Gastrointestinal Tract Pathology Overview

Gastrointestinal Tract Pathology 1

• This presentation covers various pathologies of the gastrointestinal tract.
• The presenter, Diogenis Batsoulis, M.D., M.Sc., is affiliated with the European University Cyprus School of Medicine.

GI Tract Pathology Outline

• Oral Cavity/Oropharynx:
  • Papilloma (most common benign epithelial neoplasm of the oral mucosa)
  • Squamous Cell Carcinoma
• Esophagus:
  • Barrett Esophagus
  • Adenocarcinoma
  • Squamous Cell Carcinoma
• Stomach:
  • Chronic Gastritis
  • Peptic Ulcer Disease
  • Adenocarcinoma
  • Lymphoma
• Intestine: (Further details not provided in the slides)

Papilloma

• A benign epithelial neoplasm frequently found in the oral mucosa.

Squamous Cell Carcinoma (Oral Cavity/Oropharynx)

• Two key pathways: tobacco/alcohol use and HPV (high-risk types HPV 16 and 18).
• Poorer prognosis for HPV-negative tumors, compared to HPV-positive tumors.
• HPV vaccines show promise.
• Common sites are the tongue (over 50% of cases) and the floor of the mouth.
• Histology varies from well differentiated to poorly differentiated types.
• Cervical lymph nodes are a common site for regional metastasis.

Eosinophilic Esophagitis

• Causes dysphagia (difficulty swallowing) and a sense of food remaining in the esophagus.
• Characterized microscopically by multiple eosinophils.

Schatzki Rings

• Bands of fibrous tissue, a response to inflammation or injury.

Case 1

• A 44-year-old obese woman with worsening "heartburn-like" symptoms whose pain worsens when lying down after meals.
• A regular smoker and drinker.
• Endoscopy revealed "salmon-pink" mucosa, necessitating a biopsy.

Barrett Esophagus

• A condition resulting from acid and bile reflux from the stomach.
• Characterized by metaplasia in the esophagus (stomach-like cells replacing normal esophageal cells).
• Untreated long-standing GERD can lead to Barrett's esophagus.
• Approximately 10% of patients with GERD exhibit Barrett's esophagus.
• Endoscopy reveals "salmon pink" mucosa.
• Metaplasia is reversible; however, if it persists, it can progress to dysplasia and potentially adenocarcinoma.
• Close monitoring with endoscopy and biopsy is crucial for patients with Barrett's esophagus.

Esophageal Adenocarcinoma

• Most commonly develops in the lower one-third of the esophagus.
• The most common esophageal cancer in Western populations.
• Often arises from a pre-existing Barrett's esophagus.

Case 2 

• A 56-year-old male presents with dysphagia (difficulty swallowing).
• A heavy smoker and drinker.
• Physical exam reveals cervical lymphadenopathy and hepatomegaly (enlarged liver) along with a hoarse voice.
• Patient underwent an endoscopy and biopsy to explore the cause of his symptoms.

Esophageal Squamous Cell Carcinoma

• Most frequent in the upper and middle parts of the esophagus.
• The most common esophageal cancer worldwide.
• Causes often involve alcohol and tobacco use.

Esophageal Carcinoma

• Often diagnosed at a late stage due to poor symptoms at early stages.
• Common symptoms include dysphagia, weight loss, pain, and hematemesis.
• Squamous cell carcinoma can also present with hoarse voice (laryngeal nerve involvement) or cough (tracheal involvement).

Stomach

• Chronic Gastritis: Inflammation and irritation of the stomach lining, with common causes including H. pylori infection and autoimmune responses.
• Peptic Ulcer Disease: A sore or lesion in the lining of the stomach or duodenum that can either be benign or malignant (requires biopsy for diagnosis).

Chronic H. pylori Gastritis

• The most common form of chronic gastritis, where inflammatory response involves lymphocytes/plasma cells.
• Helicobacter pylori (bacteria) is frequently identified through microscopy (Giemsa stain).
• This infection increases the chance of peptic ulcers, gastric adenocarcinoma, and MALT lymphoma.

Chronic Autoimmune Gastritis

• Results from the immune system attacking and damaging the gastric parietal cells.
• Loss of HCl and intrinsic factor causes achlorhydria (lack of hydrochloric acid in the stomach) and pernicious anemia (anemia due to lack of intrinsic factor).
• Increased risk of gastric adenocarcinoma.

Peptic Ulcer Disease

• Peptic ulcers are not precursors for cancer.
• Duodenal ulcers are rarely malignant.
• Most gastric cancers develop as ulcers predominantly on the lesser curvature of the antrum.
• Biopsies are crucial for distinguishing benign from malignant ulcers.

Explore the various pathologies affecting the gastrointestinal tract in this in-depth analysis presented by Diogenis Batsoulis, M.D., M.Sc. This presentation covers conditions related to the oral cavity, esophagus, stomach, and more. Gain insights into common benign neoplasms and cancers affecting these vital organs.