AboutNeha Dahiya MD Expertise I can help patients understand their lab report results, help them with queries regarding what pretest preparation is required. How often a follow up test needs to be done. What does a particular tissue biopsy report mean in everyday English. I can explain the biopsy or cytology procedure. I can deal with Histopathology / cytology / clinical pathology and clinical chemistry queries. Helping in this manner will be my contribution to the community.
Experience I am a pathologist and director of clinical laboratory services. I have been a practicing pathologist for last 9 years in a 350 bed multi specialty hospital laboratory.
Organizations Indian association of pathologists and microbiologists.
MIAC - Member International Academy of Cytology
International association of Pathologists - indian division
Indian association of Cytology
My spouse has colon cancer. Following are two pathology reports- the first one from the polyps removed during colonoscopy, the second one from a resection of the sigmoid colon. I would very much appreciate an interpretation that I can understand. We have no idea what many of the terms mean. Thanks for your time.
Report #1 (from colonoscopy):
Tissue A - Cecum, Biopsy: tubular adenoma
Tissue B - Colon, 23 cm, biopsy:
1. Invasive moderately differentiated adenocarcinoma arising in an adenomatous polyp (smaller polyp, 1.3 cm).
2. Adenocarcinoma invades into submucosa and extends to polyp base margin.
3. Tubulovillous adenoma, 2 cm, stalk margin free.
Microscopic description:
Tissue A: Sections are of colonic mucosa demonstrating tubular adenoma.
Tissue B: Sections are of polypoid colonic mucosa demonstrating a tubulovillous adenoma. This shows mild to moderate atypia. There is acute and old hemorrhage present within the polyp with hemosiderin deposition. The stalk margin is free of adenoma. No invasive neoplasm is seen. Sections of the smaller polyp demonstrate an invasive moderately differentiated adenocarcinoma arising in an adenomatous polyp. The tumor is coprised primarily of cribriform glandular structure which invade into the submucosa with a desmoplastic stromal reaction present. Cytologically the cells are malignant in appearance with marked hypaerchromasia, pleomorphism, and numerous mitotic figures. The tumor extends to the base of the polyp or the margin.
Gross description:
Tissue A - The specimen submitted in formalin consists of a single fragment of a polypoid portion of brown mucosal tissue 0.2 cm. All submitted in one cassette.
Tissue B - The specimen submitted in formalin consists of a polypoid of brown mucosal tissue 2 x 1.5 x 1 cm. This has a stalk present on the polyp 0.6 cm in length. The stalk margin is marked with silver nitrate, and this polyp is sectioned and submitted in cassettes 1 and 2. A second portion of tan polypoid tissue is present in the container 1.3 x 0.8 cm. This is sectioned revealing a somewhat suspicious firm tannish cut surface. This is submitted in cassette 3.
Report # 2 (from sigmoid colon resection):
1. Invasive moderately differentiated adenocarcinoma, 0.8 cm, present at prior polypectomy site.
2. Neoplasm invades focally through muscularis propia and into subserosal adipose tissue.
3. Tumor 6.5 cm from proximal and distal resection margins.
4. No lymphatic or large vessel invasion.
5. Metastic adenocarcinoma involved in 1 of 10 regional lymph nodes.
Microscopic description:
Sections of the prior polypectomy site show presence of invasive moderately differentiated adenocarcinoma. This has a predominantly cribriform growth pattern and is comprised of malignant epithelial cells with prominent nuclear pleomorphism, hyperchromassia, numerous mitotic figures, and prominent nucleoli. These malignant glands infiltrate into a desmoplastic stroma and invade deeply into and focally through the muscularis propria. No lymphatic or large vessle invasion is identified. There is prominent tattooing present in the surrounding mucosa. There is inflamation and granulation tissue change at the site of prior polypectomy. No residual polyp is identified in the other submitted tattooed mucosal areas. Sections of the pericolonic lymph nodes demonstrate metastic adenocarcinoma involving one of ten lymph nodes. This involved lymph node is 0.7 cm and shows features which suggest extranodal extension. The invasive primary tumor is 0.8 cm in greatest dimension.
