Histopathology 11: Upper G.I pathology Flashcards by D J

In which part of the stomach does H.Pylori tend to reside ?

Pyloric antrum and pyloric canal

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List the 3 layers of tissue seen on histology of the antrum and body of the stomach ?

Collomnar epithelium
Lamina propria (with specialised acid secreting glands)
Muscularis mucosa

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What is the normal villous: Crypt ratio in the duodenum ?

villous: crypt 2:1

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What do goblet cells in the stomach suggest ?

Intestinal Metaplasia

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Which risk factors are associated with squamous cell carcinoma of the oesophagus ?

Smoking and alcohol

- More common in afro-carribeans

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Which risk factors are associated with adenocarcinoma of the oesophagus ?

Barret’s oesophagus
GORD
smoking
obesity

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Which cancer is more common in the distal 1/3 of the oesophagus ?

Adenocarcinoma

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Which cancer is more common in the middle 1/3 of the oesophagus ?

Squamous cell carcinoma

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List 3 causes of acute gastritis ?

NSAIDS
Alcohol
H.Pylori

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List 3 causes of chronic gastritis ?

H.Pylori
Alcohol
Pernicious anaemia

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What does the presence of lymphoid follicles (MALT) in the stomach suggest ?

H.Pylori infection

- Increased risk of lymphoma (MALToma)

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What is meant by intestinal metaplasia of the stomach ?

-Goblet cells present in the stomach

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Which type of cancer is most common in the stomach ?

Adenocarcinoma

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What is the type of MALToma as a result of coeliac disease called?

Enteropathy associated T cell lymphoma (EATL)

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What are the 3 main histological features of coeliac?

Crypt hyperplasia

Villous atrophy

Increased numbers of intraepithelial lymphocytes

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In what condition are increased numbers of intraepithelial lymphocytes in the GIT seen?

Coeliac

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How are the villi damaged in coeliac disease?

Cytotoxic T cells

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What is the diffuse pattern of gastric adenocarcinoma?

Signet ring cells

Poorly differentiated

What is the intestinal pattern of gastric adenocarcinoma?

Well-differentiated

What is the difference between gastic dysplasia and gastric Ca?

Invasion of basement membrane

What is the key cytological feature of gastric epithelial dysplasia?

High nuclear cytoplasmic ratio

Why might you biopsy a gastric ulcer?

ALL gastric ulcers should be biopsied to exclude malignancy

What are the 3 main causes of acute / chronic gastritis?

Acute:
Aspirin/NSAIDs
Alcohol
H pylori

Chronic: (ABC)
Autoimmune (antiparietal cell Ig)
Bacterial (H pylori, affects antrum)
Chemical (NSAIDs, bile reflux, affects antrum)

What are the most common complications to remember of most GI pathologies?

Ulceration
Haemorrhage
Perforation
Stricture

What is oesophagitis mainly caused by

Reflux Corrosives

Complications of oesophagitis?

Barretts (metaplastic columnar lined oesophagus (CLO)) Malignancy Stricture Haemorrhage

Types of barretts? Which is more likely to become malignant?

1. Columnar metaplasia 2. Columnar metaplasia + goblet cells = intestinal type change 2 is more likely to have malignant transformation

What is methylene blue used for

ulcers

Oesophageal malignancies + epideidemiology + cause?

Upper / mid oesophagus = SCC - Most common worldwide - assc w/ cigarette and alcohol consumption Distal oesophagus = adenocarcinoma - Columnar epithelial transformation - most common in UK due to GORD / oesophagitis

Causes of oesophageal varicies?

Any cause of portal HTN: - Cirrhosis - Portal vein thrombosis - IVC obstruction

Mx of MALToma?

triple threat h.pylori eradication: | - PPI + Calrithromycin + Amox / metronidazole

What type of cancers are gastric cancers?

95% = adenocarcinomas 5% = SCC, Lymphoma, GIST

What are signet rings found in?

Diffuse gastric adenocarcinomas

Biopsy revealing regular stratified squamous cells w/ mucuous glands located in submucosa are found in which organ?

Lower oesophagus

How is coeliac diagnosed?

Bloods: Anti-endomysial Ab +ve Anti-TTG +ve (more sensitive) Gold standard: OGD w/ duodenal biopsy on a gluten rich diet (vilious atrophy) and off gluten diet (normal villi)

Difference in increased intraepithelial lymphocytes seen in coeliac v cancer?

in coeliac it is caused by CD8+ T cells In lymphoma it is B cells

Lymphocytic duodenitis v Coeliac?

Both have increased intraepithelial lymphocytes Lymphocytic duodentitis doesn't have changes to villous architecture

Which strain of H pylori is associated with more aggressive chronic gastritis?

cag-A positive

Histopathology of adenocarcinoma v SCC?

Adenocarcinoma: - Gland forming - Mucin secreting SCC: - Make keratin (even in non-keratinised tissues) - Inter-celular bridges

What are the two cancerous pathways in the GI system?

Metaplasia-dyplasia pathway eg oesophageal cancer, gastric cancer Adenoma-carcinoma pathway eg colon cancer

What is tropical sprue?

- **Tropical sprue** is another cause of malabsorption with very similar histology to coeliac disease - commonly found in tropical regions - marked with abnormal flattening of villi and inflammation of lining of small intestine

What cancer is associated w achalasia?

Squamous cell carcinoma (even though this is in the bottom 1/3rd of oesophagus)

Ulcer v Erosion

Only loss of surface epithelium (mucosa) = erosion Depth of tissue loss goes beyond mucosa (into submucosa and beyond) = ulcer