Esophageal and Stomach Pathology Flashcards
Zencker’s pseudodiverticulum; associated with cervical webs, an acquired anatomic variation
Eosinophilic esophagitis; see eosinophil infiltration (>15/hpf) in mid/distal esophageal mucosa, grossly see corruguated/grooved mucosa; affects primarly kids and young adults, males more than females, often associated with asthma/atopy
Herpetic esophagitis; see erosion of normal squamous epithelium, may see viral inclusions in ulcer debris, caused by type I and II HSV.
CMV esophagitis; almost always in immunocompromised pt’s, see “owl eyes”
Esophageal stricture, a complication of reflux esophagitis
Barrett’s esophagitis; see “salmon pink tongues” of columnar mucosa extending promixally >1cm from gastro-esophageal jxn; see intestinal cell (columnar epithelium) with goblet cells (photo on R)
Barrett’s esophagitis; blue arrows point to areas of columnar epithelium that flank area of well-differentiated, dark-staining/crowded nuclei (green arrow)—bad!
Photo on Right: low grade dysplasia; columnar epithelium with globet cells
Adenomatous type dysplasia of esophagous (low grade); looks like tubular adenoma of colon, sharply defined luminal borders, stratified pencillate nuclei (often with eosinophilic cytoplasm), nuclei retain basal orientation
Low grade dysplasia (adenomatous type); see stratified pencillate nuclei with eosoinphilic cytoplasm, nuclei retain basal orientation.
High grade dysplasia; see crowded cells with large nuclei, loss of basal orientation of nuclei
High grade dysplasia with intraluminal adenocarcinoma
Intramucosal adenocarcinoma
Gross adenocarcinoma
Adenocarcinoma; seen in 5% of pt’s dx’d with Barrett’s, men>women; more common than SCC in the USA, poor prognosis
Invasive carcinoma
SCC of esophagus, most common esophageal carcinoma in the world, usually seen in mid/upper esophagus; major risk factors include smoking and alcohol
A) Normal
B) Dysplasia
C) Invasive SCC
D) SCC—bright pink keratin
Esophageal varicies; often secondary to portal HTN; risk of life-threatening hemorrhage
Esophageal varices
Stomach cardia: foveolar epithelium with glands below
Stomach fundus/body: predominately glandular cells: chief cells (secrete pepsin), parietal cells (produce acid and IF), but with some foveolar epithelium apically (make mucin)
Stomach antrum
Active gastritis; focal epithelial breakdown and local hemorrhage
Hemorrhage gastritis (acute gastritis); disruption of mucosal barrier leading to inflammation and hemorrhage; due to stree (burn, trauma, surgery), local ischemia, exacerbated by NSAIDs, smoking, uremia, drugs, chemo, radiation.
Chronic gastritis; characterized by mucosal atrophy and intestinal metaplasia, see mucosal inflammation secondary to H. pylori or autoimmune processes
H. pylori in stomach
Intestinal metaplasia; complication of H. pylori infection
Chronic gastritis with atrophy; loss of glands results in more “space”
Autoimmune gastritis; anti-parietal cell Ab’s seen on IF; results in chronic gastritis, immune cells attack parietal cells leading to achlorhydria and pernicious anemia
Peptic ulcer
Gastric hypertrophy with protein loss, parietal cell atrophy, and increase mucous cells; rugae of stomach are so hypertrophied looks like brain gyri; precancerous.
Gastric adenoma
Gastric adenocarcinoma
Gastric adenocarcinoma; two main types (intestinal and diffuse)
Gastric adenocarcinoma, Diffuse type; makes up 1/3 of adenoCA, deadliest type; see marked thickening of submocosa, with “signet ring” cancer cells with large mucin vacuoles, interfers with gastric motility.
