Cook R.A., Stewart B. Colour Atlas of Anatomical Pathology
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ALIMENTARY
SYSTEM
Fig.
4.80
Fig. 4.81
Fig. 4.78 Focal
nodular
lymphoid
hyperplasia
of the
ileum.
F/9.
On the
right, small nodules
of
lymphoid hyperplasia
can be
seen.
On the
left, this hyperplasia
has
become
so
gross
as
to
produce
a
tumour which resulted
in
intestinal obstruction
necessitating resection.
Fig. 4.79
Malignant
lymphoma
of the
small
intestine.
M/3½.
The
bowel
wall
over
a
long segment
has
been thickened
by a
creamy mass
of
soft tumour.
The
mesenteric lymph nodes
are
also enlarged.
Fig. 4.80
Carcinoid
tumour
in the
terminal
ileum.
F/80.
The
yellow tumour
is
protruding into
the
lumen
of the
ileum.
This
resulted
in
intestinal obstruction.
The
bowel wall
is
thickened
by
fibrosis
and
puckered
so as to be
drawn into
the
lumen. This
appearance
is
very
characteristic
of
carcinoid tumours. Such
tumours frequently metastasize
to the
liver
and
cause
the
carcinoid syndrome,
but
this patient showed
no
evidence
of
that.
Fig. 4.81
Multiple
carcinoids
in the
small
intestine.
F/61.
Incidental postmortem finding. Carcinoids
of the
small intestine
are
frequently multiple.
91
ALIMENTARY
SYSTEM
Fig. 4.83
Fig. 4.82 Adenocarcinoma
of the
ileum.
F/63.
The
patient
had
had
recurrent attacks
of
abdominal pain
and
finally came
to
laparotomy because
of
acute intestinal obstruction.
The
obstruction
was
caused
by the
lodging
of a
large fruit seed
at
the
site
of
partial obstruction caused
by the
carcinoma. Intestinal
obstruction occurs later
in
small bowel carcinomas than
in
large
bowel carcinomas, because
the
bowel contents
are
more liquid
in
the
small intestine.
Fig. 4.83 Secondary
melanoma
in the
small
intestine.
M/51. This
had
resulted
in
intestinal obstruction. This
manifestation
of
disseminated melanoma
is
seen
fairly
frequently
in
communities
in
which malignant melanoma
is a
common
tumour.
Fig. 4.84 Leiomyosarcoma
of the
small
intestine.
M/55.
The
patient presented with intestinal obstruction.
The
tumour
is
large, cystic,
and
partially necrotic.
Fig. 4.85
Acute
peritonitis
associated
with
appendicitis.
F/18 months. Peritonitis complicates appendicitis more
frequently
in
children than
in
adults, because
in
adults
the
greater
omentum
is
more likely
to
seal
off an
acutely inflamed
appendix.
The
thin, greenish
pus can be
seen
in the
lower skin
flap.
Fig. 4.86
Normal
appendix.
Fig. 4.87
Acute
appendicitis.
M/18.
The
appendix
is
dilated
and its
serosal surface
is
reddened
and
covered
by a
fibrinopurulent exudate.
Fig. 4.84
92
ALIMENTARY
SYSTEM
Fig.
4.85
Fig.
4.86
93
ALIMENTARY
SYSTEM
Fig.
4.88
Fig. 4.90
Fig. 4.89
Fig. 4.88
Carcinoid
tumour
in the
appendix.
M/24. This
was
an
incidental finding during
an
appendectomy
for
acute
appendicitis.
The
tumour
is
usually
yellow
or
cream coloured.
In
this case
it is in the
middle
of the
appendix,
but it is
more often
situated
at the
tip.
Fig. 4.89
Mucocoele
of the
appendix.
F/40.
The
appendix
is
dilated
and
filled with clear mucus.
Fig. 4.90
Chylous
cyst
of the
mesentery
of the
small
intestine.
M/3.
The
child presented with
an
abdominal mass.
Fig. 4.91
Acquired
megacolon.
M/23.
The
patient
was
mentally
retarded
and
living
in an
institution.
The
megacolon
was
not
related
to the
cause
of
death.
Fig. 4.92
Hirschsprung's
disease.
M/1
week.
The
baby
had
been constipated since birth
and
exhibited signs
of
intestinal
obstruction. Barium enema showed
a
narrowed lower rectal
segment with dilated rectum above
it.
