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colon pathology


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List the congenital anomalies of the gut
1 duplications, malrotation, 2 omphalocele (guts outside abdomen, viscera covered with peritoneal membrane); 3 gastroschisis (vicera outside abdomen, uncovered); 4 heterotopia (normal tissue, abnormal location); 5 atresia/stenosis; 6 meckel diverticulum (vitelline duct does not involute); 7 congenital aganglionic megacolon (hirschsprung disease)
antiobiotic associated (pseudomembranous) colitis
course of antibiotics, followed by growth of resistant bugs, namely clostridium dificile; produces toxins A & B which can be detected in stool, fibrinoppurulent exudates
Classifications of inflammatory lesions of the bowel
infections; antibiotic-assoc; mechanical; ischemic; radiation induced; idiopathic (crohn and ulcerative colitis)
Rectal involvement UC vs CD
+++; +
Bleeding in UC vs CD
+++; +
Segmental disease in UC vs CD
-; +++
Fistulas in UC vs CD
-; ++
Anal disease in UC vs CD
+; +++
Remissions, excacerbations in UC vs CD
+++; +
Distribution in UC vs CD
diffuse, continuous vs focal, skip areas
Serosa in UC vs CD
normal vs fat wrapping; vascular congestion
Bowel wall thickness in UC vs CD
normal vs increased in sm. int.
mucosa in UC vs CD
varies with activity; intense hyperemia pseudopolyps vs serpiginous ulcers; longitudinal fissures; cobblestones
small bowel in UC vs CD
backwash ileitis vs usually involved; stricture formation
inflammation in UC vs CD
diffuse mucosal and submucosal vs focal transmural
UC microscopic findings
crypt abscesses; decreased mucin; vascular congestion; mucosal atrophy; crypt distortion
CD microscopic findings
granulomas lymphoid aggregates; aphthoid ulcers; neural hypertrophy
complications of UC
toxoid megacolon; carcinoma risk
complications of CD
fistulas, strictures
Diverticulosis complications
inflammation; fistula; obstruction; bleeding
polyp definition
protrusion of mucosa into gut lumen
pedunculated polyp
raspberry on a stalk
sessile polyp
no stalk; difficult to excise
hyperplastic polyps prognosis; morphology
small; saw tooth appearance of mucosa; not associated with increased risk of malignancy
juvenile polyps
large; acute inflammation in lamina propria; no increased risk
peutz jeghers polyps
associated with melanin n lips; similar to other polyps
cowden syndrome
hamartomatous polyps develop along with facial trichilemal tumors; acral keratoses; oral papilomas; increased thyroid breast cancer risk
Cronkite-canada syndrome
non hereditary, hamartomatous polyps in gi, nail atrophy, skin pidmentation; and alopecia
inflammatory polyps
occur in long standing inflammatory disease, not true polyps
adenomatous polyps
neoplastic outgrowths of gi mucosa.
tubular adenomas
75% adenomatous polyps; found in stomach and small intestine as well as colon. branching test tube shaped glands in polyp. may be pedunculated or sessile
villous adenomas
sessile. may be large. papillary fronds. pts may experience water and electrolyte loss, bleeding can occur
tubulovillous adenomas.
adenomatous polyps with 20 to 50% of polyp demonstrating villous features
serrated adenomas
1% adenomas. occur in right side of colon. sessile or pedunculated. serrated glands lining cryps, cells are stratified and dysplastic. goblet immaturity, upper zone and surface mitoses, prominent nucleoli, probably premalignant potential
familial polyposis
autosomal dominant, same gross appearance as all adenomatous polyps, so numerous mucosa is fuzzy. high risk of cancer – inevitable
gardner’s syndrome
soft tissue tumors elswehree in addition to numerous adenomatous polyps. autosomal dominance. similar morphology to familial polyposis
turcot’s syndrome
gliomas in addition to multiple adenomatous polyps. autosomal recessive
factors that play a role in polyps to cancer risk
type, villous > mixed > tubular; size 2cm > 1 cm; time, cancer after at least 10 ys; cancer not inevitable; APC gene; K ras; DCC; p53 mutations accumulate in colonic mucosa
carcinoma of colon morphology
yellow; in submucosa; monotonous cell pattern; fiew mitoses; neuroendocrine markers such as chromogranin
Clinical manifestations of colonic cancer
vasoactive disturbances (flushing, seating, hyptension), intestinal hypermotility (diarrhea); bronchoconstrictive attacks (asthma); cardiac involvement (plaques on right side of heart)

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