gastrointestinal pathology 1. -...
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Gastrointestinal pathology 1.
Upper GI tract
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Tumors of The Salivary Glands
Malignant
• Mucoepidermoid cc (15%)
• Adenocarcinoma NOS (6%)
• Acinic cell cc (6%)
• Adenoid cystic cc (4%)
• Malignant mixed tumor (3%)
• Malignant lymphoma
• Metastatic –
breast, lung, melanoma
Benign
• Pleomorphic adenoma (50%)
• Warthin tumor (5%)
• Oncocytoma (2%)
Székely Eszter: Fej-nyak patológia, tantermi előadás
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• Benign
• Slow-growing, painless, mobile discrete
mass
• Most common site: superficial lobe of
parotis
• Well-demarcated, but might protrude into
surrounding tissues → recurrs if excision
is incomplete
Pleomorphic adenoma
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Pleomorphic adenoma
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Tumor of myoepithel-derived cells
Pleomorphic adenoma
Epithelial cells: form
ducts, acini, tubules,
strands and sheets
Stroma: (mesenchyme-
like background)
myxoid-tissue, hyalin,
islands of chondroid,
rarely bone
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Pleomorphic
adenoma
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Parts of The Stomach
antrum
cardia
fundus
corpus
https://openi.nlm.nih.gov/detailedresult.php?img=PMC2940217_GMS-08-19-g-004&req=4
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Physiological background
• Defensive Forces:
• Surface mucus
• Bicarbonate
• Mucosal blood flow
• Prostaglandin
• Damaging Forces:
• Gastric acidity
• Peptic enzymes
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Acute gastritis
• Acute inflammation of
gastric mucosa
• Usually transient
• Main cellular
component: neutrophil
granulocyte
• Mucosal damage:
erosion (– see later)
/hemorrhage may
occur
Kép forrása: Pogány Péter szakvizsga előkészítő előadása
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Etiology of Acute Gastritis– Drugs
• NSAID, steroid, cytostatic drugs
– Alcohol, smoking, coffee
– Uraemia
– Stress
– Burning
– Heart failure
– Portal hypertension
– Ischaemia
– Infection, sepsis
– Harsh chemicals (acids, bases)
– Food
– Irradiation
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Chronic gastritisTwo main features:
•Inflammatory cells (acute and chronic) infiltrate the lamina propria
•Atrophy of glandular epithel
Classification: (Sydney-classification-1991)
Type Non-atrophic Atrophic Special
Etiology H. pylori • Autoimmune
• Multifocal atrophic
(H.pylori+dietary,
environmental factors)
• Chemical (NSAID,bile
reflux)
• Irradiation
• Granulomatous (eg:
vasculitis)
• Lymphocytic (immune-
mediated, gluten)
• Eosinophilic (allergy)
• Infective (bacterium,
virus)
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Helicobacter pylori Associated Gastritis
• Most common type of chronic
gastritis
• H. pylori: rod/spiral-shaped
• Gram-negative bacterium
• Tipically infects antrum
• Found in the mucus, on the inner
surface of the epithelium
https://img.medscapestatic.com/pi/meds/ckb/90/9290tn.jpg
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Chronic Gastritis (H. pylori associated)
• Lymphocytes/plasma cells
infiltrate the lamina propria
• Neutrophils invade glands
(active chronic gastritis)
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Chronic Gastritis
(H. pylori associated)
http://a.abcam.com/ps/datasheet/images/140/ab140128/Helicobacter-pylori-Primary-antibodies-ab140128-1.jpghttps://librepathology.org/w/images/thumb/1/14/Stomach_with_intestinal_metaplasia_--
_intermed_mag.jpg/300px-Stomach_with_intestinal_metaplasia_--_intermed_mag.jpg
HE
Alcian blue-
PAS
IH
• H. pylori in the mucus (Giemsa/IH)
• Intestinal metaplasiaGiemsa
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Complications of Chronic Gastritis
• Peptic ulcer
• Mucosal atrophy and intestinal metaplasia
• Dysplasia adenocarcinoma
• MALT-lymphoma (Helicobacter)
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Erosion and Ulcer
• Mucosa
• epithel
• lamina propria
• muscularis mucosae
Submucosa
Muscularis propria
Serosa
Acute erosion/ulcer
Mainly in the stomach
Causes:
• Hyperacidity
• Shock
• Stress-operation/trauma
• Cushing ulcer (CNS injury)
• Steroid ulcer
• Curling ulcer (burn)
Chronic ulcer
duodenum:stomach (antrum)
4:1
Causes:
• H. pylori
• NSAID
• Smoking
• Alcohol
• Hyperacidity
• Gastroduodenal reflux
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Pathogenesis of Peptic UlcerNormal
• Defensive Forces
• mucus
• bicarbonate
• blood flow
• prostaglandin
• Damaging Forces:
• Gastric acidity
• Peptic enzymes
mucosa
musc.muc.
submucosa
• Damaging Forces↑• H. pylori
• NSAID
• Smoking
• Alcohol
• Hyperacidity
• Gastroduodenal
reflux
• Defensive Forces↓Eg: ischaemia,
shock
necrotic debris
Infiltration of acute inflammatory cells
granulation tissue
fibrosis
Robbins: Patológia c. könyv nyomán
Ulcer
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Peptic Ulcer
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Peptic Ulcer
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Complications
• Hemorrhage
• Perforation
• Penetration
• Scar formation (eg: stenosis of pylorus)
• Malignant transformation
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Gastric Adenocarcinoma
90-95% of gastric tumors: adenocarcinoma
Early symptoms = symptoms of chronic gastritis (dyspepsia,
nausea)
Late symptoms: loss of weight, anorexia, ‘meat disgust’,
altered bowel habits, anaemia, hemorrage
Survival (5 years):
Early gastric cancer: 90%< (T1N0M0)
Advanced gastric cancer: 20%>
Prognostic factors:
Local invasion (pT)
Regional lymph node metastasis (pN)
Distant metastases
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Types of Gastric Cancer
(Lauren classification)
Intestinal
Exophytic /ulcerated
(heaped-up borders)
Glandular structures
Mucin production↑
Precursor:
dysplasia/adenoma
HER2 amplification
Diffuse
Infiltrative
Desmoplastic –
linitis plastica
Discohesive cells
Cytoplasmic mucin
vacuoles
No precursor
E-cadherin loss
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Intestinal type
Pogány Péter szövettani gyak. diasora
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Diffuse type
Képek forrása: Pogány Péter szövettani gyak. diasora
Linitis plastica
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Diffuse type
carcinoma sigillocellulare/
signet ring cell morphology
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GIST
(gastrointestinalis stromal tumor)
Most common mesenchymal tumor of the GI tract
Arises from pacemaker cells (interstitial cells of Cajal)
More than half of the cases are detected in the stomach
75-80% have KIT (CD117) mutation, 10% have PDGFR A
mutation
Peak incidence: 60 years of age
Prognostic factors:
Size
Number of mitoses
Location (more aggressive if arises in the small intestine)
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GIST
Solitary, well-circumscribed, fleshy, submucosal mass, might be
subserosal or intramural.
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GIST