Lecture 81 - Pathology of Gastric Disease Flashcards
what are the different parts of the stomach?
what cells are located in each?
what are two kinds of epithelium?
where does H pylori like to live?
Cardia — distinct region that resembles the pylorus
Body and Fundus – Parietal cells, Chief Cells
Parietal cells – targetted by Auto-immune gastritis
Antrum – Mucus Cells; G Cells
H pylori likes to live here (+ antrum)
Pylorus –
The stomach has two types of mucosa: Antral and Fundal
Gastritis vs Gastrophy
symptoms of gastropy?
common causes of gastrophy?
Gastritis – marked inflammation; often in an acute or severe phenomena
Gastrophy -- more common but less severe; Catch all for mild inflammation
Uncertain clinical significance; some asymptomatic
Common symptoms: pain and heart burn
Causes: NSAIDs, bile reflux, EtOH, Coffee, Cocaine,
major causes of Gastritis?
H. Pylori -- main cause Autoimmune Gastritis -- second most common cause of gastritis Chemical Gastritis : Bile, Iron Crohn's Gastritis: Zollinger Ellison Syndrome - Infectious
H. Pylori Gastritis
what are you looking for on histology?
Histology – PMNs (active gastritis); THe organism itself (lives in the mucous glands of the cardia and the antrum)
H. Pylori Gastritis - complications
PUD
Intestinal Metaplasia —-> Gastric Carcinoma
Similar to progression in Barrett’s
Lymphoma (MALToma)
*Intestinal Metaplasia – A complication in the setting of H pylori:
the good?
the bad?
Short Term: good function –
H pylori can’t live in intestinal type epithelium,
Long term: Bad -- not wide spread enough to actually eradicate the infection; predisposes to carcinoma
*Lymphoma (MALToma) - marginal zone lymphoma —complication of H. pylori gastritis
Stimulated by H. Pylori ongoing exposure
Autoimmune Gastritis
– what is it –
where in the stomach?
whats seen on histology?
Auto-immune destruction of intrinsic factor and Parietal cells
Presents with Pernicious Anemia
A/w other auto immune phenomena
Histology – Antrum and the Fundus (parietal cell locations)
(Can get a form a metaplasia – Fundal – > Antral Mucosa)
Gradual destruction of the mucosa (“atrophic gastritis”)
Lots of Inflammation
Autoimmune Gastritis -
Complications:
Anemia, PUD, Intestinal Metaplasia,
Neuro-endocrine cell Tumors
Neuro-endocrine cell Tumors — complication of the auto-immune gastritis
whats happening?
prognosis?
what should you stain for?
Loss of acid secretion –> hypergastrinemia –> overgrowth of ECLs
Linear hyperplasia –> nodular hyperplasia –> Neuro-endocrine Tumors
Typically indolent; low malignant potential Positive for Synaptophysin
Chemical Gastritis
- what can cause it?
histological changs?
bile and iron
Foveolar hyperplasia/elongation; may resemble villi of the small intestine
Complex glandular architecture (“corkscrew”)
Vascular congestion – looks red and inflammed
Chemical Gastritis – Iron Pill –
histology?
treatment?>
Iron apparent in the lamina propria and crusted along surface
Tx – stop taking Iron pills
Zollinger Ellison Syndrome leading to gastrin?
why/how?
hypergastrinemia, increased acid, duodenal ulcers
Overgrowth of the fundic mucosa in response to gastrin
what is a heterotopias ?
what are the two types of the Stomach?
clinically insignificant; Right kind of tissue but in the wrong place;
Antral heterotopias
Pancreatic Heterotopias
Antral heterotopias
Pancreatic Heterotopias
what are they?
Antral heterotopias –
Histologically unremarkable antral type mucosa in the body or the fundus
Clinically inconsequential
Pancreatic Heterotopias -- Piece of normal pancreatic that during embryogenesis wound up in the stomach. Usually incidental and clinical
what are the two types of Polyps seen in the stomach?
Hyperplastic Polyps –
Fundic gland polyp –
Hyperplastic Polyps –
what is it?
histology?
risk factors?
Abnormal growths of the stomach which may harbor intestinal metaplasia, dysplasia or carcinoma
Histology: Overgrowth of Foveolar epithelium; cystically dilated glands Antral type mucosa
Risk factor: Gastritis (h pylori, auto immune)
Fundic gland polyp –
two associations:
benign of malignant?
Associations;
- long term PPI use — totally benign
- FAP (familial adenomatous polyposis; mutation of APC)
polyp itself is benign, but condition itself dangerous ( Risk of colon cancer – 100%)
Gastric Polyposis Syndrome
what is the mutation?
what is it?
clinical significance?
Characterized by multiple gastric polyps; usually fundic gland polyps
Associated with mutations in APC
Cancer Risk – need screening and colonoscopy
Two premalignant conditions of gastric cancers?
what is the gross path distinction?
Gastric Dysplasia — appears as a flat lesion; often associated with metaplasia;
Adenoma – denotes glandular polyp with at least a low grade dysplasia
The bigger the polyp – the higher the grade/chance of malignancy
histological features of adenoma?
types of gastric adenomas?
May be intestinal (goblet cell)
May be gastric type (foveolar cells)
Dark Epithelium = increased replication; high N:C ratio
Mucin Depletion = cells spending less time on normal function;
two gastric malignancies to know
Adenocarcinoma –
Neuro-Endocrine Tumors:
Gastric Adenocarcinoma –
– what are two types?
Intestinal vs Diffuse
- E cadherin (classically associated with breast cancer), KRAS, p53, APC
Intestinal type Gastric adeno-carcinoma - Risk factors? - histological features? Gross path: - prognosis?
– mutations?
Risk factors: H pylori, Smoking
Diet – more so in Japan
histological: Cohesive glands;
gross path: typically discrete fungating masses or ulcers
prognosis: Much better prognosis; good outcomes if caught early enough
- E cadherin (classically associated with breast cancer), KRAS, p53, APC
Diffuse type Gastric adeno-carcinoma
- (not associated with…)
- histological feature?
gross path? - Genetics?
-prognosis?
Not associated with H Pylori
gross: Diffuse thickening of the stomach (linitis plastica = leather bottle stomach” )
histo: Very dis-cohesive; Signet Ring
EPI: usually younger patients (30s); typically found at late stage
Genetics: Usually sporadic
Outcomes: very poor; rapid progression to death
Neuro-Endocrine Tumors:
classifed by associatieon and morphology?
which has the worse prognosis?
Type 1 - - associated with auto immune gastritis; indolent (best prognosis)
Type 2 – associated with ZE (intermediate severity)
Type 3– sporadic; worst prognosis
Neuro-Endocrine Tumors:
— stains for…?
Histo – dark nodulating groups of cells
Synpatophysin Stain
Two vascular d/o of the stomach to know …
GAVE – Gastric Antral vascular Ectasia – “Watermelon Stomach”
CAP -(Caliber Persistent Artery)- Dieulafoy Lesions
GAVE – Gastric Antral vascular Ectasia – aka ….?
who gets these?
what are they?
a/w?
outcomes?
Elderly women
Dilated Capillaries with fibrin thrombi; in the setting of gastropathy
Autoimmune assocation
• Can Bleed- acute or chronic - -but usually just chronic discomfort
CAP -(Caliber Persistent Artery)
aka?
what is it?
outcomes?
managment?
Dieulafoy Lesions
• Large-caliber artery going up to surface — if it erodes just starts spurting tons of blood;
Recurrent bleeding without other symptoms
can be fatal
• Typically managed endoscopically
