Histopathology 11: Upper G.I pathology Flashcards
In which part of the stomach does H.Pylori tend to reside ?
Pyloric antrum and pyloric canal
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
What is the normal villous: Crypt ratio in the duodenum ?
villous: crypt 2:1
What do goblet cells in the stomach suggest ?
Intestinal Metaplasia
Which risk factors are associated with squamous cell carcinoma of the oesophagus ?
- Smoking and alcohol
- More common in afro-carribeans
Which risk factors are associated with adenocarcinoma of the oesophagus ?
- Barret’s oesophagus
- GORD
- smoking
- obesity
Which cancer is more common in the distal 1/3 of the oesophagus ?
Adenocarcinoma
Which cancer is more common in the middle 1/3 of the oesophagus ?
Squamous cell carcinoma
List 3 causes of acute gastritis ?
- NSAIDS
- Alcohol
- H.Pylori
List 3 causes of chronic gastritis ?
- H.Pylori
- Alcohol
- Pernicious anaemia
What does the presence of lymphoid follicles (MALT) in the stomach suggest ?
- H.Pylori infection
- Increased risk of lymphoma (MALToma)
What is meant by intestinal metaplasia of the stomach ?
-Goblet cells present in the stomach
Which type of cancer is most common in the stomach ?
Adenocarcinoma
What is the type of MALToma as a result of coeliac disease called?
Enteropathy associated T cell lymphoma (EATL)
What are the 3 main histological features of coeliac?
Crypt hyperplasia
Villous atrophy
Increased numbers of intraepithelial lymphocytes
In what condition are increased numbers of intraepithelial lymphocytes in the GIT seen?
Coeliac
How are the villi damaged in coeliac disease?
Cytotoxic T cells
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?
- Columnar metaplasia
- 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
