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Sigmoid colon mass
Contributed by Asmaa Gaber Abdou, M.D.
Intestinal actinomycosis
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Bacteria and sulfur granules
Colonies of actinomyces
Gram+ staining
Filamentous microorganisms (GMS)
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Colonoscopy
Contributed by Lili Lee, M.D.
Active colitis
Cryptitis
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Early, flat tumor
Flat, small adenocarcinoma
Invasive mucinous adenocarcinoma
Exophytic lesion
Contributed by Raul S. Gonzalez, M.D.
Low power
High power
Dirty necrosis
Cribriforming
Desmoplasia
Lymphovascular invasion
Contributed by Semir Vranic, M.D., Ph.D. and Beverly Wang, M.D.
Poorly differentiated adenocarcinoma
Adenocarcinoma
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Whole mount scan
Moderately differentiated
Dirty necrosis in gland lumens
Venous invasion
Serosal penetration
Detached carcinoma cells
Signet ring morphology
Lymph node metastasis
Histopathology colon adenocarcinoma
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Adenoma carcinoma sequence
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Giant villous adenoma
Several adenomas
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Polypoid tumor with gyrated surface sitting on a short stalk
Polypoid tumor
Contributed by Chien-Kuang Cornelia Ding, M.D., Ph.D., Kwun Wah Wen, M.D., Ph.D. and Enoch Kuo, M.D.
Tubular adenoma
Low grade tubular adenoma
Tubular adenoma with high grade dysplasia
Focal high grade dysplasia
Tubular adenoma
Colon dysplasia
Villous adenoma
Contributed by Albina Joldoshova, M.D. and Naziheh Assarzadegan, M.D.
Pedunculated tubular adenoma
Tubulovillous adenoma
Tubular adenoma with invasive adenocarcinoma
Tubular adenoma
Invasive adenocarcinoma
Lymphovascular space invasion
Poorly differentiated adenocarcinoma
High tumor budding score
Pseudoinvasion
Pseudoinvasion
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Villous tumor with central ulceration
Contributed by Raul S. Gonzalez, M.D.
Villous adenocarcinoma of colon
Contributed by Semir Vranic, M.D., Ph.D.
5x
10x
10x
10x
CK7
20x
CDX2
CK20
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Abrupt transition from benign to malignant mucosa
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Circumferential obstructive mass
Bleeding circumferential lobulated mass
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Cross section
Contributed by Raul S. Gonzalez, M.D.
Adenosquamous carcinoma
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Collision-like areas
Composite-like areas
Adenosquamous carcinoma
Malignant squamous cells with keratinization
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Infected cells with
irregular amphophilic
nuclei
Cells have eccentric
nuclei and vacuolated
cytoplasm
Adenovirus immunostain
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Intranuclear inclusions
with (inset) regular
pattern of arrangement
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Between loops of intestine
Contributed by Raul S. Gonzalez, M.D.
Serosal adhesions
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Attached to intestinal
serosa and
linking viscera
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Endoscopic findings
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Eosinophilic infiltration
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Fulminant colitis and hepatic amebiasis
Contributed by Centers for Disease Control and Prevention
Ulcerative intestinal amebiasis
Diffuse ulcerative amebic colitis
Amebic colitis with perforation
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Ulcer
Contributed by Centers for Disease Control and Prevention, Bobbi S. Pritt, M.D., M.Sc. and Blaine Mathison
Classic flask shaped ulcer
Edge of flask shaped ulcer
Invading trophozoites
Trophozoites invading muscle
Amebic trophozoites
Trophozoite in blood vessel
PAS positive trophozoites
Trichrome stained stool specimen
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Amyloid tumor (above)
and adenocarcinoma
arising from villous
adenoma (below)
Contributed by Raul S. Gonzalez, M.D.
Colonic amyloid
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Submucosal vessel involvement
With Congo red stain
Congo red stain
highlights vessel
wall and free
submucosal amyloid
Congo red stain
Subepithelial
deposits resembling
collagenous colitis
Contributed by Reade Quinton, M.D.
Colon
Contributed by Lizhi Zhang, M.D.
Colonic wall
Colonic mucosa
Cross section of crypt and lamina propria
Paneth cells and enteroendocrine cells
Submucosa and submucosal neural plexuses
Muscularis propria and myenteric plexus
CD3
Mast cells - KIT
Calretinin
S100
Interstitial cells of Cajal
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Colonoscopy
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Small bowel perforation
Perforation and colonic mucosa
Contributed by Maryam Kherad Pezhouh, M.D.
