Pathology

Pathology Dept.
VALIDATION SI AND LI Nov. 21, 2013

I. GROSS PATHOLOGY  Though FAP is still benign, the lining epithelium already exhibits
COLON ADENOCARCINOMA dysplasia and is a prerequisite for cancer
 Seen commonly in young patients (30 years old) with possible
 ORGAN: Colon /Large Intestine diagnosis in colon cancer even at this age
 Note this peculiarity since most other cancers are common in older
populations
 This autosomal dominant condition leads to development by
ADOLESCENCE of more than 100 colonic adenomas that carpet the
mucosa.
 If untreated by total colectomy, nearly all individuals develop
adenocarcinoma.

Figure 1. Large Intestine. Note the curvatures that are characteristic of the
colon called haustra. Taenia coli is characteristic of the colon as well.
Semilunar folds are prominent and apparent.

Figure 3. Even though haustra is not evident, note the carpet of

bulb- like structures which are actually numerous polyps.

Figure 2. Note the tumor/ mass within the lumen of the colon
which is already obstructive in nature.

 In life, the likely signs and symptoms experienced by the patient would
be of obstruction. Right-sided mass causes fatigue and weakness 2°
IDA; left-sided mass causes occult bleeding, changes in bowel habits
and cramping . Figure 4. Presence of numerous polyps in the mucosa
 An adenocarcinoma is arising in a villous adenoma. The surface is
usually polypoid and reddish pink (fresh specimen). INTUSSUSCEPTION
 Carcinomas are ugly-looking, bulky and with areas of necrosis
 Complication: OBSTRUCTION  ORGAN: Small intestine
 This occurs when a segment of the intestine “telescopes” into the
FAMILIAL ADENOMATOUS POLYPOSIS (FAP) COLI immediately distal segment
 The blood supply to that segment becomes compromised, predisposing
 ORGAN: Colon/ Large Intestine to infarction.
 Fortunately, this organ is difficult to confuse with anything else given  “BOWEL WITHIN A BOWEL” appearance
the numerous polyps in the mucosa  When the condition occurs in children, it is typically idiopathic.
 Familial: From transfer of APC genes  In adults, a polyp or diverticulum driven by peristalsis may lead to this
 Adenomatous: So, the polyp is neoplastic condition.

Group 9 | Gerald. Janine. Luis. Arbie. Jim Page 1 of 3

 PATHOLOGY VALIDATION SI AND LI

Figure 5. Intussuception
 Notice the curly appearance of the organ
 Prominent slits are also present partially dismembering the organ into Figure 7. Cross- section of the appendix
smaller segments
 Also note the dark streaks and dots on the surface of the organ  When you cut it cross-sectionally, a normal appendix has a pinpoint
lumen that does not dilate
 The segment that ENTERS is called the Intussusceptum, while the
segment that RECEIVES is the Intussuscipiens  In the case of acute appendicitis, fecal material is trapped inside
causing dilation of the lumen and thinning of the appendiceal wall.
 This is a common lesion in infants and children manifested as intestinal
obstruction
HEMORRHOIDS
 It is usually a secondary lesion in adults due to tumors, strictures, or
other underlying pathologies
 ORGAN: Anus
 May be precipitated by tumors, including leiomyomas, neurofibromas,
lipomas, lymphomas, small bowel adenomatous polyps, and metastatic
th
tumors [Yamada’s Textbook of Gastroenterology, 5 edition]

ACUTE APPENDICITIS

 ORGAN: Appendix

Figure 8. Hemorrhoids appearing as crumbs of viscera

Figure 6. Note that the appendix is vermiform and “wormlike” in shape
 The outer surface is dull and coated with exudates mostly made of
fibrin
 You also have fine prominent brownish streaks that represent vascular
markings highly suggestive of congestion
 These are dilated blood vessels in the submucosa occurring in the anal
canal or in the rectum that usually occurs in individuals with a long-
standing history of constipation
 Specimens appear like crumbs of viscera
 They may appear skin-covered since they came from the anus
 If it’s an EXTERNAL HEMORRHOID, it is PAINFUL!
 If it’s an INTERNAL HEMORRHOID, it is PAINLESS.
 You will see drops or trickles of blood during defecation specially if it
passes the delicate thin mucosa with blood vessels engorged beneath
it.
 When cut from the anal skin, one will see these brownish lesions
representing the dilated and congested hemorrhoidal vessels.

Group 9 | Gerald. Janine. Luis. Arbie. Jim Page 2 of 3

 PATHOLOGY VALIDATION SI AND LI
II. HISTOLOGY
ACUTE SUPPURATIVE APPENDICITS
 ORGAN: Appendix
 CLUE: One quick way to know that the organ is the appendix is to look
at the slide itself. Seeing a full circular “thing” under the cover slip is a
fair indicator to confirm if your suspicion on whether the organ is the
appendix or not.
Figure 1. Clue: Note the presence of lymphoid tissue and the glands found
in the mucosa
Figure 2. LPO. Presence of infiltrates of inflammatory cells in the
wall of the appendix predominantly neutrophils seen as dots
(PMNs)
Figure 3. HPO. Neutrophils in the wall of the appendix are
confirmed to be present as manifested by nuclei lobulation
Group 9 | Gerald. Janine. Luis. Arbie. Jim
Figure 4. Note that purulent inflammatory exudates are present within the
lumen
 It is an acute (presence of neutrophils plus necrotic debris are also
present) and suppurative type of inflammation (presence of purulent
inflammatory exudate within the lumen)
 The neutrophils usually infiltrate the muscle wall. Muscle wall invasion
is an indicator of the acuteness of the condition
HEMORRHOIDS
 ORGAN: Anus
Figure 5. Identified by the presence of non- keratinizing stratified squamous
epithelium plus big circular veins filled with blood. Note that some blood
vessels are filled with blood and some with a thrombus
Figure 6. Dilated venous channels can be easily identified
 External hemorrhoids: Non- keratinizing stratified squamous epithelium
plus big circular veins filled with blood
 Internal hemorrhoids: Columnar epithelium plus big circular veins filled
with blood
 Thrombus: Characterized by the presence of an attachment to the
vessel wall
Page 3 of 3