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21 Cards in this Set

  • Front
  • Back
Ulcerative colitis
A recurrent acute and chronic inflammatory disorder with extensive ulcers of colon and involvement of extracolonic sites

In US, an incidence of nearly 10 per 100,000 with equal sex frequency, most often in 2nd and 3rd decades

Familial clustering
Ulcerative colitis

Gross Pathology
Starts in rectum and extends proximally and in continuity
- Can progress to pancolitis over time
- There are no skip areas in untreated patients with ulcerative colitis… treatment can make parts look better .: need initial specimen

Coalescing ulcers --> progressive mucosal sloughing

Pseudopolyps (residual areas of mucosa sitting in an ulcer bed)
Ulcerative colitis

Ligh Microscope Pathology

Acute
Mucosal Based

Cryptitis and crypt abscesses that coalesce to undermine mucosa.
- Neutrophils in the mucosa
- May invade into the crypt (cryptitis)
- May form aggregates (abscesses)

Marked goblet cell depletion

Regeneration
Ulcerative colitis

Ligh Microscope Pathology

Chronic
Branched and irregular glands *most important*
- normally all the crypts are coated with connective tissue called the sheath

Increased basillar plasma cells in lamina propria *most important*
- present at base of mucosa between terminal end of crypt or gland and muscularis mucosa

Eosinophils

Gap
- Space that exists between the base of damage crypt and muscularis mucosa
- It is filled with plasma cells and occasionally eosinophils
Granulomatous Colitis

Pathology: Gross and LM
Crohn's Disease of the Colon

- Colon involved in 40% cases of Crohn’s disease; of these ileum in ½

Gross
- Segmental (skip areas)
- Predominately right sided
- Rectal sparing in 50%

LM
- Minimal mucosal atrophy and regeneration with preserved mucin
- Transmural lymphoid aggregates, granulomas, edema, fissures
Diverticular Disease

Complications
Inflammation

Pericolic abscess
- If perforation

Hemorrhage
Diverticular Disease
Hypertrophy of taeniae coli and circular muscle with flask-shaped sacs of mucosa and submucosa protruding along the side of taeniae

Sigmoid involved in 99% (44% exclusively)

Descending colon in 30%

Entire colon in 16%
Hyperplastic Polyp
Usually asymptomatic

Common in adult population

Present in 30% of all colons, especially the rectum

Usually multiple
Hyperplastic Polyp

Gross Pathology
Less than 5 mm

Sessile

On mucosal fold crest.
Hyperplastic Polyp

Light Microscopy Pathology
Elongated glands with papillary infolding

Small basal nuclei and abundant mucin

No atypia, low nuclear to cytoplasmic ratio, normal polarity

Stellate or starfish configuration lumen
Juvenile Polyp
More common in children

This is benign, but can cause rectal bleeding.

Single or multiple

Rectum is most common site
Juvenile Polyp

Gross Pathology
Pedunculated focally ulcerated, smooth surface round polyp

On sectioning numerous cysts
Juvenile Polyp

Light Microscopy Pathology
Dilated crypts embedded in excess of lamina propria which shows purulent inflammation
- Crypts are dilated with mucus

Stomal areas of edema in lamina propria
Adenoma-Carcinoma Sequence
Adenomas are precursors for adenocarcinoma of the large intestine

2/3rds of all adenocarcinomas arise in adenomas

Significant features for predicting prognosis (does it harbor cancer):

1. Size
- 1% less than 1 cm
- 10% 1-2 cm
- 50% over 2 cm

2. Histology
- Tubular 5%
- Tubulovillous 22%
- Villous 40%

3. Degree of dysplasia
Colonic Adenomas

Light Microscopy Pathology
• Tubular (75%)
- glands
• Villous (10%)
- Finger projection
• Tubulovillous (15%)

• Dysplastic epithelium with reduced mucus
• Increased nucleus:cytoplasmic
• Hyperchromasia
• High mitotic rate
• Stratifications
Colonic Adenomas

Gross Pathology
Sharply circumscribed elevations of dysplastic epithelium

Pedunculated or sessile
2 Genetic Pathways of Colon Cancer
Suppressor Pathway

Mutator Pathway
Suppressor Pathway
• Genetic changes in APC, beta-catenin and TCF4
• 80% sporadic colon cancers
• FAP
• Most often, mutation in APC gene results in abnormal truncated protein
• 50% of cases with normal APC gene, mutation in b-cat gene resulting in abnormal protein
• In either case, no phosphorylation
• b -cat builds in cytoplasm & moves to nucleus
• b -cat binds TCF4
• This results in upregulation of #genes. eg bcl-1 & PPAR
Mutator Pathway
• Multiple genetic changes in DNA mismatch repair gene system
• Results in microsatellite instability
• 10-20% sporadic cancers
• Many cases of CUC cancers
• Most often, hypermethylation (& inactivation) of hMHL1 promotor
• Increased tendency for more mutations, especially at microsatellites, a few of which are near important genes.
Gross Pathology of Colonic carcinoma
Left
- Circumferential napkin-ring (reducing size) constriction
 Results in pencil shape bowel movement
- Obstruction

Right
- Exophytic growth (polypoid); anemia
Light Microscope Pathology of Colonic carcinoma
Classic glandular adenocarcinoma
- Lumen containing gland
- Contents in lumen: debris = dirty necrosis

Colloid variant (Important variant… also known as mucinous… important because worse prognosis)

Signet ring variant