Large Intestine

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Transanal excision of the lesion (Courtesy Dr. V. Penopoulos)

Surgical specimen (Courtesy Dr. V. Penopoulos)

Cyst containing condensed mucus, lined with benign colonic epithelium, surrounded by fibrosis (Courtesy Dr. V. Penopoulos)

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Microscopic image after Hematoxylin and Eosin staining, showing fibrous connective tissue without atypia, resembling skin fibroma (Courtesy Dr. V. Penopoulos)

Giant distension of the right colon (Courtesy Dr. V. Penopoulos)

Large fecalith. Mini right hemicolectomy (Courtesy Dr. V. Penopoulos).

The excised fibroma. A white, homogeneous, fibrous mass is observed (Courtesy Dr. V. Penopoulos)

The terminal ileal stricture is evident between the surgeon's fingers (Courtesy Dr. V. Penopoulos)

Global giant distension of the entire colon (Courtesy Dr. V. Penopoulos)

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Specimen of mini right hemicolectomy (Courtesy Dr. V. Penopoulos)

Specimen after subtotal colectomy (Courtesy Dr. V. Penopoulos)

Specimen after subtotal colectomy (Courtesy Dr. V. Penopoulos)

Specimen after subtotal colectomy (Courtesy Dr. V. Penopoulos)

Specimen after subtotal colectomy (Courtesy Dr. V. Penopoulos)

Specimen after subtotal colectomy (Courtesy Dr. V. Penopoulos)

Green arrow – focal ulceration of the colonic mucosa. Yellow arrow – edema and lymphocytic infiltration of the submucosa (Courtesy Dr. V. Penopoulos)

Macroscopic view of part of the specimen (Courtesy Dr. V. Penopoulos)

Presence of air in the portal venous system, secondary to ischemic colitis (Courtesy Dr. V. Penopoulos)

Moderately differentiated rectal adenocarcinoma

Complete ischemia of the large bowel (Courtesy Dr. V. Penopoulos)

Colonoscopy. Evident findings of ischemic colitis (Courtesy Dr. V. Penopoulos)

Arterial supply of the large bowel (Courtesy Dr. V. Penopoulos)

Characteristic lesions of the descending colon (Courtesy Dr. V. Penopoulos)

Detail of the extensive lesions in the transverse colon (Courtesy Dr. V. Penopoulos)

Niti-S Stent (Courtesy Dr. V. Penopoulos)

Niti-S Stent (Courtesy Dr. V. Penopoulos)

Niti-S Stent (Courtesy Dr. V. Penopoulos)

Endoscopy after stent expulsion. Mild response of adenocarcinoma to chemotherapy (Courtesy Dr. V. Penopoulos)

Expelled intact endoprosthesis (Courtesy Dr. V. Penopoulos)

Metal stent (endoprosthesis) (Courtesy Dr. V. Penopoulos)

Atkinson tubes (Courtesy Dr. V. Penopoulos)

Mousseau–Barbin tube (Courtesy Dr. V. Penopoulos)

Souttar tubes (Courtesy Dr. V. Penopoulos)

Multiple hepatic metastases (Courtesy Dr. V. Penopoulos)

Chest CT — Esophageal adenocarcinoma with extraluminal extension (Courtesy Dr. V. Penopoulos)

Green arrow – perivenular lymphocytic infiltration in a submucosal location (Courtesy Dr. V. Penopoulos)

Green arrow – perivenular lymphocytic infiltration in a submucosal location (Courtesy Dr. V. Penopoulos)

Resected specimen showing quintuple synchronous rectal adenocarcinomas (A, B, C, D)

Highly differentiated rectal adenocarcinoma

Postoperative imaging of ileorectal anastomosis (modified Duhamel). The anastomosis of the terminal ileum to the anterior wall of the remaining rectal stump is evident (Courtesy Dr. V. Penopoulos)

