Gross and Histopathologies of the GIT-final

8/14/2019 Gross and Histopathologies of the GIT-final

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Gross and Histopathologic Features of GI Disorders

OS 214 Dr. Dimacali

Exam 1

November 3, 2008 | Monday Page 1 of 6

Noems, Vic, Jow, Kitts

I. Esophagus

Normal Proximal Esophagus-lined by squamous epithelium in contrast to the distalesophagus which is lined by glandular epithelium-transition zone is actually an interdigitating area of squamousand glandular epithelium

EsophagitisMorphologic Features:

1. lengthening of the rete pegs of the lamina propria (LP)2. basal layer hyperplasia

3. presence of inflammatory cells in the squamous

epithelium (acute-neutrophils;chronic-mononuclearcells)

Esophagitis-OGJ (oesophagealgastric junction)-do a biopsy to see if there is dysplasia (Low/High grade)

Barretts Esophagus on Endoscopy (Robbins,Fig17-6)-normal mucosa: paler areas-abnormal mucosa: red velvety mucosa extending to orifice

Barrets Esophagus-presence of goblet cells

Fungal Esophagitis-presence of hyphae upon silver staining

CMV Esophagitis-presence of dark red nuclear inclusions; associated with HIVpatients

Outline

I. EsophagusII. Stomach

III. Intestines


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Ulcerated Squamous Cell Carcinoma (Robbins, p807, Fig17-8)-squamous cell Ca begin as carcinoma in situ-develop into 3 morphologic featuresa. protruded (60%)-polypoid; protruding into lumenb. flat (15%)-diffuse and infiltrative, tends to spread into wallcausing thickening, rigidity and narrowing of lumenc. ulcerated (25%)-necrotic and excavates into surroundingstructures (eg. respiratory tree, aorta)

Squamous Cell Carcinoma (Robbins, p898, Fig17-9)-shows invasion of the submucosa but is not yet obstructive-3 Layers of the Esophagus

1. Mucosa2. Lamina Propria (LP)3. Muscularis Mucosa (MM)-most important border

-staging and outcome is based on the level of invasion of thelayers-Colorectal vs. Small Intestines/ Stomach/Esophageal Ca-

in colorectal Ca, if the tumor has NOT reached the MM,metastasis is not expected. In the latter, metastasis occurs in

8-10% of tumors that have not yet reached the MM.-to confirm cancer, do a sequential biopsy (5, 10, 15 cm)

Esophageal Cancer-normal: pale staining (lower right corner)-cancerous: darkly staining (upper left corner)-operate while still at high Grade Dysplasia/ Carcinoma In situbefore developing into cancer

II. STOMACH

Tongue, Esophagus, Stomach on Autopsy

Peptic Ulcer

Acute Gastritis (Robbins, p813, Fig17-13)-focal mucosal disruption with hemorrahge; adjacent mucosa is

normal

Chronic Gastritis (Robbins, Fig17-15)-due to presence ofHelicobacter pyloriseen as darkly stainedorganisms (silver staining). H.pyloriis found in the mucus(although some claim it can be infiltrative)- H.pyloriare attached via flagella-Initially, lymphocytes are produced against H.pylori. Later,lymphocyte clones are produced that are unresponsive to anystimuli resulting in lymphoma


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OS 214 Dr. Dimacali

Exam 1



Atrophic Gastritis-lining mucosa becomes a thin layer

Peptic Ulcer-can only be differentiated from neoplastic through a biopsy ofthe PERIPHERY of the ulcer. multiple samples should be taken

since neoplasia of the GIT are not usually homogeneous.

Peptic UlcerUpper left corner-necrotic debrisLower right corner-granulation tissue (fibrocollagenous withvascularization)

Perforated Peptic Ulcer

Gastric Adenocarcinoma (Microsopic)-no mass is formed in this picture, cancer is poorly differentiated

Gastic Ca (Signet Ring Cells)2 most important histologic types of gastric Ca1. Intestinal-neoplastic intestinal glands resembling colonicadenocarcinoma; permeate the gastric wall but grow in anexpanding manner

2. Diffuse-composed of gastric-type mucous cells which do notform glands and permeate the mucosa in an infiltrativemanner; mucin pushed the nucleus of cells to the peripheryresulting in a signet rins pattern

Gastric Ca (Gross)Macroscopic growth patterns1.confined to mucosa and submucosa

a. exophyticb. flat or depressedc. excavated

2. extends to MMd. exophytice. excavatedf. linitis plastica

-in the picture, lining of the stomach is thick (linitis plastica orleather bottle appearance) due to infiltrating malignancy-presents with easy satiety


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Gastric Ca-mucin stains pink in this slide

Trichobezoar

III. Intestines

Adhesions-prevents free sliding movements of segments

Enteritis-LP is filled with inflammatory cells-lymphona-clone of lymphocytesinflammation-abundant lymphocytes

Meckels Diverticulum

Gangrene-due to vascular accident, dark area is gangrenous

Appendicitis-with hardened fecalith (fecal matter) seen in the middle

Polyps-pedunculated-bleeds easily and discovered earlier-sessile-discovered later-occult blood in stool is used for diagnosis (we should advise thepatient not to eat any hemoglobin-containing food for 72 hrsprior to the test)


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Multiple Polyposis-100+ polyps

Ulceration (with polyps pointed by the 2 arrows)

Juvenile Polyp-called retention polyp if it is retained after childhood

Infiltrating Carcinoma

Carcinoma-but not yet infiltrating

Mucocoele in Appendix-mucinous cyst adenoma (benign) or adenocarcinoma(malignant)

Pic42. Diverticulitis

Pic43. Hirschsprung Disease-lower right:normal colon, ganglion cells are present (red stain-upper right side:abnormal colon, ganglion cells are absent


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Pic44. Carcinoid

Crohns Disease- segmental inflammation; can be found in theesophagus until the anus; a full-thickness disease; recurs andcauses fistulas unlike ulceration colitis (ulceration colitis rarelygoes out of colon, it is limited to the mucosa with lots of fibrosis)

Ulcerative Colitis-disease of the mucosa; found in colon alone

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Gross and Histopathologies of the GIT-final