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B C Morson

Publications and source records attributed to B C Morson.

At least 37 records · Page 2Linked to original sources
PubMed1987

Reporting colorectal cancer.

Reporting colorectal cancer comprises two phases: the careful collection of pathological data; and the division of patients into groups with differing prognoses. Dukes' classification of rectal cancer was the outcome of this dual approach. It evolved over many years, and full details of its final form were not published until 1958, towards the end of his career. Others modified the classification during its evolution, and numerous rival pathological and clinicopathological systems now exist. The resulting confusion that surrounds the Dukes classification may make it impossible to compare pathological findings and the results of treatment between different centres. The importance of meticulous dissection and examination of surgical specimens is emphasised and a simple set of recommendations made. It is shown how modern statistical methods may identify pathological variables that have independent clinical importance. On the basis of this information a new system of prognostic categorisation for patients receiving apparently curative surgery for rectal cancer has been developed, which is superior to the Dukes classification in that it can place many more patients into groups with clear prognostic implications.

Colonic Neoplasms↗
PubMed1986

The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases.

The grade of a tumour is gauged on the subjective assessment of a number of histopathological parameters. The problems associated with this exercise were viewed from a historical perspective and survival analysis of 447 patients receiving surgery for rectal adenocarcinoma was undertaken. Only deaths from rectal adenocarcinoma were included as events in the survival analysis. Seven grade-related parameters were scored by one observer. A grading system was constructed using the Cox regression model. The variables in the best-fitting parsimonious model comprised lymphocytic infiltration, tubule configuration and pattern of growth. Scores were derived from the model and a four grade system was created in which the groups were of similar size. Good reproducibility of the selected histopathological parameters was demonstrated. Grade-related parameters were then allowed to compete with stage-related parameters in an overall model of pathological prognostic categories. The parameters selected in the best model were number of affected lymph nodes, the presence of lymphocytic infiltration and extent of spread through bowel wall. A set of five prognostic categories was developed from this model.

Adenocarcinoma↗
PubMed1986

Collagenous colitis.

Clinical and pathological aspects of six patients with collagenous colitis are presented. These patients have been observed for between four and 15 years and the evolution of the condition is documented in three (cases 1, 3 and 5). Management and possible pathogenetic mechanisms of this enigmatic condition are discussed.

Adult↗
PubMed1985

The role of surgical local excision in the treatment of rectal cancer.

Selection of patients with ulcerating rectal cancer for treatment by local excision has been governed by a policy based on clinical and histological criteria; if these criteria are not fulfilled, major resection is recommended. This policy was re-examined in three groups of patients treated by local excision: Group 1 for cure (27 patients), Group 2 due to unfitness for major surgery (13 patients), Group 3 for local tumour control in the presence of metastatic disease (6 patients). When the policy was fulfilled, there was a cancer-specific death rate of 8.3 per cent in Group 1 (two patients with poorly differentiated tumours) and 0 per cent in Group 2. Unavoidable policy breaches occurred when patients refused major surgery or were too unfit: in the latter elderly group, this did not have the adverse effect expected. It is concluded that pre-operative clinical digital assessment and histological grading are a satisfactory means of identifying a small group of tumours appropriate for local treatment and that the results justify local excision where the policy is observed.

Adult↗
PubMed1985

Elastosis in diverticular disease of the sigmoid colon.

Diverticular disease of the sigmoid colon is an increasingly common clinical problem in the ageing population of western industrialised countries but the mechanism by which the disease develops remains unknown. The muscular abnormality is the most striking and consistent feature and this has been studied by light and electron microscopy in 25 surgical specimens of uncomplicated diverticular disease and in 25 controls. This is the first ultrastructural study of human colonic muscle to be published and shows that the muscle cells in diverticular disease are normal; neither hypertrophy nor hyperplasia is present. There is, however, an increase in the elastin content of the taeniae coli by greater than 200% compared with controls: elastin is laid down between the muscle cells and the normal fascicular pattern of the taeniae coli is distorted. There is no alteration in the elastin content of the circular muscle. As elastin is laid down in a contracted form, this elastosis may be responsible for the shortening or 'contracture' of the taeniae which in turn leads to the characteristic concertina-like corrugation of the circular muscle. Such a structural change could explain the altered behaviour of the colon wall in diverticular disease and its failure to change on treatment with bran.

Collagen↗
PubMed1985

Precancer and cancer in inflammatory bowel disease.

The risk of cancer in inflammatory bowel disease (IBD) is increased although it remains low. A clinical subgroup of patients with extensive or total ulcerative colitis and a history of symptoms for more than 10 yr is at greatest risk. In these patients biopsy evidence of epithelial dysplasia has successfully been used as a marker for increased cancer risk. A classification system for dysplasia has recently been devised, consisting of 3 categories: negative, indefinite and positive for dysplasia. The criteria for each category are discussed. For patients at high risk who decline prophylactic colectomy, a cancer surveillance programme involving periodic clinical assessment, sigmoidoscopy, colonoscopy and rectal and colonic biopsies has provided a reasonable alternative.

Colitis↗
PubMed1985

Pathology of the ageing--diverticular disease.