Postoperative imaging of ileorectal anastomosis (modified Duhamel). The anastomosis of the terminal ileum to the anterior wall of the remaining rectal stump is evident (Courtesy Dr. V. Penopoulos)

Postoperative imaging of ileorectal anastomosis (modified Duhamel). The anastomosis of the terminal ileum to the anterior wall of the remaining rectal stump is evident (Courtesy Dr. V. Penopoulos)

Total colectomy specimen. Red arrow: previous colocolonic anastomosis (Courtesy Dr. V. Penopoulos)

Total colectomy specimen. Red arrow: previous colocolonic anastomosis (Courtesy Dr. V. Penopoulos)

Incisional hernia (Courtesy Dr. V. Penopoulos)

Postoperative imaging of ileorectal anastomosis (modified Duhamel). The anastomosis of the terminal ileum to the anterior wall of the remaining rectal stump is evident (Courtesy Dr. V. Penopoulos)

Exploratory laparotomy. Marked distension of the colon (Courtesy Dr. V. Penopoulos)

Free subdiaphragmatic air (Courtesy Dr. V. Penopoulos)

Internal hernia (Courtesy Dr. V. Penopoulos)

Internal hernia (Courtesy Dr. V. Penopoulos)

Rectosigmoidectomy specimen (Courtesy Dr. V. Penopoulos)

Rectal biopsies. Absence of ganglion cells (Courtesy Dr. V. Penopoulos)

Postoperative imaging of ileorectal anastomosis (modified Duhamel). The anastomosis of the terminal ileum to the anterior wall of the remaining rectal stump is evident (Courtesy Dr. V. Penopoulos)

Postoperative imaging of ileorectal anastomosis (modified Duhamel). The anastomosis of the terminal ileum to the anterior wall of the remaining rectal stump is evident (Courtesy Dr. V. Penopoulos)

Postoperative imaging of ileorectal anastomosis (modified Duhamel). The anastomosis of the terminal ileum to the anterior wall of the remaining rectal stump is evident (Courtesy Dr. V. Penopoulos)

Postoperative imaging of ileorectal anastomosis (modified Duhamel). The anastomosis of the terminal ileum to the anterior wall of the remaining rectal stump is evident (Courtesy Dr. V. Penopoulos)

Green arrows: Hair. Blue arrow: Fibrous stroma (Courtesy Dr. V. Penopoulos)

Green arrows: Hair. Blue arrow: Fibrous stroma (Courtesy Dr. V. Penopoulos)

Green arrow: Adipose tissue. Purple arrow: Sebaceous glands (Courtesy Dr. V. Penopoulos)

Surgical specimens of mature teratoma and appendix (Courtesy Dr. V. Penopoulos)

Abdominal CT scan. Presence of calcifications, cystic-solid areas, and adipose tissue, suggestive of a right-sided teratoma (Courtesy Dr. V. Penopoulos)

Protrusion of polypropylene mesh through the anus (Courtesy Dr. V. Penopoulos)

Peritoneal coverage of the rectopexy (Courtesy Dr. V. Penopoulos)

Modified posterior Wells rectopexy (Courtesy Dr. V. Penopoulos)

Colostomy diverticulitis (Courtesy Dr. V. Penopoulos)

Colostomy diverticulitis (Courtesy Dr. V. Penopoulos)

Excised end colostomy segment. Blue arrows — Diverticular sites (Courtesy Dr. V. Penopoulos)

Inflamed diverticular orifices (Courtesy Dr. V. Penopoulos)

Mobilization of end colostomy (Courtesy Dr. V. Penopoulos)

Non-inflamed diverticula in the colon segment immediately beneath the exteriorized end colostomy (Courtesy Dr. V. Penopoulos)

Yellow arrows — Inflamed diverticula in the extra-abdominal bowel segment. Green arrow — Fluid collection (Courtesy Dr. V. Penopoulos)

Abdominal CT scan. Erosion/migration of the mesh within the rectum (Courtesy Dr. V. Penopoulos)

