Histopathology 9 - Upper GI disease

Question 1

Layers of the stomach and oesophagues

Answer 1

Mucosa, submucosa and muscularis propria

Question 2

What is the Z-line of the oesophagus?

Answer 2

The point at which the epithelium transitions from being squamous to columnar

Question 3

Which three layers is the mucosa composed of?

Answer 3

Epithelium –> lamina propria –> muscularis mucosa

Question 4

What is an important feature of the oesophagus?

Answer 4

The presence of submucosal glands

Question 5

Name the three MAIN histopathological areas of the stomach

Answer 5

Fundus, body and antrum

Question 6

Main function of body and fundus

Answer 6

They contain the most specialised glands for secreting acid and enzymes

Question 7

Where do you commonly find H.pylori associated gastritis?

Answer 7

Antrum and pyloric canal

Question 8

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

Answer 8

> 2:1

Question 9

Where do the cells of the duodenum proliferate?

Answer 9

In the crypts

Question 10

What happens when the villi get damaged?

Answer 10

The crypts will proliferate and replace the damaged villi

Question 11

Where is it abnormal to find goblet cells and what does this suggest?

Answer 11

Goblet cells should NOT be found in the stomach, if they are then it is suggestive of intestinal metaplasia

Question 12

Most common cause of acute oesophagitis

Answer 12

GORD

Question 13

Histology of acute oesophagitis

Answer 13

NEUTROPHILS

Question 14

2 main outcomes of acute oesophagitis

Answer 14

Ulceration or fibrosis, barrett’s oesophagus

Question 15

Difference between an ulcer and erosion

Answer 15

An ulcer extends beyond the muscularis mucosa (into submucosa) but an erosion is before the muscularis mucosa

Question 16

What is Barrett’s oesophagus?

Answer 16

Metaplastic process with Replacement of the squamous epithelium of the lower oesophagus with columnar epithelium

Question 17

What is CLO

Answer 17

Columnar-lined oesophagus (Seenin Barrett’s)

Question 18

What are the two main types of CLO/Barrett’s

Answer 18

CLO without IM = gastric metaplasia

CLO with intestinal metaplasia (presence of goblet cells)

Question 19

Which type of CLO/Barrett’s has a higher cancer risk?

Answer 19

CLO with IM

Question 20

Difference between metaplasia and dysplasia

Answer 20

Metaplasia is reversible and therefore not pre-malignant like dysplasia, dysplasia shows some of the cytological and histological features of malignancy with no invasion through BM

Question 21

Difference between dysplasia and adenocarcinoma

Answer 21

Adenocarcinoma INVADES through the basement membrane

Question 22

What is the commonest type of oesophageal cancer in developed countries?

Answer 22

Adenocarcinoma of the oesophagus (lower 1/3 of oesophagus)

Question 23

Main cause of adenocarcinoma of oesophagus?

Answer 23

GORD/Barrett’s

Question 24

Most common type of oesophageal carcinoma in Africa?

Answer 24

Squamous cell carcinoma (upper 2/3)

Question 25

SCC oesophagus associations

Answer 25

Smoking and alcohol

Question 26

Histology of Oesophagus SCC

Answer 26

Keratin producing cells + intercellular bridges

Question 27

Histology of oesophagus ACA

Answer 27

Mucin, glandular epithelium

Question 28

2 main causes of acute gastritis

Answer 28

Chemical (NSAIDs, aspirin, alcohol) or bacterial (H.pylori)

Question 29

The ABCDs of chronic gastritis

Answer 29

``` A = Autoimmune (pernicious anaemia) B = Bacterial (H.pylori) C= Chemical D = IBD ```

Question 30

Which part of the stomach do anti-parietal cell antibodies effect?

Answer 30

The body

Question 31

Which part of the stomach do the bacterial and chemical causes of chronic gastritis affect?

Answer 31

THe antrum

Question 32

Lymphoid follicles in the stomahc, what is the cause?

Answer 32

H.pylori infection causing MALT (associated with increased risk of lymphoma)

Question 33

What are atrophic and non-atrophic H.pylori infection associated with, respectively?

Answer 33

Atrophic --> adenocarcinoma | Non-atrophic --> MALToma

Question 34

3 main consequences of H.pylori associated gastritis

Answer 34

CLO --> IM --> Dysplasia Adenocarcinoma (8x increased risk) Lymphoma/MALToma

Question 35

Which strain of H.pylori is most worrying?

Answer 35

Cag-A positive H.pylori: has a needle like appendage which injects toxins into intracellular junctions

Question 36

Other causes of gastritis, commonly seen in immunocompromised people?

Answer 36

CMV, strongyloides

Question 37

What are the two main pathways that lead to GI cancer?

Answer 37

Metaplasia-dysplasia pathway which is seen in upper GI cancers Adenoma-carcinoma pathway (has polyps etc, lower GI)

Question 38

Technical definitino of gastric ulcer

Answer 38

Depth of the tissue loss goes beyond the mucosa (into the submucosa)

Question 39

What feature determines the difference between chronic and acute gastric ulcers?

Answer 39

There is fibrosis in chronic ulcers

Question 40

What should be done to ALL gastric ulcers?

Answer 40

They shuold be biopsied to eXCLUDE MALIGNANCY

Question 41

Complications of ulcers

Answer 41

Perforation (peritonitis), bleeidng (anaemia, shock)

Question 42

Characteristic feature of gastric intestinal metaplasia

Answer 42

Presence of goblet cells in the stomach mucosa

Question 43

Which type of gastric carcinoma is most common?

Answer 43

Adenocarcinoma

Question 44

Some other types of gastric cancer

Answer 44

SCC, MALToma, GIST, NETs (Zollinger Ellison syndrome)

Question 45

How can gastric adenocarcinomas be divided?

Answer 45

Intestinal and diffuse

Question 46

Name one type of diffuse gastric adenocarcinoma

Answer 46

Signet ring tumour (Can metastasise to ovaries = Krukenbger tumour)

Question 47

What type of tumour is a gastric MALToma?

Answer 47

B cell NHL

Question 48

Cancer associated with chronic immune stimulation by H. Pylori

Answer 48

Gastric MALToma (B CELL1!!)

Question 49

Cancer associated with Coeliac disease

Answer 49

Duodenal MALToma AKA EATL (T CELL LYMPHOMA!!!)

Question 50

How can H.pylori affect the duodenum?

Answer 50

Increased acid in the antrum spills in to the dudoenum --> chronic inflammatin --> gastric metaplasia

Question 51

What is the only cause of duodenal ulcers?

Answer 51

H.pylori

Question 52

Why do we not biopsy duodenal ulcers?

Answer 52

They are ALWAYS benign

Question 53

Common parasite in children which causes duodenitis?

Answer 53

Cryptosporidium

Question 54

Histopahtological features of malabsorption/Coeliac

Answer 54

Villous atrophy, crypt hyperplasia and INCREASED intraepithelial lymphocytes (>20 per 100 epithelial cells)

Question 55

Lymphocytic duodenitis vs coeliac

Answer 55

You get increased intraepithelial lymphocytes/inflammatory changes WITHOUT any architectural changes. Usually have coeliacs or are going to develop it.

Question 56

What does the diagnosis of coeliacs require?

Answer 56

Both serology (anti-endomysial and anti-TTGs) and a biopsy on gluten rich diet

Question 57

What is another cause of malabsorption with a similar histology to coeliacs?

Answer 57

Tropical sprue