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Outline
PATHOLOGY GI PICTURES SHOW
COLON-RECTUM –ANUS TUMORS
By Ed Friedlander.M.D
Danil Hammoudi.M.D
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ADENOCARCINOMA OF THE COLON
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Types of colon cancer:

adenocarcinoma of the colon –
 the most common type of colon cancer.
Adenocarcinoma of the colon and rectum develop in the glands of the inner lining or mucosa of the intestine and comprise 95% of colorectal cancer.

Subtypes of adenocarcinoma of the colon are:
mucinous (colloid)
signet ring

Other types include:

neuroendocrine
lymphomas
melanomas
squamous cell
sarcomas
carcinoids

polyps - common tumors found in about half the population over 40 years of age. These mushroom-like growths are usually benign, but at least one type, adenomatous polyps, may be a precursor to cancer. About 90% of colon cancers are thought to arise from these polyps.
Stages of colon cancer:
Stage I (Dukes' A) - cancer is limited to the lining or muscular wall of the colon and has not spread anywhere else.

Stage II (Dukes' B) - cancer has spread through muscular wall of the colon or has extended into adjacent organs through the intestine but has not entered the lymph nodes.

Stage III (Dukes' C) - cancer has spread outside the colon into lymph nodes nearby.

Stage IV - cancer has spread beyond colon to distant organs (such as the liver, lungs, or bones)

Recurrent - cancer has recurred after it has been treated. It may recur in or on the colon (e.g., in the suture line) or in another part of the body (metastatic colon cancer).
Metastatic Colon Cancer:

Colon cancer with bone metastases

Colon cancer with brain metastases

Colon cancer with liver metastases

Colon cancer with lung metastases

Colon cancer with liver and lung metastases

Colon cancer with skin metastases

Colon cancer metastasized to other sites such as the ovaries, buttocks, etc.
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Colon carcinoma
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Cancer after on anastomosis
Coecal cancer
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COLONIC ADENOKC
Carcinoid
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This carcinoid tumor is fairly large for this type of tumor
•Note that the mucosa has remained intact in spite of the size of the tumor
Colonic mucosa is normal
•In the submucosa clusters of tumor cells(arrow) can barely be seen at this power
High power view contains normal colonic mucosa on the right, and clusters of tumor cells on the
left •The tumor cells have a very uniform appearance and occur in small clusters
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Carcinoid, Colon
Carcinoid Tumor of Colon
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CARCINOID:The tumor has an organoid growth pattern with uniform cytologic features consisting of moderate eosinophilic cytoplasm, finely granular cytoplasm, and round nuclei with finely stippled chromatin.  The histologic patterns include spindle cells (mostly peripheral), trabecular, palisading, glandular, follicular, rosette-like, papillary and sclerosing papillary.  The cells of pulmonary carcinoid may have oncocytic, acinic-cell-like, signet-ring, mucin-producing, or melanocytic features.  Stromal deposition of amyloid, or ossification, or calcifications may be noted.
RECTAL CARCINOID
Cloacagenic_ca1
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MORE ADENOKC
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Adenocarcinoma, Colon
Adenocarcinoma with Lymph Node Metastases
•This is a view of the entire thickness of the colon wall and mesentery.
•Note the mucosal tumor(white arrow)
•Tumor involves full thickness of the muscularis propria advancing into the the pericolic fat(black
arrow) •Multiple enlarged lymph nodes contain metastatic carinoma which is white to tan(green arrows)
Adenocarcinoma of the cecum
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Adenocarcinoma of Colon
•The carcinoma penetrates the basement membrane to invade the submucosa
•The malignant cells are disorganized and crowded
•The lack of mucin within the tumor indicates loss of differentiation, in contrast to the remaining
benign mucosa in the upper left
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Adenocarcinoma, Colon
Adenocarcinoma of Colon (full spectrum of changes)
•Full spectrum from normal glandular tissue (bottom,right) dysplastic glands on the left and invasive
adenocarcinoma seen at the top. •Note the highly irregular glandular architecture in the malignant tissue with hyperchromatic,irregular

nuclei
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Adenocarcinoma, Colon
Adenocarcinoma of Colon
•The depressed central region of this raised tumor is the gross evidence that the original benign
polyp has transformed to a carcinoma. The ulcerated center represents necrotic tumor •The smooth raised pink-white tissue surrounding the ulcerated tumor is viable tumor
•The lobulated edge(arrow) represents residual component of the adenomatous polyp in which this
lesion originated •The lesion is typically sharply demarcated from the adjoining normal mucosa
Polyps
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Large bowel mucosa with multiple adenomatous polyps
Tubulopapillary carcinoma (De-novo-carcinoma)
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DYSPLASIA
Dysplasia, Colon
Colon - low grade dysplasia in IBD
•N = normal glands with small basally placed nuclei and ample amounts of mucin
•Dysplastic cells have cigar shaped hyperchromatic nuclei.
•Lack of severe architectural disarray(pseudopalisading) and continued mucin production distinguish
this from high grade dysplasia.
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HIGH GRADE DYSPLASIA IN CASE OF IBD
LOW GRADE DYSPLASIA
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MORE VARIOUS PICTURES OF COLON TUMORS
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Metaplastic polyps
Small plaques approximately 2 mm in diameter
Pathogenesis unknown
Not pre-malignant
Leiomyosarcoma, Colon
Leiomyosarcoma of Colon
•The white rubbery cut surface is typical of a GIST tumor (Gastrointestinal Stromal Tumor)
•The large size of this tumor suggests malignant potential, but is not as accurate as mitotic counts as
an aid in classifying these tumors as benign or malignant •Necrosis and hemorrhage are found in malignant tumors, but in GIST tumors are related to the size

of the tumor and are not an independant predictor of malignant potential
Peutz-Jeghers syndrome
Peutz-Jegher's syndrome
Peutz-Jegher's syndrome is an autosomal dominant condition characterised by:

multiple hamartogenous polyps of the gastrointestinal tract - most often in the small bowel but may occur affect any portion of the GI tract
mucocutaneous pigmentation - mainly, of the lips, buccal mucosa, genitalia, hands and feet

Patients often present with small bowel intussusception before the age of 10 years.

The polyps themselves have a very low malignant potential. About 10-20% of patients develop gastrointestinal carcinoma but this is thought to arise from coexistent adenomas.

Patients have an increased risk of developing carcinomas of the pancreas, lung, ovary and breast.
Peutz-Jeghers syndrome
Rare familial disorder
Circumoral pigmentation and intestinal polyps
Polyps found throughout gut but most common in the small intestine
Presents in childhood with bleeding, anemia or intussusception
Polyps can become malignant
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JUVENILE TUMOR
Juvenile polyps
Commonest form of polyp in children
Can occur throughout large bowel but are most common in the rectum
Usually present before 12 years
Present with Prolapsing lump or rectal bleeding
Not pre-malignant
Treated by local endoscopic resection
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Adenoma, Tubulovillous, Colon
Tubulovillous Adenoma of Colon
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RECTAL TUMORS
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Adenocarcinoma, Colon
Adenocarcinoma of rectum
•This colon has been opened longitudinally.
•Note ulcerated mass with raised rolled borders(arrows).
•The remaining mucosa is tan with normal folds.
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     ANAL TUMORS
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Abdominoperineal resection (extensive surgical resection from anus extending upward)

Very small tumors may only need surgical removal.

Radiation treatment for inoperable disease (disease has spread too much)

If metastatic, spreads to lymph nodes (glands) in the groin and these glands may be resected.
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