Inflammatory cloacogenic polyp with inflammatory fibromuscular stroma and hyperplastic epithelium (Courtesy Dr. V. Penopoulos)

Inflammatory cloacogenic polyp with inflammatory fibromuscular stroma and hyperplastic epithelium (Courtesy Dr. V. Penopoulos)

Colectomy specimen

Colonoscopy revealing a polypoid mass protruding in the medial aspect of the left colonic flexure

Surgical specimen. Necrosis of a portion of the cecum is evident (Courtesy Dr. V. Penopoulos)

Green arrow: necrosis of the cecum. Blue arrow: normal appendix (Courtesy Dr. V. Penopoulos)

Green arrow: necrosis of the cecum. Blue arrow: normal appendix (Courtesy Dr. V. Penopoulos)

Red arrow: presence of free air (Courtesy Dr. V. Penopoulos)

Red arrow: necrosis of the cecum (Courtesy Dr. V. Penopoulos)

PET Scan . Metastatic carcinoma in the right palatine tonsil (Courtesy Dr. V. Penopoulos).

Microscopic picture showing extensive psammoma body formation (Courtesy Dr. V. Penopoulos)

Surgical specimen. Necrosis of a portion of the cecum is evident (Courtesy Dr. V. Penopoulos)

faecaliths ( Courtesy Dr. V . Penopoulos)

Microscopic picture showing extensive psammoma body formation (Courtesy Dr. V. Penopoulos)

Peritoneum showing invasive implants (Courtesy Dr. V. Penopoulos)

Excised specimen en bloc . Red arrow rectosigmoid adenocarcinoma . Green arrow uterus – uterine fibroids . Purple arrow , hidden left ovarian psammocarcinoma (Courtesy Dr. V. Penopoulos)

Microscopic picture showing extensive psammoma body formation (Courtesy Dr. V. Penopoulos)

Positive immunohistochemistry for CDX2 and cytokeratin 20 of the ovarian tumor (Courtesy Dr. V. Penopoulos)

Positive immunohistochemistry for CDX2 and cytokeratin 20 of the ovarian tumor (Courtesy Dr. V. Penopoulos)

Positive immunohistochemistry for CDX2 and cytokeratin 20 of the ovarian tumor (Courtesy Dr. V. Penopoulos)

Photomicrographs of the histopathology of the ovarian tumor tissue shows solid areas consisting mainly of papillary structures and few glands that are covered by a layer of malignant epithelial cells (Courtesy Dr. V. Penopoulos)

Macroscopic appearance of the ovary following total hysterectomy in a 46-year-old woman with metachronous ovarian metastases diagnosed two years after right hemicolectomy for ascending colon carcinoma (CRC). The macroscopic appearance of the ovarian tumor shows cystic and solid areas (Courtesy Dr. V. Penopoulos)

Disseminated carcinomatosis of bone marrow (Courtesy Dr. V. Penopoulos)

Excised umbilicus together with SMJN (Courtesy Dr. V. Penopoulos)

Excised umbilicus together with SMJN (Courtesy Dr. V. Penopoulos)

Excised umbilicus together with SMJN (Courtesy Dr. V. Penopoulos)

Extreme inflammation of left hemicolon secondary to diverticulitis and covered perforations (Courtesy Dr. V. Penopoulos)

Disseminated carcinomatosis of bone marrow (Courtesy Dr. V. Penopoulos)

Disseminated carcinomatosis of bone marrow (Courtesy Dr. V. Penopoulos)

Extreme inflammation of left hemicolon secondary to diverticulitis and covered perforations (Courtesy Dr. V. Penopoulos)

Disseminated carcinomatosis of bone marrow (Courtesy Dr. V. Penopoulos)

Disseminated carcinomatosis of bone marrow (Courtesy Dr. V. Penopoulos)

Perforation of caecum secondary to coexisting descending sigmoid colon stenosis obstruction (Courtesy Dr. V. Penopoulos)

Meckel's diverticulum — Presence of ectopic gastric mucosa (Courtesy Dr. V. Penopoulos)

