The document describes intestinal tuberculosis and intestinal polyps. Regarding intestinal tuberculosis, it states that the ileocecum is most commonly involved. The disease is characterized by inflammation and fibrosis of the bowel wall and regional lymph nodes. Mucosal ulceration results from necrosis of lymphoid tissues and blood vessels, which can progress to bowel thickening and strictures. Regarding intestinal polyps, it distinguishes between non-neoplastic and neoplastic polyps, describing the different types such as hyperplastic, inflammatory, and adenomatous polyps, the latter conferring the greatest cancer risk.
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Intestinal Tuberculosis Guide
1. Intestinal TuberculosisIntestinal Tuberculosis
Chronic specific infection of the intestines by mycobacteriumChronic specific infection of the intestines by mycobacterium
tuberculosistuberculosis
site of involvementsite of involvement
ileocecum most commonly involvedileocecum most commonly involved
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2. Mode of transmissionMode of transmission
Ingestion of infected sputum (M. Bovis)Ingestion of infected sputum (M. Bovis)
Ingestion of contaminated milk (M. Tuberculosis)Ingestion of contaminated milk (M. Tuberculosis)
Direct spread from adjacent structureDirect spread from adjacent structure
Haematogenous spreadHaematogenous spread
Lymphatic spreadLymphatic spread
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3. Primary infectionPrimary infection
Primary – ingestion of organism in unsensitised host.Primary – ingestion of organism in unsensitised host.
Can cause severe ulcero-inflammatory disease with perforationCan cause severe ulcero-inflammatory disease with perforation
Secondary infectionSecondary infection
Swallowing ofSwallowing of infectedinfected sputum containing large no of tubercle bacillisputum containing large no of tubercle bacilli
in cases of open pulmonary tuberculosisin cases of open pulmonary tuberculosis
The local lesion is prominent & the lymph nodes are less commonlyThe local lesion is prominent & the lymph nodes are less commonly
affectedaffected
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4. PathogesnesisPathogesnesis
Most active inflammation in submucosaMost active inflammation in submucosa
Bacill in depth of mucosal glandsBacill in depth of mucosal glands
Inflammatory reactionInflammatory reaction
Phagocytes carry bacilli to Peyers PatchesPhagocytes carry bacilli to Peyers Patches
Formation of tubercleFormation of tubercle
Tubercles undergo necrosisTubercles undergo necrosis
Submucosal tubercles enlargeSubmucosal tubercles enlarge
Endarteritis & edema, Sloughing, Ulcer formation (Endarteritis & edema, Sloughing, Ulcer formation (Annular)Annular)
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5. Accumulation of collagenous tissue, Thickening & StenosisAccumulation of collagenous tissue, Thickening & Stenosis
Inflammatory process in submucosa penetrates to serosaInflammatory process in submucosa penetrates to serosa
Tubercles on serosal surfaceTubercles on serosal surface
Bacilli reach lymphaticsBacilli reach lymphatics
Bacilli via lymphaticsBacilli via lymphatics
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Lymphatic obstruction
of mesentery and bowel
→ Thick fixed mass
Regional lymph nodes
• Hyperplasia
• Caseation necrosis
• Calcification
11. Pathologically GI TB is characterized by inflammation and fibrosis ofPathologically GI TB is characterized by inflammation and fibrosis of
the bowel wall and the regional lymph nodes.the bowel wall and the regional lymph nodes.
Mucosal ulceration results from necrosis of Peyer patches, lymphMucosal ulceration results from necrosis of Peyer patches, lymph
follicles, and vascular thrombosis. At this stage of the disease, thefollicles, and vascular thrombosis. At this stage of the disease, the
changes are reversible and healing without scarring is possible.changes are reversible and healing without scarring is possible.
As the disease progresses, the ulceration becomes confluent, andAs the disease progresses, the ulceration becomes confluent, and
extensive fibrosis leads to bowel wall thickening, fibrosis, andextensive fibrosis leads to bowel wall thickening, fibrosis, and
pseudotumoral mass lesions.pseudotumoral mass lesions.
Strictures and fistulae formation may occur.Strictures and fistulae formation may occur.
The serosal surface may show nodular masses of tubercles. TheThe serosal surface may show nodular masses of tubercles. The
mucosa is inflamed with hyperemia and edema similar to thatmucosa is inflamed with hyperemia and edema similar to that
observed in Crohn disease.observed in Crohn disease.
Caseation may not always be seen in the granuloma, especially inCaseation may not always be seen in the granuloma, especially in
the mucosa, but it is almost always seen in the regional lymph nodethe mucosa, but it is almost always seen in the regional lymph node
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14. Intestinal PolypsIntestinal Polyps
AA polyppolyp is an abnormal growth of tissue projecting from a mucousis an abnormal growth of tissue projecting from a mucous
membrane.membrane.
