Page 607 - Textbook of Pathology, 6th Edition

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  TABLE 20.12: Staging and Prognosis of Colorectal Cancer (Duke's System as Modified by Astler-Coller).
Stage TNM 5-year Survival Pathologic Features
A I T 1 No Mo >90% Cancer confined to mucosa only
B 1 II T No Mo 85% Cancer extends into submucosa
2
B 2 II T No Mo 70-80% Cancer extends into muscularis+serosa
3
III Tx N 1 Mo 35-65% Cancer involves muscularis+regional lymph nodes
C 1
III Tx N 1 Mo 20-35% Cancer extends into serosa+regional lymph nodes
C 2
D IV Tx Nx M 1 5% Cancer with distant metastases
Rupture of peptic ulcer MESENTERIC CYSTS
Gangrene of bowel
Mesenteric cysts of unknown etiology and varying sizes may
Tuberculosis (specific inflammation). be found in the peritoneal cavity. On the basis of their
possible origin, they are of various types:
MORPHOLOGIC FEATURES Depending upon duration, Chylous cyst is a thin-walled cyst arising from lymph
the features in bacterial peritonitis vary. It may be vessels and lined by endothelium.
generalised or may get localised by omentum such as in Pseudocysts are those which are formed following walled-
appendiceal abscess following acute appendicitis. Depen- off infection or pancreatitis.
ding upon duration, the fluid accumulation varies from Neoplastic cysts occur due to cystic change in tumours.
serous, turbid, creamy to frankly suppurative. The fluid
may eventually resolve or may heal by organisation with TUMOURS
formation of fibrous adhesions. Peritoneum may be involved in malignant tumours—
primary and metastatic.
IDIOPATHIC RETROPERITONEAL FIBROSIS Mesothelioma is an example of primary peritoneal CHAPTER 20
tumour (benign and malignant) and is similar in morphology
Also known as Ormond’s disease or sclerosing retro- as in pleural cavity (page 505).
peritonitis, this rare entity of unknown etiology is characteri- Intra-abdominal desmoplastic small cell tumour is a
sed by diffuse fibrous overgrowth and chronic inflammation. recently described highly malignant tumour belonging to the
The condition is, therefore, more like inflammatory rather group of other round cell or blue cell tumours such as small
than neoplastic in origin. It may be associated with similar cell carcinoma lung, Ewing’s sarcoma, rhabdomyosarcoma,
process in the mediastinum, sclerosing cholangitis and neuroblastoma and others.
Riedel’s thyroiditis and termed multifocal fibrosclerosis. Metastatic peritoneal tumours are quite common and
Though idiopathic, the etiologic role of ergot derivative drugs may occur from dissemination from any intra-abdominal
and autoimmune reaction has been suggested. malignancy. The Gastrointestinal Tract

 TABLE 20.13: Causes of Gastrointestinal (G.I.) Bleeding.
Upper G.I. Bleeding Small Intestinal Bleeding Lower G.I. Bleeding
1. Oesophageal varices Vascular ectasias Inflammatory bowel disease (IBD)
2. Mallory-Weiss tear Tumours (adenocarcinoma, lymphoma, leiomyoma) Carcinoma colon
3. Haemorrhagic/erosive gastritis NSAIDs Carcinoma rectosigmoid
4. Duodenal ulcer Meckel's diverticulum Haemorrhoids
5. Gastric ulcer Intussusception Anal fissure
6. Cancer stomach Crohn's disease Diverticulosis

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