The correlation of increased incidence of diverticular disease with age is well documented. Such a correlation results from the development of a structural change in the taeniae coli, a progressive elastosis. The consequences of this elastosis are a shortening of the taeniae coli and a subsequent change in the circular muscle layer secondary to this. This type of structural alteration takes time to develop and thus explains the time lag experienced between a change in diet and an altered incidence of the disease. Eastwood et al (1982) have suggested that diverticular disease is merely a normal concomitant of ageing which is degenerative in nature. However, the changes in structure in this condition appear to be dynamic, being associated with an altered intraluminal environment. Such a concept is crucial to our understanding of the pathology of ageing in general. Atherogenesis is associated with muscle cell hypertrophy, another dynamic change, which also leads to elastin formation. This suggests that treatment of such conditions should not just be limited to the control of an inevitable deterioration but should be directed to the investigation of the stimuli that may trigger such conditions. For example, it is interesting to speculate exactly when the changes that lead to diverticular disease begin: not only is a high fibre diet eaten in Africa, but breast-feeding may continue until the age of two years. The greatest increase in thickness in the normal colon occurs in this period and it may be that early weaning distorts this proliferation. The initiating factor in the aetiology of elastogenesis could be the small stools produced on a 'Western' diet which only intermittently distend the colon. Arterial smooth muscle cells increase their uptake of elastin precursors (particularly proline) when subjected to intermittent distension (Leung et al, 1976) and this may form a common link in the changes generated in vascular and colonic muscle tissue with time. This type of change is independent of alterations in motility and thus explains why asymptomatic patients have a normal motility index (Weinreich and Anderson, 1976). The muscular thickening in uncomplicated diverticular disease can therefore be explained in terms of elastosis and contracture of the taeniae coli in the presence of normal muscle cells. This does not exclude the possibility that hypertrophy and hyperplasia of these cells can develop in response to subsequent pericolic inflammation and fibrosis.

Age Factors↗
PubMed1984

Histopathologic comparison of colorectal adenomas in English and Japanese patients.

Histopathologic comparison of colorectal adenomas removed at St. Mark's Hospital, London, England, and those removed at the University of Tokyo, Japan was performed. There were 1242 lesions in the St. Mark's series and 310 in the University of Tokyo series. All adenomas were removed either by colonoscopic polypectomy or hot biopsy. The indications and methods of colonoscopic removal were similar in the two series. Age distribution of the patients showed a younger peak incidence in the University of Tokyo series compared with the St. Mark's patients. The percentage of adenomas larger than 1 cm, of tubulovillous or villous type, and with moderate or severe dysplasia were greater in the St. Mark's series than in the University of Tokyo series. Percentages of adenomas with mild, moderate, or severe dysplasia in each category of size did not differ between the two series. In view of the fact that there is a high colorectal cancer risk in England and medium cancer risk in Japan, our results give further epidemiologic support to the concept of the adenoma-carcinoma sequence.

Adenoma↗
PubMed1984

Mucinous adenocarcinoma in anorectal fistulae.

Mucinous adenocarcinoma arising in an anorectal fistula is an uncommon condition which gives rise to difficult problems of diagnosis and pathogenesis. The clinical history and pathology of seven patients are described and compared with six patients in whom anal fistulae were lined by normal rectal mucosa or 'misplaced glands'. In five of the cases granulomas were present which were a further cause of diagnostic difficulty. The evidence from this study suggests that the fistulous tracks are congenital duplications of the lower end of the hind gut lined by rectal mucosa which is prone to malignant change to mucinous adenocarcinoma. The prognosis after excision of the rectum is good.

Adenocarcinoma, Mucinous↗
PubMed1984

Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy.

The histopathological features and results of treatment of malignant polyps removed by endoscopic polypectomy from 60 patients are presented. The patients were followed for a minimum of five years. Forty six patients were treated by polypectomy alone as local excision was judged complete and the invasive carcinoma was well or moderately well differentiated. Thirty seven of these patients are alive and well after five years and the remaining nine have died of other causes up to four years later: there was no evidence of recurrence in any of these cases. Fourteen patients underwent a subsequent major surgical resection and residual tumour was found at the site of polypectomy in two cases but regional lymph nodes were not involved. Only one patient from this group with a high grade tumour developed metastases although the operative specimen was free of tumour. Malignant polyps can be successfully treated by polypectomy alone provided both the laboratory techniques of examination and the histopathological criteria are strictly applied.

Adenoma↗
PubMed1984

The polyp story.

Explore the source record for details and available documents.

Colonic Polyps↗
PubMed1983

Cancer surveillance in ulcerative colitis. Experience over 15 years.

In the years 1966-80, 303 patients with radiologically extensive ulcerative colitis were followed up regularly, both by clinical assessment and by mucosal biopsies, to detect dysplastic (precancerous) change. Moderate or severe dysplasia (but no carcinoma) was found in the specimen in 8 patients treated surgically. Despite regular surveillance, carcinoma developed in 13 of the 186 patients with a history of disease for ten years or more. Of the total sixteen carcinomas in these 13 patients, eleven were Dukes stage A, three stage B, one stage C, and one was inoperable. There has been 1 death from carcinoma in this series over the fifteen year observation period. The method of follow-up has probably prevented the development of carcinoma in 8 patients and permitted diagnosis of carcinoma at a stage when cure is likely in 11. The incidence of moderate or severe dysplasia and carcinoma in these patients with mild or symptomless extensive colitis shows that either proctocolectomy or careful follow-up should be advised once the duration of symptoms reaches ten years.

Adult↗