Reading the pathology report
In short
A coloscopy pathology report is short, often dense, and written for clinicians. The same words tend to recur. This page translates the most common ones into plain language so you can read your own report with a sense of what each phrase is saying — and what it is not.
What this page covers
The structure of the report, the section that names the polyp, the section that describes its features, the section that comments on the resection, and a glossary of the terms most likely to appear.
- How a pathology report is laid out
- Diagnosis line — naming what was found
- Microscopic description — features, dysplasia, architecture
- Comment — about margins, fragmentation, and the resection
- A working glossary of common terms
How the report is laid out
Most reports follow a standard order. At the top is a list of specimens — labelled bottle A, B, C and so on — with the location each came from (caecum, transverse, sigmoid). Below that, the diagnosis line names what each specimen is. The microscopic description goes deeper — what the cells looked like, what features were noted, whether dysplasia was present. The comment is where the pathologist adds anything that did not fit cleanly above: a note about margins, a note about fragmentation, a recommendation to discuss the case in a multidisciplinary meeting.
The text matters more than the layout. Two laboratories may format the same finding very differently. What follows is the vocabulary, not the typography.
The diagnosis line — naming what was found
This is the sentence most people read first and most often. It usually reads something like: Sigmoid colon, polypectomy: tubular adenoma with low-grade dysplasia. Three pieces of information are packed in: the location (sigmoid), the procedure (polypectomy — removal of a polyp), and the diagnosis (a tubular adenoma containing low-grade dysplasia).
Some reports separate these. Some include the word negative — for example, negative for high-grade dysplasia, negative for invasive carcinoma — to signal explicitly what was looked for and not found. Statements about what is not present are as informative as statements about what is.
The microscopic description
This is where the report describes architecture (how the glands are arranged), cellular features (how the individual cells look), and the presence or absence of dysplasia. The phrases here can sound severe; most are technical descriptors rather than warnings.
A typical paragraph might read: Sections show a polyp with tubular architecture and crowded glands lined by columnar epithelium with elongated, hyperchromatic nuclei consistent with low-grade dysplasia. No high-grade features. The lesion is confined to the mucosa. In plain language: it is a tubular adenoma; the cells inside are abnormal in the expected mild way; nothing more advanced is present; the polyp has not invaded deeper layers.
The comment — margins, fragmentation, completeness
The pathologist's comment is often the most clinically useful sentence in the report. It is where they describe what they could and could not say about the resection itself. Three terms appear repeatedly. Margins are the cut edges of the specimen as seen on the slide; clear or negative margins mean no polyp tissue runs off the edge. Fragmentation means the specimen arrived in pieces, which is normal for larger polyps removed piecemeal but limits margin assessment. En bloc means the specimen arrived as one piece, which lets the pathologist evaluate the deepest and lateral edges with confidence.
If the comment notes cannot be assessed or indeterminate, that is not a verdict; it is a statement about what the slide allowed the pathologist to see. Your follow-up plan accounts for it.
A working glossary
The table below covers terms you are most likely to see. Words you encounter on your own report that are not here may be worth raising with the clinician who reviews it with you.
| Term | What it means in plain language |
|---|---|
| Adenoma | A polyp made of glandular tissue with cells that look mildly abnormal. The polyp type most clearly linked to colorectal cancer if left for years. |
| Tubular | Glands of the polyp are arranged in round, regular tubes — the most common adenoma architecture. |
| Villous | Glands form long, finger-like projections. Less common, somewhat higher risk than tubular. |
| Tubulovillous | A mixture of tubular and villous architecture. |
| Hyperplastic polyp | A common, low-risk polyp made of normal-looking cells in a saw-tooth arrangement, usually small and in the lower colon. |
| Sessile serrated lesion (SSL) | A flat, often pale polyp, usually right-sided, with distinctive features under the microscope. Treated with caution because of its link to colorectal cancer. |
| Dysplasia | Cells that look out of order. Low-grade is mild; high-grade is more pronounced and changes the follow-up plan, but is not cancer. |
| High-grade dysplasia | Marked cellular disorder, but the cells have not invaded deeper layers. Not the same as cancer. |
| Carcinoma in situ | Cancer cells confined to the surface layer, not yet invading. Often grouped with high-grade dysplasia. |
| Invasive carcinoma | Cancer cells that have grown through the surface layer into deeper tissue. A different category and a different conversation. |
| Sessile | Flat-based, sitting directly on the bowel wall. |
| Pedunculated | On a stalk, like a mushroom. |
| Margins | The cut edges of the removed specimen as seen on the slide. Clear or negative margins are the goal. |
| En bloc | Removed as a single piece. |
| Piecemeal | Removed in several pieces — common for larger flat polyps. |
| Fragmentation | The specimen arrived in fragments, which can limit margin assessment. |
| EMR (endoscopic mucosal resection) | A technique to lift a polyp away from deeper tissue with injected fluid before removing it. |
| ESD (endoscopic submucosal dissection) | A specialist technique used for larger lesions, usually at expert centres, to remove tissue en bloc. |
| Lymphovascular invasion | Cancer cells found inside small lymphatic or blood vessels in the specimen — relevant only when invasive carcinoma is present. |
| Indefinite for dysplasia | The pathologist cannot say with confidence whether changes are reactive or true dysplasia. Follow-up usually clarifies. |
| Crypt | The basic gland of the bowel lining; many descriptions reference how the crypts look. |
| Mucosa / submucosa / muscularis | The successive layers of the bowel wall, from inner lining outward. |
What to ask your clinician
- Could you walk me through each line of the report?
- Were any margins unclear, and does that change what you would normally recommend?
- Was anything described as fragmented or piecemeal, and does that affect the plan?
- Are there any terms in the comment that I should pay attention to?
- How does this report compare with my previous pathology, if I have any?
- Will the report be discussed at a multidisciplinary meeting?
- When will the next coloscopy be, and what is that based on?
Common worries, briefly addressed
The report has many long words. Is that bad news?
Length is not severity. A long microscopic description often reflects a thorough pathologist, not a worrying finding. The diagnosis line and the comment are the parts that carry the practical message.
I see "dysplasia" written several times. Is this serious?
Low-grade dysplasia is part of the definition of an adenoma; finding it is expected. High-grade dysplasia is a flag for closer follow-up but is not cancer. Either way, removal is part of the plan, and your interval reflects the finding.
The margin status is unclear. What now?
Often a closer-than-usual look at the resection site is recommended within months. Sometimes the recommendation is no different. Your clinician will explain which applies to you.
Should I get a copy of the report?
Yes. Most health systems and patient portals make this routine. Reading it once with a clinician who can translate is more useful than reading it alone.
Sources
- College of American Pathologists — protocols for the examination of specimens from patients with colorectal carcinoma and polyps
- U.S. Multi-Society Task Force on Colorectal Cancer — recommendations for follow-up after coloscopy and polypectomy
- European Society of Gastrointestinal Endoscopy — guidelines on advanced polypectomy and post-polypectomy surveillance
- World Health Organization classification of digestive system tumours
- British Society of Gastroenterology — post-polypectomy and post-colorectal cancer resection surveillance guidelines
- Royal College of Pathologists — datasets for colorectal cancer histopathology reporting