Focal active colitis with crypt drop out
Prominent crypt epithelial cell apoptosis
Neutrophilic crypt microabscesses
Lymphocytic colitis-like pattern
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Overview of mutations
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Type I atresia: mucosal septum
Atresia with hugely distended cecum
Atresia Type I
Contributed by Dhiraj B. Nikumbh, M.D.
Congenital pouch colon
Contributed by Dhiraj B. Nikumbh, M.D.
Congenital pouch colon: 10 day old baby boy admitted with abdominal distension and absent anal opening
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Life cycle
Contributed by Bobbi Pritt, M.D., Richard Bradbury, Ph.D. and Sarah Sapp, Ph.D.
Cyst and trophozoite of Neobalantidium coli (also known as Balantidioides) obtained from West African baboon
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Various images
Trophic stage (EM)
Intestinal lumen
Encysted ciliate
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MRI before surgical intervention and treatment
Generalized markedly
thickened wall of
the small bowel with
edematous changes
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Edematous left colon
Adherent small bowel loop
Postmortem liver
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Staining of the tissue biopsy from left retrocolic mass
Histopathology of surgically resected abdominal mass
Broad hyphae with septation
Splendore-Hoeppli phenomenon
Zygospore
Periodic acid-Schiff stain
Liver biopsy
Spore forms
Various images
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Punched-out ulcer
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Multiple penetrations
Ulcers
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Loss of normal mucosa
Various images
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Cryptitis
Edema, cryptitis and crypt abscess
Cystic crypts and cryptitis
Loss of crypts
Marked edema
Neutrophilic aggregates in lamina propria
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Fungal colonization
in patients with
GI tract disease
Contributed by Nalini Bansal, M.D.
PAS positive fungal hyphae in a case of gastric adenocarcinoma with fungal infection
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Fungal hyphae with gastric performation
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Life cycle
Contributed by Bobbi Pritt, M.D., Nicole L. Achee, Ph.D. and John P. Grieco, Ph.D.
Triatomine bugs
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Blood smears
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Familial autonomic visceral myopathy:
Muscularis propria degeneration
Muscularis mucosae with degenerative changes
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Binary toxin
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Chitin degradation
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Electron micrograph
Contributed by Raul S. Gonzalez, M.D.
Colitis cystica profunda
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Mucosal tears
Endoscopic findings
Contributed by Catherine E. Hagen, M.D.
Preserved architecture
Thickened subepithelial collagen
Epithelial detachment
Equivocal collagen
Trichrome stain
Giant cell
Crypt atrophy
Contributed by Benjamin J. Van Treeck, M.D and Christopher Hartley, M.D.
Lamina propria neutrophils
Absence of plasma cells
Increased crypt apoptosis
Mild active colitis
Reduced mucosal plasma cells
Increased lamina propria eosinophils
Increased lamina propria neutrophils
Mild to moderate active chronic colitis
CD138
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CT scan
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Colonoscopic findings
Contributed by Feng Yin, M.D., Ph.D.
Ischemic injury
with microthrombi
Withered crypts with neutrophils
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Virion particles
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Feet, face, mouth
Facial papules
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Juvenile polyp
Polyps with mildly dilated glands
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CT enterography, small bowel Crohn's disease
MRI of Crohn's disease patient with anovaginal fistula
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Endoscopic features of Crohn's disease
Contributed by Elizabeth Heidi Cheek-Norgan, M.H.S., PA (ASCP) and Catherine E. Hagen, M.D.
Stricture
Contributed by Catherine E. Hagen, M.D. and Luisa Ricaurte Archila, M.D.
Patchy involvement
Active chronic colitis
Pyloric gland metaplasia
Granuloma
Transmural inflammation
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Upper endoscopy: gastric polyposis
Contributed by Raul S. Gonzalez, M.D. and Michael Feely, D.O.
Duodenum: elongated, irregular and cystic crypts
Colon: polypoid mucosa with cystically dilated glands
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Polyp with dilated glands
Duodenum / small intestine
Contributed by Bobbi Pritt, M.D. and Institute of Tropical Medicine Antwerp
Negative fuchsine staining according to Heine
Ziehl-Neelsen staining
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Oocysts: auramine-rhodamine stain
Small blue organisms at luminal border
Modified acid-fast oocyst in stool
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Retrorectal space
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Retrorectal cyst
Oval shaped, gray-white appearance
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Squamous epithelium and focal columnar epithelium
Early malignant degeneration
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CT findings in a patient with CMV colitis
Contributed by Martha M. Yearsley, M.D.
