Details
Category: Volume 09 Issue 06 June 2021
Hits: 1093

Title: Clinico-Pathological Spectrum of Colonic Lesions

Authors: Dr Samrudhi Samant, Dr Ritesh Waghray

 DOI: https://dx.doi.org/10.18535/jmscr/v9i6.07

Abstract

Background: The colon is a seat for various diseases which include both non neoplastic and neoplastic conditions. However, due to considerable overlap in clinical manifestations in the colonic lesions further investigations are crucial in determining underlying pathology. With the advent of flexible fibre optic sigmoidoscopy and colonoscopy adequately sampled biopsies facilitate documenting normal colonic mucosa, identifying inflammatory processes, discriminating different inflammatory reaction patterns, suggesting the possibility of more than one disease process and also, at times, identifying a specific causative agent.

Materials and Methods: All colonoscopic biopsies received in Department of Pathology in a tertiary care hospital in southern India during the two-year study period.

Results: Total of 98 colonoscopic biopsies were studied with a male to female ratio of 2.3: 1. Most common clinical presentation for both benign as well as malignant lesions was bleeding per rectum. Out of the colonoscopic biopsies, 45 (45.9%) were non neoplastic, 8 (8.16%) were benign lesions and 35 (35.78%) were malignant lesions. Among the 45 Non neoplastic lesions, 22 cases (48.8%) were non-specific colitis, 17 (37.7%) cases ulcerative colitis, 3 cases (6.66%) granulomatous inflammation, 2 cases (4.44%) inflammatory polyps and 1 case (2.22%)of juvenile polyp. Out of the 8 benign cases, 4 cases (50%) of tubulovillous adenoma, 3 cases (37.5%) of tubular adenomas, 1 case villous adenoma (12.5%). Out of 35 malignant lesions, 4 cases (11.4%) were Well Differentiated Adenocarcinoma, 24 cases (68.5%) were Moderately Differentiated Adenocarcinoma, 5 cases (14.2%) were Poorly Differentiated Adenocarcinoma, 1 case (2.8%) each of Mucin Secreting Adenocarcinoma and Malignant Melanoma.

Conclusion: Though clinical features supplemented with colonoscopy serve as an adequate tool to diagnose colonic pathology, histopathology remains the gold standard for definitive diagnosis.

Keywords: Colonoscopy, Colitis, Colorectal carcinoma, IBD, Adenoma.

