Foregut Pathology

Question 1

Which layer carries gut lymphatics?

Answer 1

submucosal

Question 2

What are the normal structures of the normal esophagus.

Answer 2

basal layers: round cells with more prominent nucleus, mitoses only occurring in the basal layer
flattening keratinocytes as the layers progress upward
vasculature runs through the papillae (papillae reaches halfway through thickness)

Question 3

Describe the histology of reflux esophagitis.

Answer 3

basal cell hyperplasia
vascular congestion
extension of papillae toward the surface
inflammatory cell infiltrate (lymphocytes and eosinophils)
surface is darker pink (reactive)

Question 4

Describe the histology of eosinophilic esophagitis.

Answer 4

prominent intraepithelial eosinophils
eosinophilic micro abscesses (eosinophils clumped together)
intercellular edema
lamina propria fibrosis

Question 5

Describe the histopathology of candida esophagitis.

Answer 5

fungal invasion is required for diagnosis of candida because it is part of normal flora in GI tract

acute inflammation with many PMNs on squamous cells
yeast and pseudohyphae PAS

Question 6

Describe the histopathology of herpes esophagitis.

Answer 6

ulcer with necrotic debris an exudate with PNMs

viral inclusions are present in multinucleated squamous cells at margin of ulcer (Cowdry type A- dense eosinophilic intranuclear and cytoplasmic inclusion with thickened nuclear membrane and halo, Ground-glass inclusions that fill the nuclei)

Question 7

Describe the histopathology of CMV esophagitis.

Answer 7

virus present in enlarged endothelium and stromal cells at ulcer base

basophilic cytoplasm often has coarse intracytoplasmic granules

prominent intranuclear basophilic inclusions surrounded by clear halo (Owl Eye)

Question 8

Contrast high and low grade Barrett’s esophagus-related dysplasia.

Answer 8

high-grade dysplasia shows more severe atypia and architectural complexity, irregular gland structure with different sizes
low grade: maintain basal orientation

both grades of dysplasia show mucus depletion and prominent cytoplasmic basophilia

Question 9

Describe the appearance of squamous cell carcinoma.

Answer 9

normal stratified epithelium in well differentiated carinomas, while poorly differentiated carcinomas have disorganized sheets of cells

Question 10

Describe the appearance of stomach with gastritis.

Answer 10

diffuse erythema

acute inflammatory cells

Question 11

Describe the appearance of H. pylori on stain.

Answer 11

curved S-shaped gram negative rod, usually appearing below mucous layer and/or within the glands

often accompanied by a plasma cell infiltrate