Diffuse erythema
Pseudomembrane
formation
Irregular ulceration, loss of vascular pattern
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Diffuse inflammation
Ulcerating mass
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Ulceration and erythema
Ulceration secondary to CMV colitis
Terminal ileum
Cecum
Multiple, small punctate ulcers in the mucosa
Contributed by Martha M. Yearsley, M.D.
Enlarged cells in colonic lamina propria
Cytomegalic endothelial cells
Owl's eye and coarse red granules
Infected endothelial cells
Cytomegalic endothelial cells partially occluding vessel
Immunoreactivity with CMV immunostain
Scattered CMV positive cells
CMV positive endothelial cells
Contributed by @RaulSGonzalezMD on Twitter
Cytomegalovirus (CMV)
CMV colitis in ulcerative colitis and immunocompromised states
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Chronic diarrhea
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Postcolectomy CT and MRI
Contributed by Catherine E. Hagen, M.D. and Dustin W. Parsons, M.D.
Prominent lymphoid follicles
Crypt abscess
Lymphoid aggregate and architectural changes
Ulceration
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Physiological activity
Contributed by Bindu Challa, M.D. and Martha M. Yearsley, M.D.
CT of abdomen and pelvis
Contributed by Bindu Challa, M.D. and Martha M. Yearsley, M.D.
Colonoscopy
Colonoscopy
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Multiple diverticula
Multiple diverticula
Multiple diverticula
With bowel wall stenosis
Blue-gray diverticula
Perforated single true diverticulum
False diverticulum
Contributed by Bindu Challa, M.D. and Martha M. Yearsley, M.D.
Diverticula
Multiple diverticula
Diverticular abscess
Enterocutaneous fistula
Chronic inflammation in diverticular wall
Diverticular disease associated chronic colitis
Lymphoid aggregates in diverticular wall
Diverticulitis with complications
Histopathology of diverticular disease
Whole slide image of case of diverticulosis with diverticulitis
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Fecaloma removed
Sigmoid and colonic duplication
Final attachment of blind end
Colonic pouch and Y shaped duplication
Dilated colon and Y shaped duplication
Contributed by Celso Rubens Vieira e Silva, M.D.
Cystic congenital duplication
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T shaped tubular colonic duplication
Duplicated colon
Various images
Contributed by Celso Rubens Vieira e Silva, M.D.
Cystic congenital duplication
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Duplicated colon and appendix
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Polypoid dysplasia identified on chromoendoscopy
Nonpolypoid dysplasia
Contributed by Adela Cimic, M.D.
Descending colon lesion
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Dysplasia in a Crohn's colitis pseudopolyp
Contributed by Kenrry Chiu, M.D., C.M.
Low grade dysplasia
High grade dysplasia
Contributed by Elaine Alt, M.D.
Low grade dysplasia
Low grade dysplasia - pancolitis
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High grade dysplasia
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Model of carcinogenesis in ulcerative colitis
Case #163
9 year old boy with Type IV disease
Contributed by Raul S. Gonzalez, M.D.
Submucosal elastofibromatous change mimicking amyloid
Elastin stain
Contributed by Raul S. Gonzalez, M.D. and @Andrew_Fltv on Twitter
Colonic endometriosis
Endometriosis
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Within colonic mucosa
Present in wall of colon
Infiltration along nerves
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CT findings of eosinophilic gastrointestinal disorders
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Duodenum endoscopy
Colon endoscopy
Stomach endoscopy
Duodenum, antrum, rectum endoscopy
Duodenum endoscopy
Contributed by Byoung Uk Park, M.D. and Lizhi Zhang, M.D.
Prominent eosinophilic infiltration
Clustering of eosinophils
Intraepithelial eosinophils
Eosinophilic abscesses
Eosinophils in muscularis mucosae
Eosinophils in mucosa and submucosa
Transmural eosinophilic infiltration
Prominent eosinophilic infiltration
Intraepithelial eosinophils
Eosinophils in muscularis propria
Eosinophils in serosa
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CT scan:
thickened colon
with target sign
CECT: pancolitis
with thickened colon
and target sign
Contributed by Ateeqa Mujeeb Ullah, M.D.
E. coli colonies
Contributed by Ateeqa Mujeeb Ullah, M.D.