Abdominal CT. Red arrow — Typhlitis. Significant cecal wall thickening (Courtesy Dr. V. Penopoulos)

Abdominal CT. Red arrow — Typhlitis. Significant cecal wall thickening (Courtesy Dr. V. Penopoulos)

Abdominal CT. Red arrow — Typhlitis. Significant cecal wall thickening (Courtesy Dr. V. Penopoulos)

Mini right hemicolectomy specimen — Cecal necrosis and perforation are evident (Courtesy Dr. V. Penopoulos)

Macroscopic view after debridement (Courtesy Dr. V. Penopoulos)

Proctoscopy — Typhlitis of the anorectal region (Courtesy Dr. V. Penopoulos)

Perineal MRI. Red arrow — Pararectal fistula (Courtesy Dr. V. Penopoulos)

The excised rectal adenocarcinoma (Courtesy Dr. V. Penopoulos).

Mini right hemicolectomy specimen. Red outline: lipoma. Blue outline: ileocecal valve. Green arrow: shows the course of the lipoma, resulting in complete obstruction of the ileocecal valve (Courtesy Dr. V. Penopoulos)

Sigmoid specimen. Green arrow: tubulovillous adenoma that has transformed into adenocarcinoma (Courtesy Dr. V. Penopoulos)

Abdominal CT scan. Red arrow. Cecal carcinoma (Courtesy Dr. V. Penopoulos)

Colonoscopy. Cauliflower-like cecal mass (Courtesy Dr. V. Penopoulos)

Abdominal CT. Red arrow: lipoma of the ileocecal valve (Courtesy Dr. V. Penopoulos)

Bilateral Ovarian carcinomas

Bilateral Ovarian carcinomas

Small bowel endoluminal metastasis

Small bowel endoluminal metastasis

Colonic endoluminal metastasis

Immunohistochemical examination. Positivity for Synaptophysin (Courtesy Dr. V. Penopoulos).

Immunohistochemical examination. Positivity for Chromogranin B (Courtesy Dr. V. Penopoulos).

Infiltrative NET of the cecum (Courtesy Dr. V. Penopoulos).

Right hemicolectomy specimen. The cecal neoplasm is clearly visible (Courtesy Dr. V. Penopoulos).

Extensive colectomy of ischaemic necrotic large bowel (Courtesy Dr. V. Penopoulos)

Regional lymph node infiltration (Courtesy Dr. V. Penopoulos)

Pericolic fat infiltration (Courtesy Dr. V. Penopoulos)

Regional lymph node infiltration (Courtesy Dr. V. Penopoulos)

Mucinous cystadenoma

Bleeding diverticula (Courtesy Dr. V. Penopoulos)

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Regional lymph node infiltration (Courtesy Dr. V. Penopoulos)

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Histological findings of mucinous cystadenoma of the appendix. Cylindrical epithelium and mucin production. Note the absence of atypia and mitotic figures

En bloc rectosigmoidectomy plus total hysterectomy. Blue arrow: Utero-colic fistula. Yellow circle: Uterine leiomyoma (Courtesy Dr. V. Penopoulos).

Figure 3 . Colectomy specimen . ( Courtesy Dr . V . Penopoulos ) .

Figure 4 . Cut surface of the Specimen . ( Courtesy Dr . V . Penopoulos ) .

Right hemicolectomy and cholecystectomy specimens (Courtesy Dr. V. Penopoulos)

Histopathology pictures . Case 2 (Courtesy Dr. V. Penopoulos)

Surgical specimen (Courtesy Dr. V. Penopoulos)

Surgical specimen (Courtesy Dr. V. Penopoulos)

Surgical specimen (Courtesy Dr. V. Penopoulos)

Figure 2 . Non Solitary Rectal Ulcer . ( Courtesy Dr . V . Penopoulos ) .

