensive-begin}}The proximal surgical margin is inked blue and the distal surgical margin is inked green.{{Comprehensive-end}} | |||
or | |||
*The specimen is unoriented. {{Comprehensive-begin}}The proximal and distal surgical margins are inked blue.{{Comprehensive-end}} | |||
{{Comprehensive-begin}}The mesenteric margin is inked red.{{Comprehensive-end}} The specimen is opened longitudinally to reveal a smooth mucosa. {{Finding-begin}}There are multiple diverticula measuring up to __ cm in depth. The rest of{{Finding-end}} the mucosa is tan-pink with normal mucosal folds. The lumen is not dilated. The wall measures __ cm in thickness. Within the mesorectum there are __ possible lymph nodes measuring up to __ cm in greatest dimension. {{Comment-begin}}Sample 4-8 lymph nodes in case of diverticulitis{{Comment-end}} | |||
{{Grossreport-end}} | |||
==Microscopic evaluation== | ==Microscopic evaluation== | ||
| Line 36: | Line 54: | ||
File:Tubular adenoma of the colon.jpg|Hyperplasia and/or atypia ([[colorectal polyp]] with [[tubular adenoma]] pictured) | File:Tubular adenoma of the colon.jpg|Hyperplasia and/or atypia ([[colorectal polyp]] with [[tubular adenoma]] pictured) | ||
</gallery> | </gallery> | ||
*[[Colitis]], such as by neutrophilic infiltration | *'''[[Colitis]]''', such as by neutrophilic infiltration | ||
===Common incidental findings=== | ===Common incidental findings=== | ||
<gallery mode=packed> | <gallery mode=packed> | ||
File:Melanosis coli (4130655629).jpg|'''Melanosis coli''', lipofuscin-containing macrophages | File:Melanosis coli (4130655629).jpg|'''Melanosis coli''', lipofuscin-containing macrophages | ||
</ref> | File:Histology of subepithelial lymphoid aggregate of the colon.jpg|thumb|'''Subepithelial lymphoid aggregate''', nonspecific, and generally reported as such.<ref group=notes>It is acceptable to not mention a subepithelial lymphoid aggregate at all.</ref> | ||
</gallery> | |||
===Microscopy report=== | ===Microscopy report=== | ||
Example report in an unremarkable biopsy: | Example report in an unremarkable biopsy: | ||
{|class=wikitable | {|class=wikitable | ||
| Colonic mucosa, | | (Colon, biopsy:)<br>Colonic mucosa without significant histopathologic changes. | ||
|} | |||
Example report in a short unremarkable colon segment: | |||
{|class=wikitable | |||
| {{Moderate-begin}}Colon, segmental colectomy:{{Moderate-end}} | |||
*Short segment of benign colon {{Moderate-begin}}without significant histopathologic changes. | |||
*Negative for malignancy.{{Moderate-end}} | |||
|} | |} | ||
{{Bottom}} | In follow-ups of inflammatory bowel disease ('''IBD'''), add "Negative for colitis or dysplasia" if true. | ||
<noinclude>{{Bottom}}</noinclude> | |||
Latest revision as of 11:48, 16 December 2022
Author:
Mikael Häggström [note 1]
| Mostly: |
This article also includes the rectum.
Presentations
- Colorectal polyp
- Colon ischemia
- Colon for diverticulitis
- Intestine with tumor
- Colitis
- Hemorrhoids
- Stoma and "donuts"
Comprehensiveness
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
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.[1] Section attached fatty tissue for better fixation.
- 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.
- 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.
Gross report
Example:
| ((A. Labeled - ___. The specimen is received in formalin and consists of))A. Labeled - [
- Check name and DOB - Confirm labeling with req ]. The specimen is received in formalin and consists of a segment of large intestine which measures __ cm in length and __ cm in average diameter. The serosal surface is tan and smooth.
or
((The mesenteric margin is inked red.)) The specimen is opened longitudinally to reveal a smooth mucosa. {{There are multiple diverticula measuring up to __ cm in depth. The rest of}} the mucosa is tan-pink with normal mucosal folds. The lumen is not dilated. The wall measures __ cm in thickness. Within the mesorectum there are __ possible lymph nodes measuring up to __ cm in greatest dimension. [[Sample 4-8 lymph nodes in case of diverticulitis]] (Representative sections are submitted for microscopic examination in __ cassettes.) |
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.[notes 1]](https://upload.wikimedia.org/wikipedia/commons/thumb/7/79/Histology_of_subepithelial_lymphoid_aggregate_of_the_colon.jpg/250px-Histology_of_subepithelial_lymphoid_aggregate_of_the_colon.jpg?utm_source=commons.wikimedia.org&utm_campaign=imageinfo&utm_content=thumbnail)
Subepithelial lymphoid aggregate, nonspecific, and generally reported as such.[notes 1]
.jpg)
![Subepithelial lymphoid aggregate, nonspecific, and generally reported as such.[notes 1]](/File:Histology_of_subepithelial_lymphoid_aggregate_of_the_colon.jpg)
Microscopy report
Example report in an unremarkable biopsy:
| (Colon, biopsy:) Colonic mucosa without significant histopathologic changes. |
Example report in a short unremarkable colon segment:
(Colon, segmental colectomy:)
|
In follow-ups of inflammatory bowel disease (IBD), add "Negative for colitis or dysplasia" if true.
Notes
- ↑ It is acceptable to not mention a subepithelial lymphoid aggregate at all.
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
Image sources