Acute colitis
Attenuated familial adenomatous polyposis (FAP)
Contributed by @Andrew_Fltv on Twitter
Familial adenomatous polyposis, classic
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Carpet of adenomatous polyps
Numerous polyps
Contributed by Jennifer Findeis-Hosey, M.D. and @Andrew_Fltv on Twitter
Adenoma involving few crypts
Tubular adenoma polyp, FAP patient
Familial adenomatous polyposis, classic
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Adenoma and adenocarcinoma
FAP versus non-FAP
BCL2
Full colonoscopy in retroflexed maneuver in a familial adenomatous polyposis coli
Contributed by Safina Ahmed, M.B.B.S. and Saroona Haroon, M.B.B.S.
Colonic mucosa with cryptitis and crypt abscess
Colonic mucosa with crypt abscess
Contributed by Mona Deerwester, M.D., M.Sc.
Apple seed
Asparagus
Muscle and adipose tissue of bacon
Banana
Beet
Blackberry
Blueberry seeds
Blueberry skin
Blueberry ultrastructure
Broccoli parenchymal cells and epidermis
Parenchymal cells of broccoli
Parenchymal cells of cantaloupe
Parenchymal, phloem and xylem cells of carrot
Parenchymal cells of celery
Myocytes of chicken
Parenchymal cell of cinnamon with pigment
Parenchymal cell of cinnamon with pigment
Parenchymal cell of coconut
Cookie
Cucumber
Date fruit
Date fruit
Skin of the date fruit
Eggplant
Fig
Fig fruit, GMS
Fig fruit
Seed of a fig fruit
Fig seed
Fish retina (eye)
Fish eye
Garlic
Ginger
Red grapes
Red grapes
Green bean
Hot dog
Hot dog
Hot dog calcification
Hot dog vasculature
Jalapeño
Leek
Lemon skin
Lettuce
Mango
Mushroom
Oats
Okra
Olive
Olive
Onion
Orange
Pasta noodle
Peanut
Peanut
Peanut
Peas
Peas
Pepper seeds
Pepper seeds
Pepperoni
Pizza dough
Potato
Prune
Pumpkin seed
Radish
Raspberry
Raspberry seed
Red bean
Red bean
Red bell pepper
Rice
Sausage
Sesame seed
Shrimp
SPAM
Spinach
Strawberry seed
Strawberry
Tomato seed
Sliced white bread
Whole wheat dough
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Colonoscopy
Contributed by Christopher Hartley, M.D. and Case #305
Ganglioneuroma
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Small bowel follow through showing luminal narrowing
Contributed by Raul S. Gonzalez, M.D.
Mucosal disease
Mural disease
Mucosal disease
Ganglion and
spindled
proliferation in
muscularis propria
Mural disease with numerous ganglion cells
Case #305
Solitary ganglioneuroma
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Diffuse ganglioneuromatosis
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Abdominal CT showing
desmoid fibromatosis
in Gardner syndrome
patient
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Innumerable colon polyps from Gardner patient
Desmoid fibromatosis
Contributed by Raul S. Gonzalez, M.D.
Gastric heterotopia
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Gastric and colonic mucosa
Gastric and colonic mucosa
Heterotopic gastric mucosa with cystic dilatation
Contributed by Raul S. Gonzalez, M.D.
Rectal GIST
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Epithelioid cells and osteoclast-like giant cells
Spindled cells
KIT+
CD34+
PDGFRA+
Contributed by Gustavo Moreno, M.D. and Catherine E. Hagen, M.D.
Endoscopic
Contributed by Gustavo Moreno, M.D. and Catherine E. Hagen, M.D.
Apoptosis
Apoptosis, no crypt loss
Ulceration
Crypt dropout
Architectural distortion
Crypt abscess
Indeterminate
Endocrine cell aggregates
Contributed by Chungja C. Shim, M.D.
Cause unknown
Table 1: sectioning protocol based on polyp size
| | |
| Smaller than 0.4 cm | No sectioning |
| 0.4 - 0.8 cm | Bisect; place in 1 cassette |
| 0.9 - 1.2 cm | Trisect by shaving two sides off central section with stalk; place central section in separate cassette |
| Larger than 1.2 cm | More than 3 sections as appropriate |
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Anatomic subsites of colon and rectum (table 2)
Anatomic subsites of the colon
Mesenteric / radial margin
T category staging
Regional lymph nodes
Contributed by Ed Uthman, M.D. and Raul S. Gonzalez, M.D.
Incidental submucosal
hemangioma in
sigmoid colectomy
Colonic hemangioma
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Collision with liposarcoma
Associated with ulcerative colitis
Gastric tumor: H&E, AFP+ HepPar1- glypican3+
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Proximal extent of aganglionic segment and corresponding frequency
Contributed by Raj P. Kapur, M.D., Ph.D.
