RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE : DR. RANJEETA.S.BANAKAR.
AND ADDRESS D/O SADASHIV BANAKAR.
LIG 68, MAHANTESH NAGAR,
BELGAUM:590016.
2. NAME OF THE INSTITUTION : KEMPEGOWDA INSTITUTE OF
MEDICAL SCIENCES
BANASHANKARI 2nd STAGE,
BANGALORE:560070
3. COURSE OF STUDY AND : MD PATHOLOGY
SUBJECT
4. DATE OF ADMISSION TO : 30 MAY 2011
THE COURSE
5. TITLE OF THE TOPIC : HISTOPATHOLOGICAL STUDY OF
COLONOSCOPIC BIOPSIES
6 BRIEF RESUME OF THE INTENDED STUDY:
6.1 INTRODUCTION:
The development of flexible endoscopes has led to the great increase in the examination and mucosal biopsy evaluation of all portions of the large intestine and rectum1.
Colonoscopic examination is important in the diagnosis and treatment of suspected colonic diseases. It is a diagnostic procedure of choice for patients with diarrhoea lasting for several weeks to months or for any bloody diarrhoea2.
The colon and rectum can be sites for infections, Inflammatory Bowel Diseases, vascular disorders, motor and mechanical conditions and various neoplasm.
Macroscopically normal colonic mucosa may be pathologically inflamed, thus without biopsy, significant inflammatory bowel disease may go unrecognized or be mistaken for a functional disorder2.
In patients with chronic disorder multiple examinations are required to follow the course of the disease and to detect and correct any complications at an early stage. To put the interpretation of the biopsy findings into more rational and comprehensible content, we aim to provide herein an understanding of normal and abnormal histology and describe commonly encountered abnormal histological patterns1.
6.2 REVIEW OF LITERATURE:
Biopsy of rectum and lower colon via the rigid proctoscopy was
established as a valuable aid to histopathological diagnosis of tumors after World
war 1.The introduction of flexible retrograde colonoscope in 1969 by Dr William
Wolff and his associates, enabled endoscopists to take biopsies from all parts of
Colorectum as well as Terminal ileum3.
Fibreoptic colonoscopy is gaining an increasingly important role in
the evaluation of the patients with diseases of the colon. With the development of
fibreoptic colonoscopies, the ability to directly visualize and biopsy of the entire length
of the colon is now possible. Utilizing colonoscopy and biopsy it is possible to identify
the location and type of colon disease. The histological identification of each lesion help
in appropriate specific treatment4.
Mucosal biopsies have been shown to be most accurate indicator of the extent of
involvement of the colon in inflammatory bowel disease5.
Study performed by gastroenterology service at memorial Sloan –Kettering
cancer centre in 1972 to 1976 were reviewed. Results of this study showed out of 212
colonoscopies selected there were total of 40 patients with malignant tumours: 38
patients with primary colorectal adenocarcinomas6.
6.3 AIMS AND OBJECTIVES :
(a) To study the histopathological features of colonoscopic biopsy specimens .
(b) To provide a diagnosis and comment on the extent ,activity and severity of colonic
lesions whenever possible by histological examinations.
(c) To correlate colonoscopic findings with the histopathological diagnosis.
(d) To correlate the histopathologic colonoscopic biopsy diagnosis with histopathology of
Colectomy specimen whenever possible .
7.MATERIALS AND METHODS:
7.1 SOURCE OF THE DATA: One year retrospective (2010- 2011) and Two
years prospective study( 2011- 2013) in 120 patients to be conducted on
colonoscopic Biopsy specimen received in central laboratory,Department of Pathology
KIMS hospital and Research Centre ,Bangalore.
7.2(A) METHODS OF COLLECTION OF DATA:
Relevant clinical details and colonoscopic findings will be obtained and
maintained according to the proforma .
All the colonoscopic biopsy specimens are immediately fixed in 10% formalin.
Tissue will then be processed and embedded in paraffin wax and multiple serial sections
4-5 microns thickness will be obtained from paraffin block and then stained with H&E .
