Histopathology: Upper GI disease

Question 1

Most common cause of acute oesphagitis?

Answer 1

Acid reflux (GORD)

Question 2

Complications of any pathological process of the GI tract?

Answer 2

Perforation

Ulcuration

Stricture

Haemorrhage

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“PUSH”

Question 3

History of GORD (Reflux oesophagitis), burning retrosternal pain, dysphagia. Oesophageal biopsy shows columnar epthelium metaplasia.

Answer 3

Barrett’s oesophagus

Question 4

Burning retrosternal pain, dysphagia and hiccups. Nil GI or alcohol history. Most likely diagnosis?

Answer 4

Reflux oesophagitis

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Not specific but common things are common

Question 5

History of GORD (Reflux oesophagitis), burning retrosternal pain, dysphagia. Oesophageal biopsy shows columnar epthelium metaplasia without goblet cells. Most likely diagnosis?

Answer 5

Barrett’s oesophagus, with gastric metaplasia

Question 6

History of GORD (Reflux oesophagitis), burning retrosternal pain, dysphagia. Oesophageal biopsy shows columnar epthelium metaplasia with goblet cells. Most likely diagnosis?

Answer 6

Barrett’s oesophagus, with intestinal type metaplasia

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goblet cells means intestinal type metaplasia

Question 7

54 year old male. Dysphagia, retrosternal pain and weight loss. Most likely diagnosis?

Answer 7

Adenocarcinoma of the oesophagus

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Adenocarcinoma more common than squamous cell carcinoma of oesophagus

Question 8

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?

Answer 8

Adenocarcinoma of the oesophagus

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Histology + glands + mucin = Adenocarcinoma

Question 9

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?

Answer 9

Squamous cell carcinoma of the oesophagus

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Cells + intercellular bridges = squamous cells

Squamous cell associated with alcohol and smoking.

Question 10

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?

Answer 10

Acute haemorrhagic gastritis

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Multiple causes, in this case, alcohol and NSAIDs

Question 11

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?

Answer 11

Autoimmune gastritis

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SAT= Stool Antigen Test (+ve for H. Pylori)

Question 12

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?

Answer 12

Bacterial (Helicobacter) gastritis

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diagnosed with a stool antigen test (SAT)

Question 13

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?

Answer 13

Chemical/ reactive gastropathy

Question 14

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?

Answer 14

Iron pill gastritis

Question 15

Signet ring cells are most commonly associated with what disease?

Answer 15

Gastric carcinoma, specifically diffuse type.

Question 16

46 year old man, presents with chronic dyspepsia and weight loss. Gastric biopsy reveals infiltrating epithelial cells showing glandular structures. Most likely diagnosis?

Answer 16

Gastric carcinoma (Intestinal)

Question 17

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?

Answer 17

Gastric carcinoma (Diffuse)

Question 18

Two main types of gastric carcinoma: what are they?

Answer 18

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

Question 19

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?

Answer 19

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”

Question 20

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?

Answer 20

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

Question 21

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?

Answer 21

Duodenitis

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Excess acid causing inflammation of duodenum.

Question 22

Duodenitits, mainly caused by H. Pylori. What other organism should you be mindful of when suspecting duodenitits/ duodenal ulcers?

Answer 22

Tropheryma whippelii: Whipple’s disease

Question 23

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?

Answer 23

Coeliac disease

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ttg antibodies

Endomysial antibodies

Question 24

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?

Answer 24

Duodenal MALT lymphoma

aka Enteropathy Associated T-cell Lymphoma