Resection specimen
Histological sampling of resection
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Dilated bowel
Contributed by Raj P. Kapur, M.D., Ph.D.
Ganglionic biopsy
Aganglionic biopsy
Calretinin: ganglionic biopsy / aganglionic biopsy
Choline transporter IHC: ganglionic biopsy / aganglionic biopsy
Acetylcholinesterase histochemistry: ganglionic biopsy /
aganglionic biopsy
Leveling frozen section biopsy: ganglion cells / aganglionic segment
Myenteric hypoganglionosis
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CT findings in colonic histoplasmosis
Contributed by Wei Chen, M.D., Ph.D.
Colonoscopy showing GI histoplasmosis
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Ulcer in the sigmoid colon
Contributed by Wei Chen, M.D., Ph.D.
Colon with mucosal and submucosal inflammation
Submucosa with numerous macrophages
Macrophage containing yeast
GMS stain
PAS stain
Mucicarmine stain
Fontana-Masson silver stain
Histoplasmosis colitis
Colonoscopy in histoplasmosis
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HIV associated damage to the GI tract
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HIV associated - various images
Colonic ulceration
Healing colonic ulceration
Contributed by Nalini Bansal, M.D.
Cryptosporidiosis
Strongyloides
Amoeboma
Herpes
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Candida (esophagus)
Candidal pseudohyphae and spores (PASD stain)
CMV gastritis
CMV vasculitis
Cryptococcosis (GMS stain)
Cryptosporidiosis
Giardiasis
Histoplasmosis (GMS stain)
HIV enteropathy
HSV esophagitis
HSV cytopathic effect
Kaposi sarcoma
Mycobacterium avium-intercellulare (acid fast stain)
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Colonoscopy showing deep ulcers in the sigmoid colon
Contributed by Zarrin Hossein-Zadeh, M.D. and Raul S. Gonzalez, M.D.
Pathognomonic Cowdry type A and type B inclusions
Positive HSV antibodies
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Hyperplastic polyp at endoscopy
Contributed by Adrian C. Bateman, M.B.B.S., M.D.
Microvesicular variant
Sawtooth glands
Surface tufting
Nuclear changes at crypt bases
Goblet cell rich variant
Tapered crypts at base
Contributed by Lei Sun, M.D. and Feng Yin, M.D., Ph.D.
CAC, conventional type
CAC, signet ring type
CAC, mucinous type
Contributed by Ashwini Kumar Esnakula, M.D., M.S.
Colonoscopic findings
Contributed by Ashwini Kumar Esnakula, M.D., M.S.
Prominent crypt epithelial apoptosis and apoptotic bodies
Prominent crypt epithelial apoptosis
Cryptitis and crypt epithelial apoptosis
Cryptitis and crypt abscess
Cryptitis and lamina propria mixed inflammation
Contributed by Raul S. Gonzalez, M.D.
Biopsy: mucosal
proliferation
of thick walled
vessels
Resection:
thickened
mural veins
2 thickened veins and 1 unaffected artery
Elastin stain
highlights
internal elastic
lamina of artery
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Retroperitoneal mass enveloping aorta
Contributed by Raul S. Gonzalez, M.D.
Fibrosis and inflammation
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Fibrosis involving ureter
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Necrotic segments of colon
Contributed by Raul S. Gonzalez, M.D.
Colon infarct
Histopathology colon - hemorrhagic infarct
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Central calcified oval mass in the pelvis
Pelvic mass
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Egg shaped mass
Giant loose peritoneal body
Giant loose body attached to omentum
Round pelvic mass
Central calcifications and a distinct fat plane
Macrograph of giant loose body
Contributed by Raul S. Gonzalez, M.D.
Rounded contour
Central fat necrosis
Circumferential fibrous tissue
Contributed by John D. Paulsen, M.D. and Alexandros D. Polydorides, M.D., Ph.D.
IBD, indeterminate type
IBD, indeterminate type, favor Crohn's disease
Mimic: ulcerative colitis with cecal patch
Mimic: superficial
(ulcerative
colitis-like)
Crohn's disease
Contributed by John D. Paulsen, M.D. and Alexandros D. Polydorides, M.D., Ph.D.
Transmural chronic inflammation
Granuloma, pericolonic lymph node
Mimic: cryptolytic granuloma, ulcerative colitis
Mimic: superficial (ulcerative colitis-like) Crohn's disease
Mimic: fulminant ulcerative colitis
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Multiple colonic polyps
Contributed by Andrea L. Wiens, D.O. and Janet E. Roepke, M.D., Ph.D.
