GI tumours upper tract Flashcards
Benign oesophagus
5%
Mesenchymal tumours
squamous papillomas
(Leiomyomas, fibormas, lipomas, haemangiomas, neurofibromas, lymphangiomas, mucosal polyps)
Malignant tumours of the oesophagus:
Squamous cell carcinoma
Adenocarcinoma
Squamous cell carcinoma (90%)
- Incidence: over 50 yo, 5 vs 1/100 000 male to female (Europe) (2:1 to 20:1), geographical variation (Iran, Central China, South Africa and Southern Brazil)
- Dietary factors associated with SSC
o Deficiency of vitamins A, C, riboflavin, thiamine, pyridoxine
o Fungal contamination of foodstuffs
o High content of nitrites/nitrosamines - Lifestyle factors: burning hot beverages and food; alcohol and tobacco
- Oesophageal disorders associated: long-standing oesophagitis and Achalasia
- Genetic predisposition
Morphology of SCC. Where is it? What does it look like?
20% upper third, 50% middle third, 30% lower third
Small, grey-white, plaque-like thickenings that become tumourous masses
Three patterns:
1. Protruded polypoid exophytic (60%)
2. Flat, diffuse, infiltrative (15%)
3. Excavated, ulcerated (25%)
histology of SCC
squamous epithelium, pleomorphism, hyperchromatism, mitotic figure, degree of atypia (low vs high grade of dysplasia
Clinical features of SCC (remember lymph nodes!)
sphagia
- Extreme weight loss (cachexia)
- Haemorrhage and sepsis
- Cancerous tracheoesophageal fistula
- Metastases (lymph nodes): cervical, mediastinal, paratracheal, tracheobronchial, gastric and celiac
- Prognosis: 5% overall five-year survival
Adenocarcinoma
- Lower thirds of oesophagus
- Age 40, median age 60
- Arises from Barrett mucosa (10%) – intestinal metaplasia caused by gastric reflux
- Tobacco and obesity
Morphology of oesophageal adenocarcinoma, what does it look like?
- Flat or raised patches or nodular masses
- Infiltrative or deeply ulcerative.
Histology of adenocarcinoma
mucin producing glandular tumours
Clinical features of adenocarcinoma:
- Dysphagia
- Progressive weight loss
- Bleeding
- Chest pain
- Vomiting
- Heart burn
- Regurgitation
- Prognosis: 20% over 5-year survival
Rare malignant oesophageal tumours
carcinoid tumour, malignant melanoma, lymphoma, sarcoma
Benign tumours of the stomach
Polyps: nodule or mass that projects above the level of the surrounding mucosa, usually in the antrum
Non-neoplastic polyps
(90%)
o Most small and sessile (without a stalk)
o Hyperplastic surface epithelium
o Cystically dilated glandular tissue
Neoplastic polyps
aka Adenomas (5-10%)
o Contain proliferative dysplastic epithelium
o Malignant potential
o Sessile (without stalk) or pedunculated (stalked)
Are there other common benign tumours of the stomach?
Leiomyomas and Schwannomas are rare
Malignant tumours of the stomach
Carcinoma
Lymphoma
Carcinoid
Mesenchymal
Gastric carcinoma, prevalence
- 90%-95% of malignant tumours of the stomach
- FIfth most common tumour in the world
- High in
o Japan, Chile, Costa Rica, Colombia, China, Portugal, Russia, Bulgaria, Finland
o Six-fold less common in USA, UK, Canada, Australia, New Zealand, France and Sweden
Factors associated with gastric carcinoma
environmental, host, genetic
- Environmental o Infection by H. pylori o Diet o Low socioeconomic status o Cigarette smoking - Host o Chronic gastritis o Gastric adenomas o Barrett oesophagus - Genetic factors o Slightly increased risk with blood group A o Family history o Hereditary nonpolyposis colon cancer syndrome o Familial gastric carcinoma syndrome
Morphology, location of gastric carcinoma
- Pylorus and antrum 50-60%
- Cardia 25%
- The rest is body and fundus. Lesser curvature is involved in about 40% and the greater curvature in 12%
Gastric carcinoma classified on the basis of:
- Depth/degree of invasion (early/advanced)
- Macroscopic growth pattern
Exophytic
Flat or depressed Linitis plastic (leather bottle: diffuse infiltrative gastric carcin)
Excavated - Histological subtype
Histopathology – adenocarcinoma, Lauren Classification: Intestinal type
What cells? Does it resemble other cells? What do the cells contain, where?
o neoplastic intestinal glands (resembling those of colonic adenocarcinoma)
o cells often contain apical mucin vacuoles
(therefore abundant mucin may be present in gland lumen)
Histopathology – adenocarcinoma, Lauren Classification: Diffuse type
What cells? How do they lie? characteristic?
o gastric-type mucous cells (generally do not form glands)
these permeate the mucosa and wall
(as scattered individual cells or small clusters in an infiltrative growth patter)
o Mucin formation expands the malignant cells and pushes the nucleus to the periphery, creating a “signet ring”
other in lauren classification
mixed type
Morphology of gastric carcinoma – does it spread?
All gastric carcinomas eventually penetrate the wall and spread to regional and more distant lymph nodes