Excised extraluminal perirectal mucocele (Courtesy Dr. V. Penopoulos)

Excised extraluminal perirectal mucocele (Courtesy Dr. V. Penopoulos)

Total gastrectomy specimen. Gastric cancer (blue arrow)

Abdominal CT Scan. Transverse colon dilatation at 9.8 cm

Colonoscopy image consistent with pseudomembranous colitis

Follow-up colonoscopy - normal mucosa

Disruption of external sphincter (Courtesy Dr. V. Penopoulos)

Curvilinear incision (Courtesy Dr. V. Penopoulos)

Overlapping sphincteroplasty .Schematic drawing (Courtesy Dr. V. Penopoulos)

Green arrow - Internal and Yellow arrow external sphincters following meticulous dissection (Courtesy Dr. V. Penopoulos)

Overlapping sphincteroplasty .Schematic drawing (Courtesy Dr. V. Penopoulos)

Overlapping sphincteroplasty .Schematic drawing (Courtesy Dr. V. Penopoulos)

Red arrow - Bleeding diverticulum of the transverse colon (Courtesy Dr. V. Penopoulos)

Red arrow - Bleeding diverticulum of the sigmoid colon (Courtesy Dr. V. Penopoulos)

Figure 1 . Contrast enhanced CT showed an irregular circumferential mass in the left half of transverse colon with fat stranding adjacent to thickened bowel wall. ( Courtesy Dr . V . Penopoulos ) .

Figure 5 . CT demonstrated a retroperitoneal mass surrounding the left lumbar ureter and causing uretero-hydronephrosis: This lesion was suggestive of recurrence . ( Courtesy Dr . V . Penopoulos ) .

Figure 6 . Recurrence retroperitoneal mass with a size of 3 × 2.5 cm size composed of adenocarcinoma and neuroendocrine (GIII). Immunohistochemical study revealed neuroendocrine cells positive for chromogranin A . ( Courtesy Dr. V . Penopoulos ) .

Figure 1 . Solitary Rectal Ulcers . ( Courtesy Dr . V . Penopoulos ) .

Figure 2 . Large cell neuroendocrine carcinoma, positive for Chromogranin A, and moderately differentiated adenocarcinoma in a collision pattern.

2017 : Metachronous jejunal adenocarcinoma with lymph nodes metastases (Courtesy Dr. V. Penopoulos)

2017 : Metachronous jejunal adenocarcinoma with lymph nodes metastases (Courtesy Dr. V. Penopoulos)

2015 : Very low anterior resection of rectal recurrence (Courtesy Dr. V. Penopoulos)

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The iatrogenic perforation is shown ( red arrow ) (Courtesy Dr. V. Penopoulos)

Metastatic appendicular adenocarcinoma (red arrow)

Colonic adenocarcinoma

Figure 1 . Giant villous adenoma fully excised with AP resection . ( Courtesy Dr . V . Penopoulos ) .

The iatrogenic perforation is shown ( red arrow ) (Courtesy Dr. V. Penopoulos)

2017 : Metachronous jejunal adenocarcinoma with lymph nodes metastases (Courtesy Dr. V. Penopoulos)

Mesenteric panniculitis (Courtesy Dr. V. Penopoulos)

Diagnostic laparoscopy. Inflamed epiploic appendage (Courtesy Dr. V. Penopoulos)

Abdominal CT scan. Red arrows - Inflamed epiploic appendage with hyperattenuated peripheral rim (Courtesy Dr. V. Penopoulos)

Macroscopic view on the 2nd postoperative day. Green outline: area of excised bleeding varices (Courtesy Dr. V. Penopoulos)

Macroscopic view on the 2nd postoperative day. Green outline: area of excised bleeding varices (Courtesy Dr. V. Penopoulos)

Bleeding anorectal varices (green arrows). Marked dilatation of the external hemorrhoidal venous plexus, communicating with the rectal varices (blue arrows) (Courtesy Dr. V. Penopoulos)

Bleeding anorectal varices (green arrows). Marked dilatation of the external hemorrhoidal venous plexus, communicating with the rectal varices (blue arrows) (Courtesy Dr. V. Penopoulos)