Detailed study of the sections are done under the microscope. An attempt is
made to correlate histopathological diagnosis with the colonoscopic findings.Special
stains will be performed wherever necessary.
7.2(B) SAMPLING METHOD:
Purposive sampling.
7.2(C) INCLUSION CRITERIA:
- All the colonoscopic biopsies from terminal ileum ,large intestine,rectum upto
pectinate line of anus received in the Central laboratory,Department of pathology,
KIMS Hospital and research centre,Bangalore.
7.2(D)EXCLUSION CRITERIA:
- Autolysed specimen.
- Tiny inadequate biopsy specimen difficult to process.
- Specimens above the the terminal ileum below the pectinate line of anus will not
be considered.
7.2(E) PLACE OF STUDY : Department of Pathology,Central laboratory KIMS
Hospital and Research Centre,Bangalore.
7.2(F)STUDY DESIGN: Correlation study
7.2(G)STUDY PERIOD:2010-2013
7.2(H) STATISTICAL METHODS INVOLVED: Data collected will be analyzed
statistically using frequency distribution and will be presented in the form of graphs ,
tables and charts.
7.3 INTERVENTIONS:
(a) No intervention conducted on patients.
(b) No animal studies conducted.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Yes, approved.
8.LIST OF REFERENCES:
1. Teague R H, Solman P R, Read A E. Fibreoptic examination of the colon: A Review of 255 cases. Gut 1973;14:139.
2. Herschel A.Carpenter, Nicholas J.Talley. The importance of clinicopathological correlation in diagnosis of inflammatory conditions of colon: Histological patterns with clinical implications. Am J Gastroenterol 2000;95:878-896.
3. Normal Mucosa Architecture.Biopsy Pathology Colorectal
disease.I.C.Talbot,by Chapman and Hall Ltd,London;1987: 1.
4. Schmitt MG, Wu WC, Greenen JE,et al. Diagnostic colonoscopy an
assessment of clinical condition.Gastroenterology 1995,69:765
5. Large Bowel. Rosai and Akerman,Surgical Pathology .Vol 1;9thEdition,Juan Rasai by Mosby,Missouri. 2009:pp 778.
6. Sidney J.Winawer,Sheldon D Leidner et al.,Colonoscopic Biopsy and
Cytology in the diagnosis of colon cancer.Cancer 1973 ;42:2849-2853.
9. Signature of the candidate:
10. Remarks of the Guide :The colonoscopic examination
combined with the mucosal biopsies is an important investigation to detect various
diseases of Colon and Rectum and also for commenting on extent, activity and severity of
colonic lesions which aid the clinician in giving specific treatment ,hence the study is
being done.
11. Name and Designation of
11.1 Guide : PROF. DR. RANGASWAMY. R
M.D,D.N.B
department OF
PATHOLOGY, KIMS,
BANGALORE.
11.2 Signature of Guide :
11.3 Co-guide : DR SAHADEV .R.,M.S,FSGE
ASSOCIATE PROF.DEPT OF
GASTROENTROLOGY,
KIMS BANGALORE.
11.4 Signature of co-guide :
11.5 Head of the Department : Prof. dr.GEEThAMANI.V.
MD
PROFESSOR AND HEAD OF
THE DEPARTMENT, DEPT
OF PATHOLOGY
KIMS, BANGALORE .
11.6 Signature :
12 12.1 Remarks of the
Chairman and Principal :
12.2 Signature :
ETHICAL COMMITTEE CLEARANCE
1. TITLE OF DISSERTATION : “HISTOPATHOLOGICAL STUDY OF
COLONOSCOPIC BIOPSIES”.
2. SUBJECT : M.D.(PATHOLOGY)
3. NAME OF THE GUIDE : PROF. DR. RANGASWAMY.
M.D.D.N.B
DEPARTMENT OF PATHOLOGY,
KIMS, BANGALORE
4. APPROVED/NOT APPROVED :
9