Large Intestine

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Crohn’s disease in mucosa

Gross< Thick wall:OedemaFibrosisMuscle hypertrophy Alternation of affected and normal areas Sharp border

Microscopic picture

Inflammation in the mucosa Crypt abscesses Chronic mucosal damage Ulcers and deep narrow fissures Transmural inflammation Non-necrotising granulomas Irregular muscle layer thickening due to fibrosisand reduplication Nerve hyperplasia Possible vasculitis

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Crohn’s disease in submucosa

1.Granuloma

2.Gaint cells

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Crohn’s disease granuloma in submucosa

1.granuloma without necrosis

2.inflammation

3.muscle layer

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Crohn’s disease granuloma in subserosal fat;

Inflammatory cells, granlomma central with fat cells

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Crohn’s disease: granuloma and nerve hyperplasia.

1. Granuloma

2. Nerve hyperplasia

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Crohn’s disease wide fissure

1.Fissure ulcer

2.Wide ulcer

3.Rectal epithelium

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Crohn’s disease; fissure like ulcer

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Crohn’s disease; deep ulcer

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Mucosa of the large intestine

- Difference severe inflamatory cells

- Loss of goblet cells

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Ulcer colitis

- Loss of goblet cells

- Crypt abcess

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Necrosis of small intestine due mesenterial thrombosis;

1. Edema

2. Hemorrhage

3. Necrosis(dark)

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Hernia sac of large bowel showing hemorrhagic necrosis;

Middle - complete necrosis

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External haemorrhiodes

- Dilated veins with blood clots inside of it.

we pay attention to

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Internal hemorrhiodes,

-Mucosa is dilated

Haemorrhage overlaying

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Acute appendicitis;

Initial acute appendicitis

Flegmonous appendicitis

Gangrenous appendicitis

Perforation and purulent peritonitis

* Diffuse appendicitis

In early acute appendicitis, subserosal vessels are congested,and a modest perivascular neutrophilic infiltrate is presentwithin all layers of the wall.

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Phlegenomous appendicitis - purlent infiltation muscle layer: neutrophilic infiltrate is present within all layers of the wall.

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Gangrene appendicitis with perforation, to the left is there appendicitis with perforation into fat cells

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Ganagrenous appendicitis - complete necrosis

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Appendicular enteriobiosis - parasite(eosinophils)

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Appendicular enterbiosis - parasites - infiltereted e

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Chronic appendicitis, thickning of submucosa, increased level of lymphocytes.

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Tubular adenoma of large bowel;

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Epithelia dysplasia in adenoma, irregular shaped of cells, profliferation, greater lumen,loss of goblet cells.

Green arow - normal

Red arrow - Adenoma

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Familial adenematous polyposis,

60 years polyposis,

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Familial adenematous polyposis

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Vilious adenoma, is high risk to be malignant

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Intraepithelial carcinoma in large bowel, dysplasia, high number of cells.

1.Dysplasia

2. Normal gland cells with normal cells

3. Border between normal and abnormal

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Gross view of colorectal cancer, the dark dots showes the cancer and the progression is intensive.

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Colorectal adenocarcinoma, 99%

Low grade - high differentiated

High grade - low differented

In the right picture - we see red structure is apoptic body.

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Medullary cancer, lots of inflammatory cells, the brown cells are tumor cells, and tumor assicated cells.

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Signet ring cell cancer, typical for gastric cancer

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Mucinous cancer, another form of colorectal cancer.

T0 No primary tumour

Tis Carcinoma in situ: intraepithelial or possessing invasion into lamina propria.

T1: invasion into submucosa

T2: invasion into lamina muscularis propria

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Colorectal adenocarcinoma - invasion in lamina musclaris propria,

its T2, because its profliferation into muscle layer

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Serosal invasion, tumor cells into the right

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Metastasis in lymph nodes, cancerinoma

1.

2.

3.

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Perineural invasion

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Invasion in lymphatic capillaries, specific stain to determine whether the tumor cells are inside the lymphatic cells.

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Invasion in blood vessels, thrombosis inside the blood vessel.

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Gastrointestinal stromal tumor(GIST)

mesenchymal tumour in the stomach and large bowel arising from Cajal cells and showing c-Kit s. CD117 positivity.

Microscopic; Spindle cell (70%)Epitheloid (20%)Mixed

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Gastrointestinal stromal tumor(GIST);

Rounded mass lesion

Cystic change possible

Usually softer than leiomyoma

White to tan

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GIST(CD117)

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GIST(CD117)

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GIST, desmin negative

1.

2.

3.

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GIST(CD34)

1.