Gross desription:
The specimen submitted in formalin consists of a portion of colon consistent with sigmoid colon. This is 12 cm in length and 2.5 cm in diameter. Also present in the container are two mucosal rings which are up to 1 cm in length, and these are without gross lesions. A suture is present at one end indicating the proximal end of the specimen. The bowel is opened revealing three areas of mucosal tattooing present in the central aspect of the length of bowel 6.5 cm from the proximal margin and 6.5 cm from the distal margin. One of these mucosal tatoos is adjacent to an area of ulceration consistent with polypectomy site. This ulcer is 3 mm in greatest dimension. This area is sectioned and submitted in cassette 1. The other two areas of mucosal tattooing are sampled and submitted in cassette 2. No additional mucosal lesions are seen with normal folds present in the remaining colonic mucosa. The area of prior biopsy is approximated to be 6 cm from the apparent mesentric margins. The regional lymph nodes are disected from mesentric fat with one of these lymph nodes grossly being suspicious measuring 1 cm in greatest dimension. These lymph nodes are sumbitted in cassettes 3, 4, and 5.
AJCC TNM staging: pT3, pN1, pMX
Thanks for your assistance.
ANSWER: Hello Dee:
This is a regular detailed pathology report and can be intimidating to read and understand.
The first Report indicates that two samples from the large intestine were submitted.
Tissue A has one polyp and tissue B has two polyps.
A polyp is a raised or flush along the surface outgrowth of the lining of the intestine with a core of supportive tissue , blood vessel and some muscle fibers.
Gross description: gives the naked eye appearance of the tissue...its size, shape, color / texture and overall anything seen by the eye.
Microscopic description: describes the type of cells which are present in the tissue, their architectural pattern, appearance of the cells -their shape, size, staining characteristics of the cells and their nuclei. If these are not normal cells found in the given tissue this description tells how much different they are from normal cells---mild, moderate or severe atypia or atypical cells. Or it tells you that these are cancer cells.
In the first tissue A it is a benign polyp...an outgrowth which is not cancer. The second Tissue B has two polyps one is benign the smaller of the two shows presence of invasive cancer. The following line from your report describes why the tissue is cancer. I have provided explanation of most of the terms within parenthesis
"Cytologically the cells are malignant in appearance with marked hyperchromasia (dark staining chromatin...the stuff present in nuclei), pleomorphism (variation in shape and size...most normal cells are fairly uniform), and numerous mitotic figures (cells showing active division indicating that they are proliferating....normal adult cells are mostly resting."
Since the tumor is found to extend to the end of polyp the resection was required
Report 2: of the resected section of intestine indicates that
1) There is an invasive cancer - moderately differentiated...(some similarity of cells to normal intestine cells can be made out). This cancer is an adenocarcinoma...which means it has a tendency to form glands
2) It invades right through the intestine into the surrounding fat
3) There is a wide clearance of tissue - with the cancer situated 6.5 cm from either margin of the resected length of intestine. This indicates that most all the tumor was removed
4) the lymphatic channels or blood vessels do not show cancer cells
5) 10 lymph nodes were found and one of which shows cancer cells. This indicates that at some future point cancer cells may or may not appear and form a recurrence of cancer cells
AJCC TNM staging: pT3, pN1, pMX: this gives the staging of cancer
pT3 is arrived at based on the size of the tumor, pN1 indicates one node is involved and pMX indicates that no distant spread of cancer is documented at this stage. This will help the surgeon to plan follow up visits and treatment protocols.
I hope this has helped you understand the report a little better. Please feel free to ask for any further clarification.
I wish your spouse good health
---------- FOLLOW-UP ----------
QUESTION: Thanks so much for your help. One more question: what does "lymph node is 0.7 cm and shows features which suggest extranodal extension" mean? I'm confused by the extranodal extension part.
Answer Hello Dee:
I apologize for the delay in answering, due to unforeseen circumstances I was unable to attend to your question.
The size of the node is 0.7 cm and there is a suggestion that some cancer cells may have spread outside the node (extra nodal)
