Histopathology Upper Gi tract Flashcards Preview

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Flashcards in Histopathology Upper Gi tract Deck (62):
1

Oesophagus length

40 cm, this is used to assess degree of change in the oesophagus during endoscopy.

2

inflammatory oesophagus conditions

1. Reflex Oesophagitis
2. Achalasia

3

Oesophageal histology

Non-keratinized squamous epithelium

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Reflux oesophagitis

Reflux of bile salts and stomach acid

5

Risk factors forReflux oesophagitis

Hiatus hernia
Peptic ulcer
Smoking and alcohol
Excessive vomiting
Pregnancy
Diabetes
Surgery of/around GOJ

6

Endoscopy findings Reflux oesophagitis

Normal patches with red inflamed areas

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Reflux oesophagitis Histologically

1. Increased number of inflamed cells
2. Basal hyperplasia
3. Upward extension of vascular papillae

8

Reflux oesophagitis Complications

Stricture
Barrett’s
Neoplasia

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Achalasia: Aetiology

Unknown potentially autoimmune

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Achalasia: Definition

Inflammatory destruction of myenteric ganglion cells – reduced peristalsis

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Achalasia: Long-term complication

Squamous cell carcinoma

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Achalasia: Macroscopically

Lower oesophagus: Destruction = stricture/obstruction distally
Upper oesophagus: Dilation with stagnation of food =
• Inflammation of squamous epithelium which leads prolonged neoplasia – dysplasia – squamous cell carcinoma develops/

13

Infection of oesophagus Types of organisms

Candida
Herpes simplex virus
Trypanosomiasis

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Candida and HSVpresent in

Immunosuppressed patients:
1. Elderly
2. Young – think more serious

15

Endoscopic appearance of candida →

Cottage cheese

16

Trypanosoma cruzi transmitted by

Transmitted in faeces of ‘blood sucking’ reduviid bug – via its bite

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Trypanosoma cruzi effects

• Myocardium: increased inflammation and fibrosis = cardiac failure
• Smooth muscle of GI: inflammation and fibrosis = strictures (pseudo-achalasia)

18

Barretts metaplasia/columnar lined oesophagus Definition

Metaplastic replacement of oesophageal lining by glandular mucosa.

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Barretts metaplasia/columnar lined oesophagus Aetiology

Reflux of gastric (acid) and duodenal (bile) contents into the oesophagus

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Barretts metaplasia/columnar lined oesophagus Endoscopically

Transition of squamous to columnar cells (SCJ) is above the gastrooesophageal junction (GOJ)

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Barretts metaplasia/columnar lined oesophagus Subtypes

1. Gastric Cardia
2. Gastric Body
3. Pancreatic (v. Rare)
4. Intestinal: most likely to form in cancer

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Barretts metaplasia/columnar lined oesophagus Developmental stages to carcinoma

Normal squamous
Barretts
Dysplasia
Adenocarcinoma

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Oesophageal neoplasia: Types of neoplasia


• Squamous cell carcinoma
• Adenocarcinoma
Rare:
• Mesenchymal neoplasms (e.g. leiomyoma)
• Lymphoma

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Oesophageal neoplasia: Squamous cell carcinoma epi

205 of oesophageal cancers
M:F = 3:1
Lower>upper>middle
China, Japan, Iran, South Africa

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Oesophageal neoplasia: Squamous cell carcinoma prognosis

Poor: DXT +/- surgery

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Oesophageal neoplasia: Adenocarcinoma epi

80% of oesophageal neoplasia
Increasing + +
More common in the UK

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Oesophageal neoplasia: Staging

TNM
T3 or less = operable

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Stomach →
Inflammatory:
Histology

Cardiac and antral region similar mucosa

Body/fundus specialised gastric mucosa: parietal and chief

29

gastritis Epi

• More frequently recognised
• Now the commonest form of ‘chronic’ gastritis

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gastritis Causes

• Bile reflux
• Drugs: aspirin, other non-steroidal anti-inflammatory drugs (NSAIDS)
• Alcohol

31

gastritis Histo changes(don’t need to know)

• Extension of glands
• Smooth muscle fibres extended

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Helicobacter Pylori: Disease caused by H. Pylori


