The Spectrum of colonic lesions; A Clinico-pathological study of colonic biopsies

Abstract Background: The colon is a seat for various diseases which include both non neoplastic and neoplastic conditions, with some of the inflammatory diseases being premalignant. The endoscopic evaluation of the large bowel has helped in not only direct visualisation of these lesions but also in taking a biopsy for histopathological diagnosis which also helps in the further assessment and treatment of the patient. Colonoscopy is also considered gold standard for cancer surveillance, which is the third prevalent cancer in men and women.23Thus colonoscopic biopsy is an important tool in the diagnosis of large bowel diseases. Objectives: To study the spectrum of lesions of colon in conjunction with clinical data and to evaluate the histomorphology of colonoscopic biopsies. Materials and Methods: All colonoscopic biopsies received in Department of Pathology, of a tertiary health care centre during a three year study period ,i.e from August 2012 to August 2014, were subjected to histopathological study and data analysed. Results: A total of 159 colonoscopic biopsies were studied. Out of them, 68 (42.8%) were non neoplastic, 23 (14.4%) were benign lesions and 68 (42.8%) were malignant lesions. Among the 68 Non neoplastic lesions, 32 cases were non-specific colitis, 11 cases ulcerative colitis, 5 cases juvenile polyps, 5 cases hyperplastic polyps, 4 cases SRUS, 3 cases granulomatous inflammation,3 cases retention polyp, 2 cases Crohn’s disease and one case each of acute inflammation, inflammatory polyp and endometriosis. Out of the 23 benign cases, 18were tubular adenomas (78.3%); 3 were villous adenomas (13%); 1 case of tubulovillous adenoma (4.3%) and 1 case of Benign spindle cell lesion (4.3%).Out of 68 malignant lesions, 24 cases(35.3%) were Well differentiated Adenocarcinoma, 25 cases (36.8%) were Moderately differentiated Adenocarcinoma, 9 cases (13.2%) were Poorly differentiated, 8 cases (11.8%) were Mucin secreting Adenocarcinoma and 2 cases(2.9%) were Signet ring cell carcinoma. Conclusion: Colonoscopy is a simple and a safe procedure, helps in not only assessing the lesions clinically but also helps in confirming histopathologicaly through guided biopsy. Colonoscopic biopsies also play a key role not only in diagnosis, but also in follow up and treatment, of Inflammatory bowel disease and malignancies. The incidence of colorectal carcinoma is increasing at the rate of 2%.It is also the gold standard for cancer surveillance.