Inflammatory polyp of colon secondary to mucosal prolapse
Contributed by M.J. Fernández-Aceñero, M.D., Ph.D.
Endoscopic lesion
Contributed by Taofic Mounajjed, M.D.
Pedunculated cecal polyp
Cut surface with white color
Contributed by M.J. Fernández-Aceñero, M.D., Ph.D.
Typical features
Large bowel lesion
Typical growth pattern
Edema
Myxoid change
Stain for collagen
Mitotic activity
CD34
SMA
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Polypoid lesion, on imaging
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Endoscopic view of polypoid lesion
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2 cm polypoid lesion with central depression
3.9 cm fungating yellow mass
2 year old boy with colonic mass causing anemia
Contributed by Raul S. Gonzalez, M.D.
Not necessarily colon
Contributed by Michael Feely, D.O.
Epithelioid inflammatory myofibroblastic sarcoma
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Various images (H&E and IHC)
Spindle cells
in hyaline
stroma, with
inflammation
Positive
for vimentin
and smooth
muscle actin
Inflammatory cells and spindle cells
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Inflammatory pseudopolyps in ulcerative colitis
Contributed by Andrew L.J. Dunn, M.D.
Dense inflammation in lamina propria
Surface mucosal ulceration
Surface erosion with granulation tissue
Cryptitis
Inflammatory polyp on colonoscopy
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Various images
Contributed by Aaron R. Huber, D.O. and @RaulSGonzalezMD on Twitter
Basophilic fringe
Silver stain
Treponema IHC
Intestinal spirochetosis
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Spirochetes attach end on to the colonic epithelium
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Mass in colonoscopy
Subpeduculated polyp
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Resected intramucosal carcinoma
Contributed by Raul S. Gonzalez, M.D.
Intramucosal carcinoma
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Intramucosal adenocarcinoma
Image hosted on other servers:
Ipilimumab associated colitis
on colonoscopy
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Cecal perforation due to severe colitis
Contributed by Raul S. Gonzalez, M.D. and @SueEPig on Twitter
Acute inflammation with focal cryptitis
Broad mucosal ulceration
Increased apoptosis and lymphocytosis
Lymphoplasmacytic expansion of lamina propria
Ipilimumab associated colitis
Ipilimumab associated colitis
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Colonoscopic findings
Endoscopic images
Contributed by Gagandeep Kaur, M.D. and Monika Vyas, M.D.
Ischemic bowel
Ischemic bowel with pseudomembranes
Gangrenous bowel
Contributed by Gagandeep Kaur, M.D. and Monika Vyas, M.D.
Acute ischemic changes
Ischemic changes
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Ultrasonography and color Doppler sonography
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Endoscopic images
Contributed by Nalini Bansal, M.D.
Multiple polyps
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Macroscopic appearance
Contributed by Lewis Hassell, M.D., Nalini Bansal, M.D. and Christopher Hartley, M.D.
Juvenile polyp from stomach
No dysplasia
Ulcerated
Dilated colonic glands
Dysplasia
Mild frond-like growth pattern
Histopathology of juvenile polyps
Endoscopy of juvenile polyps
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Bowel resection
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Prominent lamina
propria with
edema and
inflammatory cells
Dense stroma
Colonoscopy of juvenile polyposis
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Kaposi sarcoma
Contributed by Raul S. Gonzalez, M.D.
H&E, intermediate power
H&E, high power
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Low power
High power
CD34
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Leiomyoma on colonoscopy
Endoscopic removal of a leiomyoma
Contributed by Raul S. Gonzalez, M.D., @Andrew_Fltv and @ThatGlassTho on Twitter
Leiomyoma
Symplastic leiomyoma
Leiomyoma
Leiomyoma
Leiomyoma
Contributed by Raul S. Gonzalez, M.D.
Colonic leiomyosarcoma
Nuclear atypia
Numerous mitotic figures
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Well differentiated tumor
Moderately differentiated
Poorly differentiated
Contributed by Maryam Kherad Pezhouh, M.D., M.Sc.
Fresh ORISE in the submucosa
Fresh ORISE in a background of red blood cells
Several months after injection of lifting agent
Foreign body reaction to lifting agent
Lifting agent granuloma
Lifting agent is negative for Congo red
Contributed by Catherine E. Hagen, M.D. (Case #507)
Lifting agent granuloma
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Large pedunculated submucosal tumor
Cut section of tumor
Contributed by Raul S. Gonzalez, M.D.
