Villous adenoma

villous adenoma

This large (6.5 cm) villous adenoma of the sigmoid colon had no invasive component, so the patient's prognosis after excision is excellent. The photo above is shot using conventional copy stand techniques and shows what this tumor looked like to the pathologist on the gross board, and to the gastroenterologist through the endoscope. The photos below show the specimen as immersed in tapwater. The buoyancy of the delicate villous structures causes them to stand up and separate, showing the complex coral-like filigree produced by this type of growth pattern.

villous adenoma

The image below is not a close-up as such; it is simply a high-resolution scan of the transparency reproduced immediately above. Scanned at near the maximum resolution of the Polaroid SprintScan scanner, this image shows the detail that Ektachrome Elite is capable of.

villous adenoma

All the above photos were shot with a Minolta X-370 with bellows lens, on Ektachrome Elite 100 film, daylight type, through a blue filter to correct for Photoflood ilumination. Exposure was f/8 at something like 1/2 or 1 second.

Below is another case of villous adenoma of the transverse colon, this one more discrete and polyp-like than the case above. Although it had a semi-decent stalk, it was still far too large for safe removal by endoscopy, so the surgeon was called in to do a segmental resection of the colon. Prior to photographing, the specimen was pinned out in formalin and fixed overnight. The pink color in the center of the mass indicates that the formalin did not penetrate the whole lesion. Shame on me for being chintzy with the formalin!

Note how the surface texture of the villous adenoma differs markedly from that of the surrounding colonic mucosa.

villous adenoma

The photo above was shot with a Nikon D100 digital SLR with Sigma 50mm f/2.8 macro lens. I stopped the diaphragm way down (about f/22) to bring as much of this very three-dimensional lesion as possible into focus. In Photoshop, I resized the image for Web display, sharpened the 'L' channel in Lab mode, and used the Levels command to brighten it a bit. Since many Web users now have flat-panel displays (not as bright as CRTs) and use their monitors in full room lighting, I like to brighten up pictures more than I would for an image that was meant for projection in a properly darkened lecture hall.

Photography by Ed Uthman, MD. Public domain. Posted 27 May 01; updated 20 Feb 05

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