Excised varices (Courtesy Dr. V. Penopoulos)

Excised varices (Courtesy Dr. V. Penopoulos)

Excised fistulous tract, together with a cystic formation of subcutaneous fat (Courtesy Dr. V. Penopoulos)

Anorectal varices. Marked dilatation of the external hemorrhoidal venous plexus, with obvious communication with the venous network of the rectal varices. Incipient variceal rupture at the 12 o'clock position is highlighted (Courtesy Dr. V. Penopoulos)

Anorectal varices (Courtesy Dr. V. Penopoulos)

Esophageal varices at the 2 o'clock position. Thick vessel protrusion on the varix representing a hematocystic spot (Courtesy Dr. V. Penopoulos)

Pseudo-tumor of the mesenteric root - Mesenteric panniculitis (Courtesy Dr. V. Penopoulos)

Esophageal varices at the 6 and 9 o'clock positions. Cherry-red spots at the 9 o'clock position. Red wale markings at the 6 o'clock position, as well as hematocystic spots (Courtesy Dr. V. Penopoulos)

Red arrows: massive dilatation of the right superior rectal vein. Collateral circulation between the superior rectal veins (red arrows) and the anorectal varices (yellow and green arrows) (Courtesy Dr. V. Penopoulos)

Massive rectal varices (Courtesy Dr. V. Penopoulos)

Omental infarction (Courtesy Dr. V. Penopoulos)

Surgical specimen of right hemicolectomy (Courtesy Dr. V. Penopoulos)

Intraoperative cecal volvulus (Courtesy Dr. V. Penopoulos)

Non functional Adrenocortical Adenoma

Abdominal CT scan - Cecal MALToma and paracolic lymph node (Courtesy Dr. V. Penopoulos)

Colonoscopic image of mucocele — Submucosal mass. Blue arrow — "Volcano sign" (Courtesy Dr. V. Penopoulos)

Colonoscopic image of mucocele — Submucosal mass. Blue arrow — "Volcano sign" (Courtesy Dr. V. Penopoulos)

PET Scan. Appendiceal adenocarcinoma (Courtesy Dr. V. Penopoulos)

Removal of disseminated gelatinous material from the peritoneal cavity (Courtesy Dr. V. Penopoulos)

Pseudomyxoma peritonei (Courtesy Dr. V. Penopoulos)

Pseudomyxoma peritonei — Complete involvement of the greater omentum (Courtesy Dr. V. Penopoulos)

Colonoscopic image of appendiceal mucocele intussusception (Courtesy Dr. V. Penopoulos)

CT — Appendiceal mucocele — Ileocolic intussusception (Courtesy Dr. V. Penopoulos)

CT — Appendiceal mucocele — Ileocolic intussusception (Courtesy Dr. V. Penopoulos)

Mucinous cystadenocarcinoma (Courtesy Dr. V. Penopoulos)

Mucinous cystadenoma (Courtesy Dr. V. Penopoulos)

Mucinous cystadenoma (Courtesy Dr. V. Penopoulos)

Hyperplastic mucocele (Courtesy Dr. V. Penopoulos)

Hyperplastic mucocele (Courtesy Dr. V. Penopoulos)

Retention mucocele (Courtesy Dr. V. Penopoulos)

Retention mucocele (Courtesy Dr. V. Penopoulos)

Retention mucocele (Courtesy Dr. V. Penopoulos)

Retention mucocele (Courtesy Dr. V. Penopoulos)

Histopathological examination of appendiceal mucocele. Extensive mucin in the appendiceal lumen, mucosal atrophy, wall thinning, and chronic inflammatory cell infiltration (Courtesy Dr. V. Penopoulos)

Histopathological examination of appendiceal mucocele. Extensive mucin in the appendiceal lumen, mucosal atrophy, wall thinning, and chronic inflammatory cell infiltration (Courtesy Dr. V. Penopoulos)

