آزمايشگاه رز - Ackerman Atlas(chaptr17)

Large bowel

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Figure 17.1 Schematic diagram of gross and microscopic changes in 15 cases of Hirschsprung disease

Figure 17.2 Gross Specimen of Hirschsprung Disease. The proximally dilated segment of bowel has been resected

Figure 17.3 Colonic mucosa stained for acetocholinesterase from a patient with Hirschsprung disease. There is a marked increase in the number of nerve fibers in the lamina propria

Figure 17.4 Classic radiographic appearance of diverticulosis

Figure 17.5 Extensive diverticulosis of the sigmoid colon with segmenta- tion and shortening of bowel. Openings of diverticula can be clearly seen. The circular muscle is thick and corrugated

Figure 17.6 Whole-mount section of colonic diverticular disease

Figure 17.7 Whole-Mount Section of Colonic Diverticulosis. One of the diverticula shows marked chronic peridiverticulitis. Note hypertrophy of the muscular wall

Figure 17.8 Various Gross Appearances of Ulcerative Colitis. A, Acute ulcerative colitis with marked hyperemia. B, Ulcerative colitis showing mucosal ulceration with residual foci of elevated and hyperemic mucosa. C, Longstanding ulcerative colitis showing total mucosal atrophy. D, Fulminant ulcerative colitis with toxic megacolon

Figure 17.9 A and B, Pseudopolyps in separate cases of ulcerative colitis

Figure 17.10 Low-power view of ulcerative colitis showing a chronic active colitis pattern of injury

Figure 17.11 Chronic changes in ulcerative colitis with basal plasmacytosis and separation of the base of the crypts from the muscularis mucosae by a sheet of plasma cells

Figure 17.12 Chronic changes in ulcerative colitis characterized by crypt architectural distortion and Paneth cell metaplasia

Figure 17.13 Fulminant ulcerative colitis complicated by toxic megacolon

Figure 17.14 Focus of polypoid low-grade dysplasia in ulcerative colitis. The focus is histologically indistinguishable from a sporadic tubular adenoma

Figure 17.15 Focus of flat low-grade dysplasia in ulcerative colitis

Figure 17.16 Flat high-grade dysplasia in ulcerative colitis characterized by marked cytologic atypia and architectural complexity

Figure 17.17 Invasive adenocarcinoma with abundant extracellular mucin arising in a colon affected by ulcerative colitis

Figure 17.18 Gross Appearance of Crohn Disease of the Large Bowel. A, Segmental involvement with transmural inflammation and a stricture. The appearance is similar to that seen in small bowel Crohn disease. B, Typical cobblestone appearance

Figure 17.19 Comparison between pseudopolyps in ulcerative colitis (right) and the cobblestone pattern of Crohn disease (left)

Figure 17.20 Focus of pyloric gland metaplasia in mucosa involved by Crohn disease

Figure 17.21 Patchy active inflammation in mucosa involved by Crohn disease with crypt abscesses

Figure 17.22 Crohn disease with a mucosal granuloma in the ileum

Figure 17.23 Resection specimen of Crohn disease showing transmural lymphoid aggregates

Figure 17.24 Cholesterol emboli in mesenteric vessels which resulted in ischemic colitis

Figure 17.25 Ischemic Colitis. A, Mucosal erosion associated with regenerative epithelial changes and lamina propria hyalinization charac- teristic of ischemic colitis. B, High-power view of lamina propria hyalinization

Figure 17.26 Acute self-limited colitis with patchy neutrophil-mediated crypt injury

Figure 17.27 Collagenous colitis showing expanded lamina propria, lymphocyte-mediated surface injury, and subepithelial thickening of the collagen table

Figure 17.28 High-power view of lymphocyte-mediated surface injury in a case of lymphocytic colitis

Figure 17.29 Focal active colitis pattern of injury

Figure 17.30 Pseudomembranous Colitis. There are multiple discrete white plaques of purulent exudate on the mucosal surface. This patient was taking ampicillin. (Courtesy of Dr. R.A. Cooke, Brisbane, Australia, from Cooke RA, Stuart B. Colour Atlas of Anatomical Pathology. Edinburgh: Churchill Livingstone; 2004.)

