Description

• tumour - site: ileocaecal valve/caecum/colon (which segment, flexure)/rectum (above, straddling or below the peritoneal reflection and upper, mid or lower, anterior, posterior or lateral)/anus.

lumenal/mural/extramural/mesenteric.

- size: length x width x depth (cm) or maximum dimension (cm).

- appearance: polypoid/nodular - adenoma, carcinoma, carcinoid, multiple lymphomatous polyposis, GIST.

ulcerated/stricture - carcinoma, malignant lymphoma, metastatic carcinoma.

fleshy/rubbery - malignant lymphoma, GIST.

multiple - adenomas, carcinoma (primary or metastatic), malignant lymphoma.

- edge: circumscribed/irregular.

- perforation.

- adjuvant therapy changes: necrosis, ulceration, fibrosis.

- ulcerative colitis: contiguous/diffuse mucosal distribution, granularity, ulceration (linear/ confluent), inflammatory polyps, synechiae, nodular or sessile DALMs, tumour, mucosal reversion with healing and atrophy, backwash ileiitis, treatment-related rectal sparing.

- Crohn's disease: segmental/transmural distribution, cobblestone mucosa, ulceration (aphthous/linear/confluent), stricture, fat wrapping, fistula, polyps or tumour, lympha-denopathy, adhesions, abscess formation, ileal/anal disease.

• ischaemia - serosal hyperaemia/constriction band, mucosal hyperaemia/haemorrhage/ulcer-ation/necrosis, wall thinning/perforation/stricture.

1. Sample the ileal and colorectal resection limits

2. Process the appendix as usual

3. Sample representative blocks of any abnormality including the junction with adjacent mucosa

4. Sequentially sample normal bowel

5. Sample mesenteric lymph nodes

Figure 5.8. Ulceroinflammatory colorectal conditions.

• pseudomembraneous colitis - pseudomembranes (adherent/yellow), mucosal granularity/ erosion/ulceration, stricture.

• obstructive enterocolitis - ulceration or stricture (contiguous or distant, diffuse or segmental), dilatation, wall thinning, perforation, ileal component.

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