Mucinous-gelatinous contents of appendiceal mucocele (Courtesy Dr. V. Penopoulos)

Greater omentum specimen. Presence of multiple microscopic implants (Courtesy Dr. V. Penopoulos)

Right adnexa excision, en bloc with parietal peritoneum. Green circles — Microscopic implants (Courtesy Dr. V. Penopoulos)

Laparoscopic view of appendiceal mucocele (Courtesy Dr. V. Penopoulos)

Gross specimen image (Courtesy Dr. V. Penopoulos)

Gross specimen image (Courtesy Dr. V. Penopoulos)

Abdominal CT scan - Cecal MALToma and paracolic lymph node (Courtesy Dr. V. Penopoulos)

Gross specimen image (Courtesy Dr. V. Penopoulos)

Histopathological examination - Cecal MALT lymphoma (Courtesy Dr. V. Penopoulos)

Whole-body PET scan. Pathological uptake in the right palatine tonsil (Courtesy Dr. V. Penopoulos)

Whole-body PET scan. Pathological uptake in the right palatine tonsil (Courtesy Dr. V. Penopoulos)

Whole-body PET scan. Pathological uptake in the right palatine tonsil (Courtesy Dr. V. Penopoulos)

Adenocarcinoma — Abdominoperineal resection of the rectum. Yellow arrow — Site of excised neoplasm (Courtesy Dr. V. Penopoulos)

Adenocarcinoma — Abdominoperineal resection of the rectum. Yellow arrow — Site of excised neoplasm (Courtesy Dr. V. Penopoulos)

Adenocarcinoma — Abdominoperineal resection of the rectum. Yellow arrow — Site of excised neoplasm (Courtesy Dr. V. Penopoulos)

Excised rectal neoplasm specimen (Courtesy Dr. V. Penopoulos)

Blue arrows — Proctotomy closure (Courtesy Dr. V. Penopoulos)

Blue arrow — Upper edge of proctotomy. Yellow arrow — Rectal neoplasm (Courtesy Dr. V. Penopoulos)

Green arrow — Anus. Blue arrow — Rectum. Rose arrow — Tape encircling the rectum (Courtesy Dr. V. Penopoulos)

Blue arrow — Exposure of the rectum. Entry into the presacral space from the right (Courtesy Dr. V. Penopoulos)

Endoscopic views of extra-peritoneal rectal rupture

Cancerous perforation

Rectal ECHO. Perirectal abscess

Resected rectosigmoid colon. The site of the perforated diverticular abscess is evident

Rectal endoscopy

CT Scan. Perirectal abscess

Subtotal colectomy specimen (Courtesy Dr. V. Penopoulos)

Lymphoma perforation

Diverticular perforation

Figure 6 . The excised rectum . ( Courtesy Dr . V . Penopoulos ) .

Figure 4 . Vulvar and clitoris varices . ( Courtesy Dr . V . Penopoulos ) .

Figure 3 . Subserosal ileocolic varices of no significance . ( Courtesy Dr . V . Penopoulos ) .

Figure 1 . Rectal submucosal varices are clearly seen . ( Courtesy Dr . V . Penopoulos ) .

Figure 2 . Pelvic congestion syndrome . Dilated left ovarian veins , left ureteric veins , ovarian varix and para-uterine veins . ( Courtesy Dr . V . Penopoulos ) .

Figure 5 . Lumbar region and perianal varices together with prolapsed hemorrhoids prior to surgery . No anomaly in the iliac vessels was detected . (Courtesy Dr . V . Penopoulos) .

