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PCM1 Exam 4 > DERS Images > Flashcards

DERS Images Flashcards

1
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Oral leukoplakia

Metaplastic/Dysplastic changes in the oral mucosa

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2
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Reflux esophagitis

Intraepithelial eosinophils. But only a few, if there are more than ~15 per HPF, it’s probably eosinophilic esophagitis

Also, basal zone hyperplasia

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3
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Reflux esopagitis

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4
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Endoscopic view of Barret esophagus

Replacement of the normal pearly white esophageal squamous mucosa with velvety pink columnar mucosa (aka - serpiginous salmon colored patch)

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5
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Barret esophagus

Columnar metaplasia with goblet cells

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6
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Barret Esophagus - low grade dysplasia

note the elongated nuclei (used to distinguish between metaplasia and dysplasia)

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7
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Barret esophagus - high grade dysplasia

Note extreme disoranization of epithelium

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8
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Barium swallow showing esophageal varices

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9
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Gross image of esophageal varices

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10
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Esophageal varices

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11
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Eosinophilic esophagitis

  • Marked increase in intraepithelial eosinophils. If there are only a few, it could be reflux esophagitis
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12
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Infectious Esophagitis - Herpes Simplex Virus Infection

  • Large multinucleated cells seen in esophagus
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13
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Infectious Esophagitis - CMV infection

  • Owl’s eye nucleus cells seen in esophagus
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14
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Esophageal Squamous Cell Carcinoma

Nests of squamous cells

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15
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Esophageal Adenocarcinoma

  • Infiltrative (past basement membrane)
  • Gland formation
  • Hemorrhagic
  • Occurs near gastroesophageal junction
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16
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Chronic gastritis

  • Lymphocytes in lamina propria
  • Neutrophils in surface epithelium
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17
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Chronic gastritis caused by H. pylori

  • Reactive lymphoid aggregates seen along surface
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18
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Autoimmune gastritis

  • Chronic inflammation along the bottom
  • Glandular atrophy along the top
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19
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Autoimmune gastritis

  • Appearance of goblet cells in gastric mucosa
20
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Peptic Ulcer

  • Necrotic bottom
  • Granulation tissue in the base
21
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Peptic Ulcer

  • Round/Oval punched out hole with slightly raised margins

If the hole is >2cm or the margins are very raised, it’s probably an ulcer caused by a gastric adenocarcinoma

22
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Diffuse gastric adenocarcinoma

Linea plastica appearance (aka - leather bottle stomach)

23
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Diffuse gastric adenocarcinoma

  • Appearance of signet ring cells in gastric mucosa
24
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Intestinal gastric adenocarcinoma

  • Ulcer with highly raised margins surrounded by intact rugae
25
Intestinal gastric adenocarcinoma * Glandular structures formed by neoplastic cells
26
GI Stromal Tumor (GIST) * When cut, holes are seen inside the tumor * The overlying gastric mucosa appears normal
27
This could be any mesenchymal tumor but this is a picture of a GI Stromal Tumor (GIST) * Whorls and/or bundles of spindle fibers (seen in all mesenchymal tumors)
28
Chron's Disease A - stricture B - linear ulceration with cobblestone appearance C - Bowel perforation and serositis D - Creeping fat
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Ulcerative Colitis * Erythematous loss of mucosal folds starting at the rectum and moving proximally with a clear demarcating line (unless its pancolic) * Remaining mucosal folds have pseudopolyps
30
Ulcerative Colitis * Left - only mucosal and submucosal involvement * Center - cryptitis (neutrophils in epithelium of crypts) * Right * Misshapen crypts (also seen in Crohn's) * Psedopyloric metaplasia of crypt epithelium
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Chrohn's Disease Left - lymphoid aggregates and granulomas seen transmurally Center - misshapen crypts (also seen in UC) Right - noncaseating epitheliod granulomas
32
Celiac Sprue * Flattening and widening of the villi * Increase of chronic inflammatory cells (macrophages and lymphocytes) in the lamina propria * Crypt elongation, thickening, and deepening * Increase in number of intraepithelial lymphocytes. \>30 lymphocytes per 100 enterocytes
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Juvenile Polyp * Dilated, irregularly shaped crypts containing inflammatory exudate * Lamina propria contains inflammatory cells * Surface of polyp may be eroded or ulcerated
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Peutz Jegher Polyp * Misshapen but not dilated crypts * Arborization - smooth muscle surrounding and sectioning off crypts * Crypts are lined with epithelium full of goblet cells
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Top are intestinal adenomatous cells, bottom are normal cells * Large, hyperchromatic, crowded nuclei (almost stratified appearing) * Decrease in the number of goblet cells
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A - tubular intestinal adenoma B - villous intestinal adenoma D - sessile serrated intestinal adenoma
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Adenoma with high grade dysplasia * Nuclei have ascended to the luminal surface of their cells * Glands have merged to form cribiform glands
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Adenoma with invasive adenocarcinoma * Cribiform glands and desmoplastic stroma seen in submucosa you know its the submucosa because of the vessels
39
Familial Adenomatous Polyposis
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Tropheryma whippelii * Enlarged foamy cytoplasm of macrophages in teh cytoplasm * Marcrophages stain pink with PAS * Bacilli seen in macrophages with EM
41
Giardia Flattened disks with tiny nuclei in the lumen
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Cryptosporidium * Appear as dark purple balls on surface of enterocytes
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Esophagitis caused by Candida spp * Cottage cheese like white lesions/plaques
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Esophagitis caused by HSV1 * Small discrete superficial ulcers
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Esophagitis caused by CMV * Flat ulcers that look like volcanoes
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Amebic colitis * The Entamoeba histolytica look like foamy histiocytes with red dots (ingested RBCs)
47
Pseudomembranous colitis * Dilated crypt extending from muscularis mucosae to luminal surface * Crypt filled with fibrinous mucopurulent debris that it has released onto the luminal surface, forming a pseudomembrane

PCM1 Exam 4 (19 decks)

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