Ulcerative colitis

Discussion:

The patient went on to have a subtotal colectomy.

Histology

MACROSCOPIC DESCRIPTION:

A subtotal colectomy specimen measuring 820mm, including 15mm terminal ileum, and some proximal rectum. Located 10mm from the distal resection margin is a peritoneal reflection. There is an unremarkable appendix 30x5mm. Located 10mm from the distal resection margin, at the junction of the sigmoid colon and rectum is a fungating, stenosing mucosal tumor measuring 60mm in length. Cross sectioning show there may be invasive of the tumor into but not through the muscularis propria. There are 2 sessile polyps 70mm and 120mm proximal from the tumor. No other focal mucosal lesions are seen. The mucosa shows diffuse flattening in the distal half of the specimen, and this is associated with irregular, corrugated thickening of the wall. There is no evidence of perforation or ulceration.

MICROSCOPIC DESCRIPTION:

Sections show a moderately differentiated adenocarcinoma arising in the distal sigmoid colon. It invades through the muscularis propria into subserosa. There is focal mucinous differentiation. Lymphovascular invasion is not seen. The tumor is well clear of the radial and soft tissue margins. There is associated transmural chronic inflammation, muscular hypertrophy, neuronal hyperplasia and submucosal fibrosis. Granulomata are not seen. The macroscopically identified polypoid lesions are inflammatory polyps. Random mucosal sections from the uninvolved colon show mild crypt architectural distortion. Cryptitis and crypt abscess formation are not seen. There is no terminal ileitis. The appendix shows fibrous obliteration. No metastatic tumor is seen in 47 lymph nodes.

In immunostains, the malignant cells express MLH-1, MSH-2, MSH-6 and PMS-2 in a normal pattern.

FINAL DIAGNOSIS:

Moderately differentiated adenocarcinoma of the distal sigmoid colon on a background consistent with quiescent ulcerative colitis

AJCC Stage IB (T2b, N0, M0).

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