Histopathology: Upper GI disease Flashcards
Most common cause of acute oesphagitis?
Acid reflux (GORD)
Complications of any pathological process of the GI tract?
Perforation
Ulcuration
Stricture
Haemorrhage
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“PUSH”
History of GORD (Reflux oesophagitis), burning retrosternal pain, dysphagia. Oesophageal biopsy shows columnar epthelium metaplasia.
Barrett’s oesophagus
Burning retrosternal pain, dysphagia and hiccups. Nil GI or alcohol history. Most likely diagnosis?
Reflux oesophagitis
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Not specific but common things are common
History of GORD (Reflux oesophagitis), burning retrosternal pain, dysphagia. Oesophageal biopsy shows columnar epthelium metaplasia without goblet cells. Most likely diagnosis?
Barrett’s oesophagus, with gastric metaplasia
History of GORD (Reflux oesophagitis), burning retrosternal pain, dysphagia. Oesophageal biopsy shows columnar epthelium metaplasia with goblet cells. Most likely diagnosis?
Barrett’s oesophagus, with intestinal type metaplasia
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goblet cells means intestinal type metaplasia
54 year old male. Dysphagia, retrosternal pain and weight loss. Most likely diagnosis?
Adenocarcinoma of the oesophagus
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Adenocarcinoma more common than squamous cell carcinoma of oesophagus
54 year old male. Dysphagia, retrosternal pain and weight loss. History of reflux. Oesophageal biopsy shows infiltrating cells with glandular differentiation and mucin production. Most likely diagnosis?
Adenocarcinoma of the oesophagus
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Histology + glands + mucin = Adenocarcinoma
54 year old male. Dysphagia, retrosternal pain and weight loss. History of alcohol and smoking. Oesophageal biopsy shows infiltrating cells with intercellular bridges. Most likely diagnosis?
Squamous cell carcinoma of the oesophagus
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Cells + intercellular bridges = squamous cells
Squamous cell associated with alcohol and smoking.
54 year old alcoholic presents with sudden onset retrosternal pain, nausea and vomitting. History of using ibuprofen for headaches. Endoscopy shows numerous punctate erosions which ooze blood. Biopsy shows neutrophillic infiltration. Most likely diagnosis?
Acute haemorrhagic gastritis
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Multiple causes, in this case, alcohol and NSAIDs
54 year old man presents with chronic retrosternal pain, nausea and vomitting. Endoscopy shows numerous punctate erosions which ooze blood. Biopsy shows infiltration of lymphocytes and plasma cells directed towards fundic glands. SAT negative. Most likely diagnosis?
Autoimmune gastritis
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SAT= Stool Antigen Test (+ve for H. Pylori)
54 year old man presents with chronic retrosternal pain, nausea and vomitting. Endoscopy shows numerous punctate erosions which ooze blood. Biopsy shows heavy infiltration of lymphocytes in the lamina propria. SAT positive. Most likely diagnosis?
Bacterial (Helicobacter) gastritis
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diagnosed with a stool antigen test (SAT)
54 year old man presents with sudden onset retrosternal pain, and nausea. ECG is normal. Regularly takes aspirin. Endoscopy shows erythema of the gastric mucosa. Biopsy shows minimal inflammation. SAT negative. Most likely diagnosis?
Chemical/ reactive gastropathy
54 year old man presents with retrosternal pain, and nausea. ECG is normal. Regularly takes iron tablets. Endoscopy shows numerous punctate erosions which ooze blood. Biopsy shows ulceration with yellow-brown pigment. SAT negative. Most likely diagnosis?
Iron pill gastritis
Signet ring cells are most commonly associated with what disease?
Gastric carcinoma, specifically diffuse type.
46 year old man, presents with chronic dyspepsia and weight loss. Gastric biopsy reveals infiltrating epithelial cells showing glandular structures. Most likely diagnosis?
Gastric carcinoma (Intestinal)
46 year old man, presents with chronic dyspepsia and weight loss. Gastric biopsy reveals infiltrating epithelial cells showing poor cohesion, signet ring cells with no gland formation. Most likely diagnosis?
Gastric carcinoma (Diffuse)
Two main types of gastric carcinoma: what are they?
Diffuse type and intestinal type.
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Diffuse type: poorly differentiated
Inestinal type: well differentiated
Rest (5%) of gastric cancers are made of
54 year old man, presents with a palpable upper abdominal mass and weight loss. Gastric biopsy reveals infiltrating mesenchymal cells showing spindle cells with paranuclear vacuoles. Most likely diagnosis?
Gastrointestinal Stromal Tumour
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Specific type of GI (oesophagus to rectum) mesenchymal (Stromal cell) tumour, most common in stomach.
“A connective tissue tumour”
54 year old man, presents with a palpable upper abdominal mass and weight loss. Gastric biopsy reveals infiltrating lymphocytes showing follicle formation. SAT negative. Most likely diagnosis?
Gastric MALT Lymphoma
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Weight loss suggests its not just H. pylori infection
Under normal conditions: lymphoid follicles not present in stomach
46 year old man, burning epigastric pain relieved by eating. history of H. Pylori infection. Endoscopy shows mucosal erythema and superficial erosions in the duodenum. Upon duodenal biopsy, gastric metaplasia is noted. Most likely diagnosis?
Duodenitis
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Excess acid causing inflammation of duodenum.
Duodenitits, mainly caused by H. Pylori. What other organism should you be mindful of when suspecting duodenitits/ duodenal ulcers?
Tropheryma whippelii: Whipple’s disease
46 year old man presents to GP with abdominal pain and diarrhoea. Full blood count shows low Hb with Low MCV. Duodenal biopsy shows villous atrophy. Most likely diagnosis?
Coeliac disease
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ttg antibodies
Endomysial antibodies
46 year old man presents to GP with weight loss, abdominal pain and diarrhoea. Full blood count shows low Hb with Low MCV. Duodenal biopsy shows villous atrophy and large lymphocyte infiltrative mass. History of poor adherence to gluten free diet. Most likely diagnosis?
Duodenal MALT lymphoma
aka Enteropathy Associated T-cell Lymphoma