Intramucosal lipoma
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Lipoma with overlying sessile serrated adenoma
Contributed by Raul S. Gonzalez, M.D.
Low grade tubuloglandular adenocarcinoma in ulcerative colitis patient
Background colitis
Contributed by Martha M. Yearsley, M.D.
Intact crypt architecture
Lamina propria expansion
Mixed lamina propria inflammatory infiltrate
Increased surface intraepithelial lymphocytes
Crypt intraepithelial lymphocytes
Surface epithelial damage
Lymphocytic colitis and celiac disease
Microscopic colitis
Contributed by Arvind Rishi, M.D., M.B.B.S.
Histological algorithmic approach
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Endoscopic appearance
Contributed by Arvind Rishi, M.D., M.B.B.S.
Lymphoid aggregate with germinal center
Prominent Peyer patches
Polarized germinal center
Tingible body macrophages
Superficial lymphoid aggregate
Small bowel polyps
Surface reactive changes, rectum
Tingible body macrophages
Incidental
hyperplastic polyp
with lymphoid
aggregate
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Michaelis-Gutmann bodies
Liver transplant recipient
Adjacent to adenocarcinoma
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Lymphomatoid polyposis
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80 year old woman
Contributed by M.J. Fernández-Aceñero, M.D., Ph.D.
Slight inflammatory infiltration
Eosinophils in the infiltrate
KIT expression
Increased mast cells
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Fleshy, ulcerated lesion
Contributed by Raul S. Gonzalez, M.D.
Medullary carcinoma
Contributed by Raul S. Gonzalez, M.D. and Yuri Tachibana, M.D.
Melanosis coli
Pigment in lamina propria
Melanosis coli
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Soft tissue mass
due to squamous
cell carcinoma
primary of lung
Contributed by Raul S. Gonzalez, M.D.
Metastatic breast carcinoma
Metastatic ovarian clear cell carcinoma
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Metastatic melaonoma to sigmoid colon
Poorly differentiated
squamous cell
carcinoma metastatic
from lung
Contributed by Raul S. Gonzalez, M.D.
Micropapillary carcinoma
Contributed by Phoenix D. Bell, M.D.
MMR deficient adenocarcinoma
MMR deficient mucinous adenocarcinoma
MMR deficient medullary carcinoma
MMR deficient mucinous adenocarcinoma
Contributed by Phoenix D. Bell, M.D.
Colon adenocarcinoma biopsy (low power)
MMR deficient colorectal cancer (low power)
Colon adenocarcinoma resection
MMR deficient colorectal cancer (medium power)
MMR deficient medullary carcinoma
MMR deficient mucinous adenocarcinoma
Contributed by Phoenix D. Bell, M.D.
Microsatellite instability analysis
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Treatment modalities in retrospective study
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CT with colon tumor
CT: liver metastasis, intraperitoneal fluid
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Tumor causing intussusception
Colonoscopy
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Multiple polypoid masses
Contributed by Lewis A. Hassell, M.D. and Catherine E. Hagen, M.D.
Mixed acinar cell neuroendocrine carcinoma
Acinar cell carcinoma component
Neuroendocrine carcinoma component
Mixed adenocarcinoma neuroendocrine carcinoma
Small cell carcinoma
Adenocarcinoma
Chromogranin IHC
Synaptophysin IHC
Trypsin IHC
Mixed neuroendocrine and nonneuroendocrine carcinoma of the esophagus
Mixed neuroendocrine nonneuroendocrine neoplasms
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Causing intussusception
Cecal tumor
Arising in villous adenoma
Contributed by Raul S. Gonzalez, M.D.
Abundant extracellular mucin
Epithelial cells within mucin
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Rectal polyps on colonoscopy
Contributed by Raul S. Gonzalez, M.D.
Lesion confined to mucosa
Bland nuclei with occasional enlargements
S100+
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Low power view of hematoxylin and eosin
S100 positivity
Histologic findings
of mucosal
Schwann cell
hamartomas
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MSH2+
Significant loss of MSH6
Colon adenoma and colonic mucosa
Contributed by Raul S. Gonzalez, M.D.
Adenoma associated with MUTYH mutation
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Endoscopic appearance
Contributed by Catherine E. Hagen, M.D.
