DERS Images Flashcards
Oral leukoplakia
Metaplastic/Dysplastic changes in the oral mucosa
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
Reflux esopagitis
Endoscopic view of Barret esophagus
Replacement of the normal pearly white esophageal squamous mucosa with velvety pink columnar mucosa (aka - serpiginous salmon colored patch)
Barret esophagus
Columnar metaplasia with goblet cells
Barret Esophagus - low grade dysplasia
note the elongated nuclei (used to distinguish between metaplasia and dysplasia)
Barret esophagus - high grade dysplasia
Note extreme disoranization of epithelium
Barium swallow showing esophageal varices
Gross image of esophageal varices
Esophageal varices
Eosinophilic esophagitis
- Marked increase in intraepithelial eosinophils. If there are only a few, it could be reflux esophagitis
Infectious Esophagitis - Herpes Simplex Virus Infection
- Large multinucleated cells seen in esophagus
Infectious Esophagitis - CMV infection
- Owl’s eye nucleus cells seen in esophagus
Esophageal Squamous Cell Carcinoma
Nests of squamous cells
Esophageal Adenocarcinoma
- Infiltrative (past basement membrane)
- Gland formation
- Hemorrhagic
- Occurs near gastroesophageal junction
Chronic gastritis
- Lymphocytes in lamina propria
- Neutrophils in surface epithelium
Chronic gastritis caused by H. pylori
- Reactive lymphoid aggregates seen along surface
Autoimmune gastritis
- Chronic inflammation along the bottom
- Glandular atrophy along the top
Autoimmune gastritis
- Appearance of goblet cells in gastric mucosa
Peptic Ulcer
- Necrotic bottom
- Granulation tissue in the base
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
Diffuse gastric adenocarcinoma
Linea plastica appearance (aka - leather bottle stomach)
Diffuse gastric adenocarcinoma
- Appearance of signet ring cells in gastric mucosa
Intestinal gastric adenocarcinoma
- Ulcer with highly raised margins surrounded by intact rugae
Intestinal gastric adenocarcinoma
- Glandular structures formed by neoplastic cells
GI Stromal Tumor (GIST)
- When cut, holes are seen inside the tumor
- The overlying gastric mucosa appears normal
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)
Chron’s Disease
A - stricture
B - linear ulceration with cobblestone appearance
C - Bowel perforation and serositis
D - Creeping fat
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
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
Chrohn’s Disease
Left - lymphoid aggregates and granulomas seen transmurally
Center - misshapen crypts (also seen in UC)
Right - noncaseating epitheliod granulomas
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
Juvenile Polyp
- Dilated, irregularly shaped crypts containing inflammatory exudate
- Lamina propria contains inflammatory cells
- Surface of polyp may be eroded or ulcerated
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
Top are intestinal adenomatous cells, bottom are normal cells
- Large, hyperchromatic, crowded nuclei (almost stratified appearing)
- Decrease in the number of goblet cells
A - tubular intestinal adenoma
B - villous intestinal adenoma
D - sessile serrated intestinal adenoma
Adenoma with high grade dysplasia
- Nuclei have ascended to the luminal surface of their cells
- Glands have merged to form cribiform glands
Adenoma with invasive adenocarcinoma
- Cribiform glands and desmoplastic stroma seen in submucosa
you know its the submucosa because of the vessels
Familial Adenomatous Polyposis
Tropheryma whippelii
- Enlarged foamy cytoplasm of macrophages in teh cytoplasm
- Marcrophages stain pink with PAS
- Bacilli seen in macrophages with EM
Giardia
Flattened disks with tiny nuclei in the lumen
Cryptosporidium
- Appear as dark purple balls on surface of enterocytes
Esophagitis caused by Candida spp
- Cottage cheese like white lesions/plaques
Esophagitis caused by HSV1
- Small discrete superficial ulcers
Esophagitis caused by CMV
- Flat ulcers that look like volcanoes
Amebic colitis
- The Entamoeba histolytica look like foamy histiocytes with red dots (ingested RBCs)
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
