{"id":3530,"date":"2017-03-08T14:33:01","date_gmt":"2017-03-08T06:33:01","guid":{"rendered":"http:\/\/https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=3530"},"modified":"2020-06-18T16:33:08","modified_gmt":"2020-06-18T08:33:08","slug":"a-real-life-case-a-colon-tumour","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/gastrointestinal-tract\/a-real-life-case-a-colon-tumour\/","title":{"rendered":"A Real Life Case: A Colon Tumour"},"content":{"rendered":"\n\t

Hi students, here is an example of a real life case<\/strong> that is handled by a pathologist in the diagnostic pathology laboratory.\u00a0<\/p>\n\t

This is a COLONIC TUMOUR<\/strong> from a right hemicolectomy specimen that is received from the operating theatre.<\/p>\n

The pathologist’s role is to provide diagnostic and prognostic information<\/strong>\u00a0for \u00a0the managing team (surgeons, medical and radiation oncologists etc).\u00a0<\/p>\n\n\n\n\n\t\t\tHow does the pathologist do this? (Click to expand)<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\tFor every case the pathologist receives, he or she will:\n

<\/p>\n\n

    \t\n
  1. Examine the specimen grossly (in this case, identify the tumour, lymph nodes, etc.)<\/li>\n

    \t<\/p>\n

  2. Trim the specimen – sample specific areas for microscopic examination<\/li>\n

    \t<\/p>\n

  3. Examine the specimen microscopically to evaluate prognostic factors<\/li>\n

    \t<\/p>\n

  4. Reporting – prepare a Pathology\u00a0report<\/strong> for the managing team<\/li>\n<\/ol>\n\n\t

    Let’s walk through this case from the beginning:\u00a0<\/strong><\/p>\n

    <\/h3>\n\t

    I. History and relevant investigations\u00a0<\/strong><\/p>\n

    Mr Tan, a 77 year old retired taxi driver, presents with lower abdominal pain and loss of weight over the past 3 months. He had a faecal occult blood test which was negative.<\/p>\n

    (Click HERE<\/a> to find out more about faecal occult blood test as a screening tool for colorectal cancer in Singapore.)<\/p>\n

    Colonoscopy<\/strong>\u00a0was performed:\u00a0<\/p>\n\t\t\tCOLONOSCOPY AND BIOPSY<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t

    Colonoscopy showed an annular tumour in the distal transverse colon causing luminal constriction. The endoscopist was unable to pass the endoscope beyond the tumour. A biopsy was taken and\u00a0Mr Tan was diagnosed with colorectal adenocarcinoma.<\/p>\n

    \"\"<\/a><\/p>\n

    Other findings include a polyp\u00a0distal to the tumour. Biopsy revealed a tubular adenoma.<\/p>\n

    \"\"<\/a><\/p>\n\t

    Staging investigations included\u00a0CT scan of the thorax, abdomen and pelvis<\/strong> which showed no other tumour deposits.<\/p>\n

     <\/p>\n

    His baseline serum CEA was 41ug\/L. CEA<\/strong>\u00a0is a tumour marker for colorectal cancer and can be used to monitor response to therapy and disease recurrence.<\/p>\n

    Mr Tan underwent an extended right hemicolectomy and the specimen was sent to the pathology lab.<\/p>\n\t

    II. In the Pathology Lab<\/strong><\/p>\n

    Upon receiving the specimen, the first step is to describe it and sample relevant tissues for microscopic examination. This is called “Grossing”.<\/p>\n

    Video 1. Grossing the colon<\/strong><\/p>\n

    If you can’t play the video, watch it here on YouTube: https:\/\/youtu.be\/mTuVNMDcqIo<\/a><\/p>\n\t