The Endoscopic Biopsy: How to Proceed and How to Look at a Biopsy

Pathology is one of the tools for reaching a diagnosis. Like all procedures in medicine, the analysis of biopsies has some limitations. The diagnostic yield can be increased by using good quality samples, by optimizing the number of samples and sections, by optimal preparation of the samples and by confronting the findings with appropriate clinical information. Numbers of samples needed depend on the indication for the endoscopic procedures. When reading a biopsy, analysis can be improved with a systematic approach. This implies a proper knowledge of the normal histology and of potential artifacts. The pathologists should take note of the origin, the number, and the size of the samples and subsequently evaluate the architecture and cytological aspects of the specimen. The analysis can be improved by using a checklist or pro forma report

Infectious colitis

La colite infectieuse est une pathologie courante. Elle engendre habituellement des diarrhées aiguës. Le diagnostic différentiel des diarrhées aiguës comprend les infections coliques, les lésions d'origine médicamenteuse, les Maladies Inflammatoires Cryptogéniques de l'Intestin (MICI), les lésions coliques ischémiques et des désordres de type fonctionnel tels que le côlon irritable. Un diagnostic précis n'est pas toujours facile. Dans beaucoup de cas, les lésions d'origine médicamenteuse doivent être prises en compte. Les biopsies sont d'une grande utilité dans le diagnostic non seulement de colite (diagnostic différentiel avec les désordres d'origine fonctionnelle) mais également dans le diagnostic différentiel entre les colites infectieuses et les MICI. L'aspect microscopique des colites infectieuses est très variable. Dans la majorité des cas, il n'existe pas d'aspect histologique spécifique. Le diagnostic histologique repose à la fois sur la présence d'une inflammation aiguë et sur l'absence d'aspect histologique suggestif de MICI. Quelques infections virales mycotiques ou bactériennes ont un aspect microscopique suggérant un diagnostic précis, diagnostic confirmé quand l'agent pathogène est mis en évidence sur les coupes histologiques

Serrated lesions of the colorectum, a new entity: what should a clinician/ endoscopist know about it ?

Serrated polyps of the colorectum have received much attention in recent literature. Several classifications have been proposed and created considerable confusion. Morphology and molecular biology have greatly contributed to the better identification of these entity. The recently published WHO classification, proposed using the term of "serrated polyp" as a generic term and defined sporadic serrated polyps as "a heterogeneous group" of lesions characterized morphologically by a serrated (sawtooth or stellate) architecture of the epithelial component which include hyperplastic polyps (HP), sessile serrated adenomas/polyps (SSA/P) and traditional serrated adenomas (TSA). With the development of molecular biology, it is now clear that the serrated pathway is one of the new carcinogenic pathways in the colon. There is now strong evidence that some serrated polyps correspond to precursors of some sporadic colorectal cancer (CRC). The aim of this article is to summarize the present data concerning the morphological and molecular characteristics of these serrated lesions and to give some recommendations for the management of such lesions