Immunohistochemical examination positive for CD56 (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for synaptophysin (Courtesy Dr. V. Penopoulos)

Specimen cut by the pathologist (Courtesy Dr. V. Penopoulos)

The excised mass together with right hemi colon and abdominal wall (Courtesy Dr. V. Penopoulos)

Abdominal CT Scan pictures, showing cystic type lesion, between liver and colonic hepatic flexure, in contact with the bowel outer layer expressing enriched wall and low density centre (Courtesy Dr. V. Penopoulos)

Infiltrated lymph nodes with both cancerous and atypical lymphocytes (Courtesy Dr. V. Penopoulos)

The obstructing adenocarcinoma of the transverse colon (Courtesy Dr. V. Penopoulos)

The obstructing adenocarcinoma of the transverse colon (Courtesy Dr. V. Penopoulos)

Infiltrated lymph nodes with both cancerous and atypical lymphocytes (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for chromogranin (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for Ki-67 (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for Ki-67 (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for Ki-67 (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for Ki-67 (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for Ki-67 (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for Ki-67 (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for Ki-67 (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for CK20 (Courtesy Dr. V. Penopoulos)

Immunohistochemical examination positive for neuron-specific enolase (Courtesy Dr. V. Penopoulos)

Pouchoscopic images of healthy ileal pouches (Courtesy Dr. V. Penopoulos)

Pouchoscopic images of healthy ileal pouches (Courtesy Dr. V. Penopoulos)

Plain abdominal radiograph. Hyperlucent liver sign (Courtesy Dr. V. Penopoulos)

Plain abdominal radiograph - Multicolored arrows - Rigler sign (Courtesy Dr. V. Penopoulos)

Plain abdominal radiograph - Multicolored arrows - Rigler sign (Courtesy Dr. V. Penopoulos)

The fully deflated pouch in the pelvis (Courtesy Dr. V. Penopoulos)

Intraoperative image of chronically inflamed, distended, dysfunctional pouch with associated proximal small bowel distension (Courtesy Dr. V. Penopoulos)

Plain abdominal radiograph. Distension of the ileal pouch and its displacement to the right side of the abdomen (Courtesy Dr. V. Penopoulos)

Resected Liver Metastases (Courtesy Dr. V. Penopoulos)

Bisegmentectomy of liver secondary deposits (Courtesy Dr. V. Penopoulos)

Bisegmentectomy of liver secondary deposits (Courtesy Dr. V. Penopoulos)

Resected sarcoma (Courtesy Dr. V. Penopoulos)

Resected sarcoma (Courtesy Dr. V. Penopoulos)

Abdominal CT Scan (Courtesy Dr. V. Penopoulos)

Postoperative biopsies of ileal pouch - Pouch adaptation (Courtesy Dr. V. Penopoulos)

Postoperative biopsies of ileal pouch - Pouch adaptation (Courtesy Dr. V. Penopoulos)

Postoperative biopsies of ileal pouch - Pouch adaptation (Courtesy Dr. V. Penopoulos)

Postoperative biopsies of ileal pouch - Pouch adaptation (Courtesy Dr. V. Penopoulos)

Green arrow - Normal blind end of ileal pouch (Courtesy Dr. V. Penopoulos)

Pouchoscopic images of healthy ileal pouches (Courtesy Dr. V. Penopoulos)

Postoperative biopsies of ileal pouch - Pouch adaptation (Courtesy Dr. V. Penopoulos)

Postoperative biopsies of ileal pouch - Pouch adaptation (Courtesy Dr. V. Penopoulos)

Postoperative biopsies of ileal pouch - Pouch adaptation (Courtesy Dr. V. Penopoulos)

Photomicrograph of a hematoxylin and eosin-stained tissue section revealing the neuroendocrine tumor cells (Courtesy Dr. V. Penopoulos)

Photomicrograph of a hematoxylin and eosin-stained tissue section revealing the neuroendocrine tumor cells (Courtesy Dr. V. Penopoulos)

Photomicrograph of a hematoxylin and eosin-stained tissue section revealing the neuroendocrine tumor cells (Courtesy Dr. V. Penopoulos)

Photomicrograph of a hematoxylin and eosin-stained tissue section revealing the neuroendocrine tumor cells (Courtesy Dr. V. Penopoulos)

Appendicular carcinoid (Courtesy Dr. V. Penopoulos)