HISTOPATHOLOGY INDIA.COM

         Atypical Fibroxanthoma

           Dr Sampurna Roy MD

 
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April 2007

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   Gastrointestinal Stromal Tumour

   

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Pathogens commonly affecting Small Intestine:

Ascariasis

Cryptosporidium

Cytomegalovirus infection

Giardiasis

Hookworm Infection

Isosporiasis

Microsporidia

Mycobacterium Avium Intracellulare

Schistosomiasis

Whipple's disease

               
Colorectal polyps may be biopsied or removed by snare diathermy.

Gross description of the polyp should include:
  1. Diameter of head and length of the stalk.
  2. Polyp stalk present or absent - sessile or
      pedunculated. 
  3. Surface - smooth or papillary.
  4. Surface ulceration present or absent.
  5. Cross-section of polyp - any cyst, mucoid
      areas, haemorrhage .  
  6. Appearance of stalk - normal or abnormal.

I. Local excision specimens:

Key to the handling of polyps is to provide a block that ensures a complete section through its stalk, base and head.

-Small polyps -  embedded whole.
-Lesions less than 1cm - bisection through the stalk
-Lesions more than 1cm - (see diagram). Edges should be  trimmed. There should be three pieces. The central section contain the intact stalk. The two side pieces are put into a separate cassette.

At least three levels are cut from a small polyp and six or more from a larger polyp.

II Submucosal polypectomies and transanal full thickness local excision specimens:

Indication: 1. In cases of large adenomas and  early carcinomas. 2. Performed as palliative procedure in patients unsuitable for more radical surgery
Specimen: Both types of specimens consist of a  lesion with narrow rim of surrounding normal tissue.
Procedure: (see diagram)
1.For proper examination the fresh specimen needs to be pinned around the entire circumference and fixed for at least 24hrs.
(Note: Fixing of specimen without pinning can cause tissue shrinkage.It becomes difficult to orientate the specimen and assess the resection margins.)
2.Next specimen margins are identified with coloured markers.
3.The whole specimen is transversely sectioned into 3mm slices and submitted for histology in sequentially labelled cassettes.
4. In specimens where the margin of normal tissue is less than 3mm, a 10mm slice containing the relevant margin should be made a and further sectioned at right angles as shown in the diagram.

                     

III Sampling of multiple polyps and polyposis:

Multiple adenomatous and metaplastic polyps may be present in the backround of colorectal resections performed for both neoplastic and non-neoplastic lesions and in polyposis syndromes.
All polyps under 1cm in a colectomy specimen do not necessarily need to be sampled.
All suspected adenomas above 1 cm in diameter should be submitted for histology.

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Soft Tissue Pathology;

Myxoid Tumours of Soft Tissue Classification of Soft Tissue Tumour;  Gross examination of soft tissue specimen ;  A practical approach to histopathological reporting of soft tissue tumours Grading of soft tissue tumours ; Lipomatous tumours ;Neural tumours ; Myogenic tumours ;Vascular tumours ;Fibroblastic/Myofibroblastic tumours ; Myofibroblastic tumours ;  Fibrohistiocytic tumours ; ChondroOsseous tumours ; Soft TissueTumours of Uncertain Differentiation ; Notochordal Tumour -Chordoma ;Extra-adrenal Paraganglioma ; Gastrointestinal Stromal Tumour ;

 
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Pedunculated polyp-
 (with a stalk ).Less than 3cm in diameter. 
     
 


Sessile polyp -
(without a stalk)
Larger size


 

click on this image


- Normal Histology of the Large Intestine

- Interpretation of Large Intestinal Biopsies

- Assessment of abnormalities -1 (lumen, surface epithelium, subepithelial zone)

- Assessment of abnormalities - 2  (crypt density , architecture and epithelium)

- Assessment of abnormalities - 3 (changes in the lamina propria,muscularis mucosae and submucosa)

- Microscopic/ collagenous colitis ;  

- Pseudomembranous colitis;

-
Pathology of Amebic Colitis
 ; 

- Drug related lesions of the Gastrointestinal Tract

- Gross examination of colorectal resection specimens in  non-neoplastic diseases

Pathology of the Intestinal Polyps

Gross examination of polypectomey specimens

Hyperplastic polyps and serrated adenomas

Inflammatory polyps/ Inflammatory cap polyps / Polypoid mucosal polyps

Juvenile polyp ; Peutz-Jeghers polyp ; Inflammatory fibroid polyp ; Multiple Lymphomatous polyposis ;  Lymphoid polyp.