Architectural distortion
Injured crypt
Apoptosis
Inflammation
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In situ
Thickened wall, mucosal ulceration, cyst-like spaces
Transverse section shows cyst-like spaces in wall
Alimentary tract
Small intestine
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Hemorrhagic necrosis
Mucosal necrosis and cyst-like spaces in submucosa
Submucosal cyst-like spaces
Lined by flattened cells
Subserosal lymph node with cyst-like spaces
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Ulcer post NSAID therapy
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Multiple defects and gastrochisis
Contributed by Raul S. Gonzalez, M.D. and Christopher Hartley, M.D.
Medium power
High power
Weak positivity on EMA
Perineurioma
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Multiple gastric polyps on endoscopy
Characteristic mucocutaneous pigmentation
Contributed by Michael Feely, D.O. and Christopher Hartley, M.D.
Colonic Peutz-Jeghers polyps
Duodenal Peutz-Jeghers polyps
Peutz-Jeghers polyp
Contributed by Raul S. Gonzalez, M.D.
Kayexalate and sevelamer in a rectal ulcer
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Incidental luminal polystyrene
sulphonate resin particles in
jejunal diverticular tissue
Particles at site of colonic
necrosis (direct Schiff stain
with light counterstain)
Particles at site of aspiration
pneumonia (Ziehl-Neelsen stain
with light counterstain)
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Multiple subserosal bubbles
Diffuse hemorrhage
Pneumatosis intestinalis
Pneumatosis intestinalis and focal mucosal necrosis
Contributed by Raul S. Gonzalez, M.D.
Mural pneumatosis
Mucosal pneumatosis
Pneumatosis intestinalis
Understanding the cancer predisposing syndrome caused by defective POLE and POLD1
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Rectal mass
Noncontrast CT scans of abdomen
Contributed by Raul S. Gonzalez, M.D., Aaron Huber, D.O. and Diana Agostini-Vulaj, D.O. (Case #531)
Large cell neuroendocrine carcinoma
Synaptophysin
Chromogranin
INSM1
Contributed by Raul S. Gonzalez, M.D.
Posttreatment changes of rectal carcinoma
Contributed by Subramanya Sakaleshpura Mallikarjunappa, M.B.B.S., M.D.
Linear radiolucencies in left lumbar region
Extensive submucosal edema
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White to yellow plaques and nodules on the colonic mucosa
Hyperemic mucosa and green-yellow exudate
Mucosal denudation and exudate
Contributed by Raul S. Gonzalez, M.D. and Subramanya Sakaleshpura Mallikarjunappa, M.B.B.S., M.D.
Volcano shaped eruption
Pseudomembrane
Withered crypts
Pseudo-signet ring change
Volcano shaped eruption
Pseudomembrane
Contributed by Raul S. Gonzalez, M.D.
Serosal hyaline
predominant
pulse granulomas
Pulse material
with numerous
foreign body
giant cells
Cellular predominant pulse granuloma
Scant pulse material embedded in colon wall
Contributed by @RaulSGonzalezMD on Twitter
Pulse granuloma
Pulse granuloma
Pulse granuloma
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Jejunal pyogenic granuloma
Upper duodenum findings
Endoscopic duodenal mucosal resection
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High power H&E
IHC for CD31 and CD34
Duodenum-edematous granulation tissue
Jejunum postsurgical pyogenic granuloma
Jejunum-CD34
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Edematous rectal mucosa
Rectal mucosa
Contributed by Maryam Kherad Pezhouh, M.D., M.Sc.
Acute radiation associated injury
Chronic radiation associated injury
Chronic radiation associated injury
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Protruding lesion on back wall of gastric cardia
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Cut surface of lesion
Excised specimen in cut section
Fibrotic nodules in pouch of Douglas
Contributed by Raul S. Gonzalez, M.D.
Low power
Intermediate power
Interaction with adjacent fat
Entrapped nerves
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Typhoid rash
Contributed by Elliot Weisenberg, M.D.
Acute self limited colitis
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Typhoid nodules
Contributed by M.J. Fernández-Aceñero, M.D., Ph.D.
Slight mucosal changes in sapovirus infection
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Typical morphology of sapovirus
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USG showing pipestem fibrosis
Large pedunculated polyp
Contributed by Nalini Bansal Gupta, M.D., Lisa Cerilli, M.D. and @zaalruwai83 on Twitter
Calcified eggs of schistosomiasis
Within colonic mucosa
Schistosomiasis
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Several eggs noted in stroma of polyp
Eggs
S. mansoni eggs
S. japonicum:
Eggs
Within tissue - species not specified:
intramucosal calcified bodies
Calcified bodies often clustered
Granuloma surrounding egg
Occasional forms
suggestive of spines
or hooks
Ziehl-Neelsen staining