Gastritis
Ulcers
2 types of neoplasia:
1. MALT lymphoma
2. Carcinoma

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Helicobacter Pylori: MALT Lymphoma

Mucosa associated Lymphoid tissue

34

Helicobacter Pylori: MALT lymphoma Rx

Eradication of HP with PPI, antibiotics +/- bismuth causes regression of MALT lymphoma

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Helicobacter Pylori: H. Pylori regional

Antrum

36

Carcinoma: Stages in development of gastric carcinoma




1. Normal gastric mucosa (H pylori infiltrates post this)
2. Superficial gastritis
3. Atrophic gastritis (precancerous)
4. Intestinal metaplasia (precancerous) – similar to barretts
5. Dysplasia (precancerous)
6. Carcinoma

37

Carcinoma:H. Pylori WHO

• Most common bacterial infection
• Gastric carcinoma is the 2nd leading cause of cancer-related deaths worldwide
• Class 1 carcinogen

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Carcinoma:Gastric Neoplasia

• Adenocarcinoma
• Lymphoma
• Neuro-endocrine tumour (including ‘carcinoid’)
• CIST (gastrointestinal stromal tumour)

39

Adenocarcinoma of the stomach → Epi

M:F = 3:1
7th commonest cancer killer in UK; was 4th
Japan, Korea, Chile – shows environmental aspect e.g. food when they migrated to the states

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Adenocarcinoma of the stomach →Risk factors

Diet (high in salt, low dairy products)
Helicobacter and intestinal metaplasia

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Adenocarcinoma of the stomach → Prognosis

Poor (<20% 5 yr survival)
Good if early gastric cancer (90% 5 yr survival)

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Adenocarcinoma of the stomach → Use of Herceptin

Slows progression by inhibiting Her2 not a cure.

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GIST → Epi

RARE

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GIST →Common locations

Stomach> SI > oesophagus and large bowel

45

GIST → Mutations

Tyrosine Kinase genes (KIT)

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GIST →Rx

Surgery +/- TKI inhibitors (e.g. imatinib)

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GIST →Histology

Varying histology

48

Coeliac disease: Definition

Malabsorption (e.g. anaemia, low albumin)
Auto-immune disease with an abnormal immunological reaction to gluten

49

Coeliac disease:Rx

Improvement on gluten-free diet
Relapses when gluten re-introduced

50

Coeliac disease:Pathology in small intestine - histology

1. Flat mucosa
2. Reduction in the normal villous height to crypt depth ratio from 5:1 to <3:1
3. Crypt Hyperplasia
4. Increased intraepithelial lymphocytes
5. Infiltration of the lamina propria by plasma cells and lymphocytes

51

Coeliac disease:Complications

6. Refractory sprue (non-responsive to gluten restriction) – could means its neoplastic.
7. Ulcerative jejunitis
8. Neoplasia:
• Enteropathy – associated T-cell lymphoma (EATL)
• Small intestine adenocarcinoma

52

Giardiasis: Organisms

Giardia Lamblia – commonest SI protozoal infection worldwide.

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Giardiasis: Transmision

Contaminated water (person –to- person spreading by faecal-oral transmission)

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Giardiasis: At risk patients

Immunocomprimised patients more likely to be infected e.g. AIDS and common variable immunodeficiency (Ig defiency).

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Giardiasis: histology

Small intestinal mucosa may be normal – or inflamed.

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Small intestinal Neoplasia Types

1. Adeonmas –
2. Adenocarcinoma
3. Lymphoma
4. GIST – gastrointestinal stromal tumours
5. Neuro endocrine tumours

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Small intestinal Neoplasia Adenomas

Duodenal (Familial adenomatous polyposis)

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Small intestinal Neoplasia Adenocarcinoma

Rare (coeliac disease, Crohn’s disease, FAP)

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Small intestinal Neoplasia Lymphomas

B cell e.g. Burkitt’s lymphoma in ileum (can be driven by Epstein barr)
T cell e.g. EATL

60

Neuroendocrine tumours: Common sites

Small intestine
Appendix

61

Neuroendocrine tumours: Macro features

Polyps
Masses
Smaller primary tumours
Large metastasis

62

Neuroendocrine tumours: Subtypes

Carcinoid (liver mets)
Small cell carcinoma

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