Gastrointestinal Tract Pathology 1 PDF

Gastrointestinal Tract Pathology 1 Diogenis Batsoulis, M.D., M.Sc.  GI Tract Pathology Outline  Oral Cavity/Oropharynx Papilloma Squamous Cell Carcinoma  Esophagus  Stomach  Intestine  Papilloma Most common benign epithe...

Gastrointestinal Tract Pathology 1 Diogenis Batsoulis, M.D., M.Sc.  GI Tract Pathology Outline  Oral Cavity/Oropharynx Papilloma Squamous Cell Carcinoma  Esophagus  Stomach  Intestine  Papilloma Most common benign epithelial neoplasm of the oral mucosa http://www.papilloma-virus.com/oral-papilloma- Image adapted, with permission, from the Iowa Virtual Slidebox (www.mbfbioscience.com/iowavirtualslidebox ) pictures_18.html Papilloma Papilloma Papilloma Laryngectomy for papilloma Papilloma Papilloma  Squamous Cell Carcinoma (O Cavity/Oropharynx) 2 major pathways:  Tobacco and alcohol use  HPV virus (high-risk types HPV 16 and 18) Prognosis: better for HPV-positive than HPV-negative tumors (the former carry less mutations)! HPV vaccine offers promise  Squamous Cell Carcinoma (O Cavity/Oropharynx) Common locations: tongue (more than 50% of cases), floor of mouth Histology: ranges from well to poorly-differentiated (low to high grade) squamous cell carcinoma Cervical lymph nodes are the MOST COMMON sites of regional metastasis  Squamous Cell Carcinoma (Ora Cavity/Oropharynx) Author: Welleschik; this file is licensed under the Creative Commons Attribution- Share Alike 3.0 Unported lic ense Image from http://www.cytopath.co.uk (http://www.cytopath.co.uk/caseofmonthFeb2011.html) Squamous Cell Carcinoma (Oral Cavity) Metastasis in Cervical Lymph Nodes Image from http://www.cytopath.co.uk (http://www.cytopath.co.uk/caseofmonthFeb2011.html)  Squamous Cell Carcinoma (Oral Cavity/Oropharynx): Potential Precursors Leukoplakia Erythroplakia Thisfile is licensed under the Creative Commons Attribution-Share Alike 3.0 Image from: http://www.exodontia.info/Erythroplakia_Erythroplasia.html Unported license  Squamous Cell Carcinoma (Oral Cavity): Potential Precursors Leukoplakia:  white plaque that cannot be scraped away (in contrast to oral candidiasis, commonly seen in immunocompromised patients)  Mostly benign but occasionally represents dysplasia (5% to 25% of cases) Erythroplakia  red plaque  represents dysplasia in 40% of cases; also carcinoma in 50% of cases  Erythroplakia and leukoplakia are often biopsied to rule out carcinoma Santorini, Aegean Sea, Greece  GI Tract Pathology Outline  Oral Cavity/Oropharynx  Esophagus Barrett Esophagus Adenocarcinoma Squamous Cell Carcinoma  Stomach  Intestine  Eosinophilic oesophagitis - Causes dysphagia and sense of food remnant. - Appears microscopically with multiple eosinophils Eosinophilic oesophagitis Eosinophilic oesophagitis Eosinophilic oesophagitis Eosinophilic oesophagitis  Schatzki rings - Bands of fibrous tissue - Response to inflammation/ injuy  Case 1 A 44 year old obese woman presents to you with worsening episodes of “heartburn” Pain occurs 30 minutes after eating most meals and is getting worse when lying down after eating She is also a regular smoker and drinker Endoscopy reveals “salmon pink” mucosa and a biopsy is performed  Barrett Esophagus Metaplasia Cause: acid and bile reflux from the stomach Untreated and long-standing GERD can lead to Barrett Esophagus Barrett Esophagus is seen in around 10% of patients with GERD Clin Endosc. 2014;47 (1):15-22. Publication Date (Web): 2014 January 24 (Focused Review Series: Endoscopic and Endoscopy: “salmon pink” mucosa Molec ularImaging of Premalignant GILesions, Part II) doi:https://doi.org/10.5946/c e.2014.47.1.15 distributed under the terms of the Creative Commons Attribution Non-Commercial License  Barrett Esophagus Squamous to mucin-producing columnar epithelium Image adapted, with permission, from the Iowa Virtual Slidebox (http://www.mbfbioscience.com/iowavirtualslidebox)- Slide 353  Barrett Esophagus Location: lower 1/3 of the esophagus (distal esophagus) Metaplasia is reversible but if insists it might progress to dysplasia; dysplasia might progress to adenocarcinoma Patients with Barrett Esophagus should be closely monitored with endoscopy and biopsy for the possible development of dysplasia/carcinoma!!!  