Figure 17.31 High-power view of a pseudomembrane in a case of C. difficile-associated pseudomembranous colitis

Figure 17.32 Necrotizing Enterocolitis. A, Gross appearance with mucosal necrosis and numerous small gas-filled cysts within the wall. B, Low-power microscopic appearance showing extensive ulceration, necrosis, and hemorrhage. C, Gram stain showing coating of the ulcerated surface by organisms

Figure 17.33 Amebic Colitis. Multiple, undermined ulcers are present in the cecum and ascending colon. (Courtesy of Dr. R.A. Cooke, Brisbane, Australia, from Cooke RA, Stuart B. Colour Atlas of Anatomical Pathology. Edinburgh: Churchill Livingstone; 2004.)

Figure 17.34 Cytomegalovirus Infec- tion of the Large Bowel in a Renal Transplant Recipient. A, Gross appearance of a resected specimen showing numerous superficial ulcer- ations. B, Microscopic section showing inflammation and ulceration. C, High- power view of infected cell with huge intranuclear inclusion. D, Immunohis- tochemical stain for cytomegalovirus

Figure 17.35 High-power view of graft-versus-host disease with char- acteristic scattered apoptotic cells

Figure 17.36 Melanosis Coli. A, The change begins sharply at the level of the ileocecal valve. B, Large bowel diffusely involved by melanosis coli. There is also a carcinoma which is not involved by the melanosis

Figure 17.37 Melanosis coli with pigment-containing macrophages within the lamina propria

Figure 17.38 Endometriosis of the large bowel showing thickening of the wall associated with muscular hypertrophy resulting in partial obstruction

Figure 17.39 Endometriosis. A, Low-power view of endometriosis. B, High-power view of endometriosis showing endometrial glands sur- rounded by endometrial stroma

Figure 17.40 Malakoplakia. A, Low-power view showing packing of the lamina propria by a histiocyte-rich infiltrate. B, High-power view showing numerous histiocytes and rare Michaelis-Gutmann bodies (arrow)

Figure 17.41 Subendothelial accumulation of foamy macrophages within a vessel in radiation colitis

Figure 17.42 Gross appearance of radiation colitis with thickening of the wall, ulceration, and perforation

Figure 17.43 Pneumatosis cystoides intestinalis in a patient with scleroderma

Figure 17.44 Pneumatosis cystoides intestinalis. The cysts are partially lined by multinucleated giant cells

Figure 17.45 Low-power view of colitis cystica profunda

Figure 17.46 Mucosal Prolapse. A, Rectal mucosal prolapse with parallel strands of smooth muscle emanating into the mucosa. B, Mucosal prolapse with ulcer and granulation tissue (so-called solitary rectal ulcer syndrome)

Figure 17.47 Colonic Rosai-Dorfman Disease. A, Rosai-Dorfman disease with enlarged histiocytes admixed with lymphocytes and plasma cells. B, Strong S-100 protein immunoreactivity is characteristic of Rosai-Dorfman disease

Figure 17.48 Various Gross Appearances of Colonic Adenomatous Polyps. A, Polyp with a sessile growth. B and C, Pedunculated polyps

Figure 17.49 Tubular adenoma with characteristic low-grade dysplastic appearance

Figure 17.50 Adenomatous Polyp. A, Gross appearance of a polyp with tubulovillous features. B, Microscopic appearance of a tubulovillous adenoma

Figure 17.51 Adenoma with high-grade dysplasia showing a complex growth pattern, often formerly referred to as "carcinoma in situ," a term which is discouraged from being used

Figure 17.52 Pseudoinvasion in an Adenomatous Polyp. A, Intact adenomatous fragment floating in the center of a pool of well-circumscribed mucin within the submucosa. B, Misplaced adenomatous glands viewed at low power with characteristic rounded or lobular architecture. C, High-power view of misplaced adenomatous glands surrounded by lamina propria, as opposed to stromal desmoplasia

Figure 17.53 Rare case of an adenoma with focal neuroendocrine differentiation (arrow)

Figure 17.54 Hyperplastic Polyp. A, Characteristic low-power view of a hyperplastic polyp. B, Serrated crypts in a hyperplastic polyp

Figure 17.55 Sessile Serrated Polyp. A, Characteristic anchor-shaped crypts at the base of the mucosa in a sessile serrated polyp. B, Dilation of crypts at the mucosal base characteristic of sessile serrated polyp

Figure 17.56 Sessile Serrated Polyp With Cytologic Dysplasia. The residual sessile serrated polyp is found on the left side. There is an abrupt transition to the dysplastic component located on the right

Figure 17.57 Traditional Serrated Adenoma. A, Lateral ectopic crypts in a traditional serrated adenoma. B, Apically located cytoplasmic eosinophilia is a characteristic feature. C, Most cases of traditional serrated adenoma show villiform architecture which can be mistaken for a tubulovil- lous adenoma

Figure 17.58 Juvenile Polyp. A, Outer aspect of a juvenile polyp. B, Cut section showing cystically dilated glands in an edematous stroma. (Courtesy of Dr. R.A. Cooke, Brisbane, Australia, from Cooke RA, Stuart B. Colour Atlas of Anatomical Pathology. Edinburgh: Churchill Livingstone; 2004.)