References

  1. Gill MK, Jain K, Manjari M, Kaur T. Expression of Her-2/neu in Colon Carcinoma and Its Correlation with the Histological Grades and the Lymph nodes status. Journal of Clinical and Diagnostic Research.2011 December, Vol-5(8): 1564-68.
  2. Singh H, Turner D, Xue L, Targownik LE, Bernstein CN. Risk of developing colorectal cancer following a negative colonoscopy examination. JAMA. 2006; 295(20): 2366-73.
  3. NCRP (2013) Three-year report of the population based cancer registries- 2009-2011. National cancer registry programme, Indian council of medical research (ICMR), Bangalore, India, 2013.
  4. Cappell MS, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy and complication. Med Clin North Am 2002 Nov;86:1253-88
  5. Qayyum A, Sawan AS. Profile of colonic biopsies in King Abdul Aziz University Hospital, Jeddah. J Park Med Assoc 2009 Sep;59(9):608-11.
  6. Guidelines for the initial biopsy diagnosis of chronic inflammatory bowel disease. BSG- A structured approach to colorectal biopsy assessment. Guidelines in Gastroenterology August 1997.
  7. A. Carpenter, N. J. Talley. The importance of clinicopathological correlation in the diagnosis of inflammatory conditions of the colon: histological patterns with clinical implications.bbAm J Gastroenterol. 2000 Apr; 95(4): 878–896.
  8. Cappell M.S. The pathophysiology, clinical presentation and diagnosis of colon cancer and adenomatous polyps. Med Clin N am.2005; 89(1):1-42.
  9. Pandey M, Pandey A, Dombale V D.. Histomorphological Profile of Colonoscopic Biopsies - A Two Year Study in a Tertiary Care Hospital in South India. International Journal of Science and Research 2016,Vol-5 (2);2319-7064
  10. Pavani M, Raghu K, Srikanthbabu Y, Chandrasekhar KPA, Parimala S, Aravinda B, Manoja V, Pramod M. Histopathological Study of Lesions of Colon - A 5-Year Study. Int J Sci Stud 2017;5(2):65-68.
  11. Lam AK-Y, Chan SS-Y, Leung M. Synchronous colorectal cancer: Clinical, pathological and molecular implications. World Journal of Gastroenterology : WJG. 2014;20(22):6815-6820.
  12. Chaitanya B, Ramakrishna BA, Shanthi V, Reddy SR. Microscopy after Colonoscopy: an Institutional experience in India. Int J Med Res Rev 2014;2(2):92-97.
  13. Teague RH, Salman PR , Read AE. Fiberoptic examination of the colon: a review of 255 cases. Gut,1973;14:139-142.
  14. Rajbhandari M, Karmacharya A, Khamal K, Dhakal P, Shreshtha R. Histomorphological profile of colonoscopic biopsies and pattern of colorectal carcinomas in Kavre district. Kathmandu Univ Med J 2013; 43(3):196-200.
  15. Sidney J, Sheldon D Leidner et al. Colonoscopic Biopsy and Cytology in the diagnosis of colon cancer. Cancer 1973;42:2849-53.
  16. H.Karve, Vidya. K, Shivarudrappa A.S, Prakash.C.J. The Spectrum of colonic lesions: A Clinico-pathological study of colonic biopsies. Indian Journal of Pathology and Oncology, October – December 2015;2(4);189-209
  17. Halazonetis TD, et al: An oncogene-induced DNA damage model for cancer development.  Science2008; 319:1352.
  18. Lieberman DA, Rex DA, Winawer SJ, Giardiella FM, Johnson DA, Levin TR. Guidelines for Colonoscopy Surveillance after Screening & Polypectomy : A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012;143:844-57.
  19. Nusko G, Mansmann U, Altendorf-Hofmann A, Groitl H, Wittekind C, Hahn EG. Risk of invasive carcinoma in colorectal adenomas assessed by size and site. Int J Colorectal Dis. 1997:12(5):267–271.
  20. Church JM. Clinical significance of small colorectal polyps. Dis Colon Rectum. 2004:47(4):481–485.
  21. Sudarshan V, Hussain N, Gahine R, Mourya J. Colorectal cancer in young adults in a tertiary care hospital in Chattisgarh, Raipur. Indian Journal of Cancer, 2013; 50(4): 337-40.
  22. Gill MK, Jain K, Manjari M, Kaur T. Expression of Her-2/neu in Colon Carcinoma and Its Correlation with the Histological Grades and the Lymph nodes status. Journal of Clinical and Diagnostic Research.2011 December, Vol-5(8): 1564-68.
  23. Ojo OS, Odesanmi WO, Akinola OO. The surgical pathology of colorectal carcinomas in Nigerians. Trop Gastroenterol. 1992;13:64–69.
  24. Adesanya AA, da Rocha-Afodu JT. Colorectal cancer in Lagos: a critical review of 100 cases. Niger Postgrad Med J. 2000;7:129–136.
  25. Deo SV, Shukla NK, Srinivas G, et al. Colorectal cancers–experience at a regional cancer centre in India. Trop Gastroenterol 2001;22:83–6.
  26. M C Peedikayil, P Nair, S M Seena,  L Radhakrishnan, S Sadasivan, V A Naryanan, V Balakrishnan. Colorectal cancer distribution in 220 Indian patients undergoing colonoscopy. Indian J Gastroenterol 2009:28(6):212–215
  27. Laishram RS, Kaiho N, Shimray R, Devi SB, Punyabati P, Sharma DC. Histopathological Evaluation of Colorectal Carcinomas status in Manipur, India. International Journal of Pathology, 2010; 8(1): 5-8.
  28. Rangaswamy R, Sahaddev R, Suguna B V, Preethan K N, Ranjeeta S B. Clinico-colonoscopic and Histomorphological Spectrum of Colonic Diseases in an Academic Tertiary care Centre. Journal of Evolution of Medical and Dental Sciences 2014;3(1):1-9.
  29. Shyamal Kumar Halder et al. Epidemiological, Clinico-Pathological Profile and Management of Colorectal Carcinoma in a Tertiary Referral Center of Eastern India. JKIMSU, 2013; 2(1): 45-50.

Corresponding Author

Dr Samrudhi Samant

Asst Professor, Dept of Pathology, 5 Air Force Hospital, Assam, India