Esophageal Adenocarcinoma Arises most frequently in the the lower one-third of the esophagus (distal esophagus) Most common type of esophageal carcinoma in the West Cause: pre-existing Barrett esophagus that progresses  Adenocarcinoma Image adapted, with permission, from the Iowa Virtual Slidebox(http://www.mbfbioscience.com/iowavirtualslidebox)  Case 2 A 56 year old man presents to the clinic with symptoms of dysphagia and weight loss He is a heavy drinker and smoker On physical examination, you notice both cervical lymphadenopathy and hepatomegaly, as well as a hoarse voice when the patient responds to your questions You order an endoscopy with biopsy Squamous Cell Carcinoma Image adapted from http://link.slidehosting.com/@65031/view.apml  Esophageal Squamous Cell Carcinoma Arises most frequently in the upper and middle thirds of the esophagus Most common esophageal cancer worldwide Causes: alcohol and tobacco  Esophageal Carcinoma Most times, esophageal carcinoma presents late (poor prognosis) Symptoms include dysphagia,weight loss, pain, and hematemesis Squamous cell carcinoma may additionally present with hoarse voice (laryngeal nerve involvement) and cough (tracheal involvement) Aiges, Macedonia, Greece  GI Tract Pathology Outline  Oral Cavity/Oropharynx  Esophagus  Stomach Chronic Gastritis Peptic Ulcer Disease Adenocarcinoma Lymphoma  Intestine  Chronic Gastritis Chronic inflammation of stomach mucosa Classic causes:  H.pylori  Autoimmune Clinical picture: asymptomatic or epigastric pain  Chronic H. pylori Gastritis Presence of chronic inflammation (lymphocytes/plasma cells) Giemsa stain highlights Helicobacter pylori microorganisms Image adapted, with permission, from the Iowa Virtual Slidebox(http://www.mbfbioscience.com/iowavirtualslidebox) Image from: http://oac.med.jhmi.edu/Pathology/Images/048B.gif  Chronic Helicobacter pylori Gastritis Most common form of chronic gastritis Endoscopic biopsy shows inflammation and Helicobacter pylori microorganisms Increased risk for  Peptic ulcer disease  Gastric adenocarcinoma  MALT lymphoma Chronic Helicobacter pylori Gastritis  Chronic Autoimmune Gastritis Due to autoimmune destruction (autoantibodies) of gastric parietal cells Parietal cells normally secrete HCl and intrinsic factor Clinical picture: achlorhydria; pernicious anemia (due to lack of intrinsic factor) Increased risk for gastric adenocarcinoma Chronic Autoimmune Gastritis Chronic Autoimmune Gastritis Chronic Autoimmune Gastritis Chronic Autoimmune Gastritis  Peptic Ulcer Disease Image adapted, with permission, from http://aperio.duhs.duke.edu/Pathology_200/0240_Q%20Stomac h.svs/view.apml?  Peptic Ulcer Disease Might involve the:  duodenum (90%) or  stomach (10%)  Duodenal Ulcer Almost always due to H. pylori Presents with epigastric pain that improves with meals Complications: bleeding, perforation  Gastric Ulcer Usually due to H pylori (75%); other causes include NSAIDs and bile reflux Presents with epigastric pain that worsens with meals Ulcer is usually located on the lesser curvature of the antrum Complications: bleeding, perforation Benign Ulcer Vs Malignant Ulcer These works have been released into the public domain by their author, Ed Uthman. This applies worldwide.  Peptic Ulcer Disease Peptic ulcer is NOT a precursor of malignancy! However, differential diagnosis of ulcers includes carcinoma  Duodenal ulcers are almost never malignant Gastric carcinomas might present as ulcers, also most commonly located on the lesser curvature of the antrum!!!  Peptic Ulcer Disease  Benign peptic ulcers are usually small(< 3 cm), sharply demarcated  Malignant ulcers are usually large and irregular Biopsy is ALWAYS required for a definitive diagnosis in ALL gastric ulcers and gastric masses!!!