If it is attached to the surface by a narrow elongated stalk it is saidIf it is attached to the surface by a narrow elongated stalk it is said
to be pedunculated.to be pedunculated.
If no stalk is present it is said to be sessile.If no stalk is present it is said to be sessile.
Polyposis signifies the presence of multiple polypsPolyposis signifies the presence of multiple polyps
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16. Classification – types of intestinal polypsClassification – types of intestinal polyps
A. Non-neoplastic polypsA. Non-neoplastic polyps
Hyperplastic polypHyperplastic polyp
Inflammatory polyp - These are polyps which are associated withInflammatory polyp - These are polyps which are associated with
inflammatory conditions such as IBDinflammatory conditions such as IBD
Hamartomatous polyp – They are growths, like tumours found inHamartomatous polyp – They are growths, like tumours found in
organs as a result of faulty development.organs as a result of faulty development.
Lymphoid polypLymphoid polyp
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18. Tumours of Small intestineTumours of Small intestine
All types are uncommon. Simple epithelial tumours are particularly rareAll types are uncommon. Simple epithelial tumours are particularly rare
A. Epithelila tumoursA. Epithelila tumours
Benign Adenomas – single or multiple ployps. Multiple adenomaBenign Adenomas – single or multiple ployps. Multiple adenoma
may occur in familial multiple polyposismay occur in familial multiple polyposis
Malignant – AdenocarcinomaMalignant – Adenocarcinoma
B. Connective tissue tumoursB. Connective tissue tumours
Benign (most common) leiomyoma, fibroma , neurofibromaBenign (most common) leiomyoma, fibroma , neurofibroma
Malignant – lymphoma (primary or secondary), leiomyomosarcomaMalignant – lymphoma (primary or secondary), leiomyomosarcoma
C. Carcinoid tumour of neuroendocrine cells – potentially malignantC. Carcinoid tumour of neuroendocrine cells – potentially malignant
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19. Tumours of large intestineTumours of large intestine
Almost all the tumours are of epithelial originAlmost all the tumours are of epithelial origin
A. Epithelial tumours (common )A. Epithelial tumours (common )
BenignBenign
Adenoma or neoplastic polypsAdenoma or neoplastic polyps
MalignantMalignant
Carcinoma – colorectal carcinoma is the 2Carcinoma – colorectal carcinoma is the 2ndnd
most common visceralmost common visceral
cancercancer
B. Connective tissue tumours (rare)B. Connective tissue tumours (rare)
Beningn – leiomyomaBeningn – leiomyoma
Malignant – malignant spindle cell (mesenchymal) tumors,Malignant – malignant spindle cell (mesenchymal) tumors,
malignant lymphomamalignant lymphoma
Carcinoid tumurs – may arise anywhere in the colon especially theCarcinoid tumurs – may arise anywhere in the colon especially the
rectumrectum
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20. Adenoma / Beging Neoplastic polypsAdenoma / Beging Neoplastic polyps
Derived from glandular epitheliumDerived from glandular epithelium
4 fold greater risk of colorectal carcinoma in any person with adenomas4 fold greater risk of colorectal carcinoma in any person with adenomas
Predictors of cancer riskPredictors of cancer risk
Size – greater than 2.5 cm – high riskSize – greater than 2.5 cm – high risk
Villous component more – higher the riskVillous component more – higher the risk
Dysplasia of neoplastic cells – more dysplasia more riskDysplasia of neoplastic cells – more dysplasia more risk
21. 3 types3 types
Tubular Adenoma - 75%Tubular Adenoma - 75%
Most common (rectum & sigmoid colon)Most common (rectum & sigmoid colon)
Singe or multipleSinge or multiple
Pedunculated, tubule shaped glandsPedunculated, tubule shaped glands
Head of the polyp has neoplastic epithelium forming well formedHead of the polyp has neoplastic epithelium forming well formed
tubules or glandstubules or glands
Low malignant potentialLow malignant potential
Core of the stalk is fibrovascularCore of the stalk is fibrovascular
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22. 2222
tubular adenoma – dysplastic epithelium (dark purple) on left of image;
normal epithelium (blue) on right
23. 2. Villous adenoma – 10 %2. Villous adenoma – 10 %
Commonly found in rectumCommonly found in rectum
Most are broad & sessile,Most are broad & sessile,
Velvety red, finger like epi projectionsVelvety red, finger like epi projections
It consists of frond like papillary projections of adenomatousIt consists of frond like papillary projections of adenomatous
epitheliumepithelium
Highest potential for malignancy transformationHighest potential for malignancy transformation
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