Figure 17.59 Whole-mount view of a juvenile (so-called retention) polyp

Figure 17.60 Peutz-Jeghers Polyp. There are ramifying bundles of smooth muscle and an absence of dysplasia

Figure 17.61 Radiograph of familial adenomatous polyposis involving the entire bowel

Figure 17.62 Gross appearance of familial adenomatous polyposis. The entire large bowel is involved by innumerable small polyps

Figure 17.63 Familial adenomatous polyposis complicated by adenocarcinoma

Figure 17.64 Juvenile Polyposis. The marked hyperemic quality is a characteristic feature of these lesions

Figure 17.65 Colonic polyps in a patient with Cronkhite-Canada syn- drome. The appearance resembles that of a juvenile polyp

Figure 17.66 Low-power view of a malignant colorectal polyp

Figure 17.67 Adenomatous polyp with "never-ending" pattern of glands but evidence of stromal desmoplasia (intramucosal adenocarcinoma)

Figure 17.68 Various Gross Appearances of Colonic Adenocarcinoma. A, Polypoid pattern of growth

in a rectal lesion. B, Cake-like configuration with central ulceration. C, Deeply penetrating and ulcerating tumor. (Courtesy of Dr. R.A. Cooke, Brisbane, Australia, from Cooke RA, Stuart B. Colour Atlas of Anatomical Pathology. Edinburgh: Churchill Livingstone; 2004.)

Figure 17.69 Microscopic appearance of an invasive colonic adenocar- cinoma characterized by stromal desmoplasia

Figure 17.70 Mucinous Adenocarcinoma. A, Gross appearance of a mucinous adenocarcinoma of the rectum. B, Microscopic appearance of mucinous adenocarcinoma

Figure 17.71 Signet Ring Adenocarcinoma. A, Gross appearance of signet ring carcinoma. This tumor type is highly malignant and characteristi- cally results in luminal narrowing. B, Microscopic appearance of signet ring carcinoma

Figure 17.72 Poorly differentiated adenocarcinoma with micropapillary features and prominent angiolymphatic invasion

Figure 17.73 Characteristic appearance of basaloid squamous cell carcinoma arising in the anus

Figure 17.74 Characteristic appearance of so-called medullary carcinoma

Figure 17.75 Mixed Adenocarcinoma-Choriocarcinoma. A, Low-power view showing an admixture of adenocarcinoma and choriocarcinomatous elements. B, High-power view of a focus of choriocarcinoma in a mixed tumor

Figure 17.76 Colonic Small Cell Neuroendocrine Carcinoma. A, The small cell carcinoma is seen in association with a tubular adenoma. B, High-power view of small cell carcinoma

Figure 17.77 Rectal Carcinoid Tumor. The trabecular arrangement is typical of well-differentiated neuroendocrine tumors in this location

Figure 17.78 Mantle Cell Lymphoma of the Large Bowel. A, Whole- mount view showing characteristic "lymphomatous polyposis" appearance. B, High-power view of the neoplastic cells showing irregularity of their nuclear contours

Figure 17.79 Colonic Neural Neoplasms. A, Diffuse-type ganglioneu- roma involving the wall of the colon. B, High-power view of a polypoid ganglioneuroma

Figure 17.80 Colonic Schwannoma. A, Low-power view showing characteristic lymphoid rim surrounding the neoplastic cells. B, High-power view of cells with a schwannian appearance. Scattered degenerative atypical cells are characteristic

Figure 17.81 Mucosal Schwann cell hamartoma causing a small polyp in the sigmoid colon

Figure 17.82 High-power view of a mucosal perineurioma with bland spindle-shaped cells surrounding crypts. This lesion has also been referred to as a benign fibroblastic polyp

Figure 17.83 Florid reactive vascular proliferation in a colon involved by intussusception. This florid vascular proliferation can be mistaken for a more ominous lesion