This operative photograph
shows
the
typical appearance
of
Hirschsprung's disease. There
are
no
ganglion cells
in the
narrowed segment.
The
suture
(arrow)
is at the
site
of
biopsy
of the
intermediate zone,
in
which
there
are no
ganglion cells
but
nerve fibres between
the two
muscle layers
of the
bowel wall. There
are
normal ganglion cells
in
the
dilated segment
- the
'cone'.
Fig. 4.93
Imperforate
anus.
M/newborn.
94
ALIMENTARY
SYSTEM
Fig. 4.91
Fig. 4.92
Fig. 4.93
95
ALIMENTARY
SYSTEM
Fig.
4.96
Fig.
4.97
96
Fig.
4.95
Fig.
4.94
ALIMENTARY
SYSTEM
Fig. 4.98
Fig. 4.94
Diverticulosis
of the
sigmoid
colon.
F/59.
An
incidental postmortem finding.
Fig. 4.95
Chronic
diverticulitis.
F/75.
A
resected segment
of
thickened, fibrotic sigmoid colon that
had
caused obstruction.
There
is
acute
colitis
proximal
to the
obstruction.
Fig. 4.96
Diverticulosis
of the
colon.
The
thin-walled
diverticulum extends through
the
fibrotic wall
of the
colon into
the
pericolic fat. Characteristically,
the
colon
in
areas
of
diverticulosis
shows submucosal fibrosis
and
muscle
hypertrophy,
as
shown here.
Fig. 4.97
Melanosis
coli.
F/73. Note
the
black coloration
of
the
mucosa throughout
the
whole length
of the
colon, whereas
the
terminal ileum
is a
normal colour.
Fig. 4.98
Acute
ulcerative
colitis.
F/16.
The
mucosa
throughout
the
length
of the
colon
is
reddened, oedematous,
ulcerated
and
bleeding. Colectomy
was
performed because
the
patient
was not
responding
to
medical treatment.
Fig. 4.99
Chronic
ulcerative
colitis.
F/58.
The
bowel
is
shortened
and its
wall
is
fibrotic.
The
mucosa
is
reddened
and
atrophic.
The
disease
had
been present
for
over
10
years
and
colectomy
was
performed, partly
to
relieve symptoms
of
diarrhoea
and
partly
to
prevent
the
development
of
cancer. Fig. 4.99
97
ALIMENTARY
SYSTEM
Fig. 4.100 Fig. 4.101
Fig. 4.100
Chronic
ulcerative
colitis
with
hyperplastic
polyps.
F/40. Colectomy
was
performed because
of
long-standing disease. Virtually
the
whole
of the
mucosal
surface
has
been converted into polyps, which
have
resulted
from
re-epithelialization after
the
initial ulceration.
Fig. 4.101
Chronic
ulcerative
colitis
with
mucosal
dysplasia
in the
sigmoid
colon.
F/49.
The
abnormal areas
were
seen during routine colonoscopy
to
assess
the
progress
of
the
disease. Biopsy showed
severe
dysplasia,
and
colectomy
was
performed
to
prevent
the
development
of
carcinoma.
Fig. 4.102
Chronic
ulcerative
colitis
with
a
carcinoma
arising
in the
caecum.
F/30.
A
total
colectomy
was
performed.
The
patient
had had
long-standing ulcerative colitis
and the
carcinoma
was
found
on
colonoscopy.
Fig. 4.102
98
ALIMENTARY
SYSTEM
Fig. 4.103
Fig. 4.103
Crohn's
disease
of the
colon.
F/60.
Total
colectomy performed
for
disease which could
not be
controlled
by
medical treatment. Nearly
the
whole length
of the
colon
is
involved,
but
there
is a
segment
in the
sigmoid colon that
is
less
involved
than
the
rest.
In
advanced cases such
as
this
it is not
easy
to
identify
the
segmental involvement characteristic
of
Crohn's disease
of the
colon.
Fig. 4.104 Closer view
of the
splenic flexure
of the
specimen
in
Figure 4.103 showing thickening
of the
wall
and a
'cobblestone'
appearance
of the
mucosal surface.
99
Fig. 4.104
ALIMENTARY
SYSTEM
Fig. 4.107
Fig. 4.108
100
Fig. 4.106
Fig. 4.105