Pathology: Lecture 1 = Mouth & oesophagus and Lecture 2 = Stomach Flashcards
look at photo of normal oesophagus - slide 7.
What is an important line in the oesophagus?
look at photo of normal oesophagus - slide 7
= Z line
look at histological slide of oesophagus - slide 9.
look at histological slide of oesophagus - slide 0
what are some inflammatory disorders of the oesophagus?
1) acute oesophagitis (rare)
2) chronic oesophagus (common)
what is acute oesophagitis?
= corrosive following chemical ingestion
- infective in immunocompromised patiens. e.g. cadidiasis, herpes, CMV
what is chronic oesophagittis also known as?
= reflux diseases “reflex oesophagitis”
- rare causes include Crohn’s disease
what is reflux oesophagitis?
= inflammation of oesophagus due to reflex low pH gastric contents
what might reflux oesophagitis be due to?
= defective sphincter mechanism +/- hiatus hernia
= abnormal oesophageal motility
= increased intra-abdominal pressure (pregnancy and obese people)
how would reflux oesophagus show microscopically?
1) basal zone epithelial expansion
& lengthening of papillae
2) intra-epithelial neutrophils, lymphocytes and eosinophils
what are complications of reflux?
1) ulceration (bleeding)
2) stricture
3) Barrett’s Oesophagus
what is Barrett’s oesophagus in pathological terms?
= replacement of stratified squamous epithelium by columnar epithelium
when does Barrett’s oesopjaus occur?
= due to persistent reflux of acid or bile
what may cause Barrett’s oesophagus?
= due to expansion of columnar epithelium from gastric glands or from sub-mucosal glands
- may be due to differentiation rom oesophageal stem cells
- protective response, faster regeneration
what macroscopically would you see in Barrett’s oesophagus?
= red velvety mucosa in lower oesophagus
what would you see under a microscope, hidtrologically, in Barrett’s oesophagus?
1) columnar lined mucosa with intestinal metaplasia
describe eh mucosa in barrette’s oesophagus and what does this cause an increased risk of developing?
= unstable mucosa (contains damage)
+ increased risk of developing dysplasia & carcinoma and adenocarcinoma of oesophagus
+ requires surveillance although value of this is disputed
what is allergic oeosphagitis?
= eosinophilic oesophagitis
what do people with allergic oeosphagitis present with?
- personal/family history of allergy
- asthma
- young
- males > females
- pH probe negative for reflux
- increased eosinophils in blood
what would the oesophagus look like in allergic oeosphagitis?
- corrugated (feline) or spotty’ oesophagus
describe the histological appearance in allergic oeosphagtiis?
= large numbers of intra-epithelial eosinophils
what could you treat allergic oeosphagitis with?
= steroids
= chromoglycate
= montelukast
what is a common type of benign oesophageal tumour?
= squamous cell papilloma
- rare
- papillary
- asymptomatic
- HPV related
what are 4 other benign oesophageal tumours?
- Leiomyomas
- Lipomas
- Fibrovascular polyps
- Granular cell tumours
what are 2 examples of malignant oesophageal tumours?
1) squamous cell carcinoma
2) adenocarcinoma
describe the epidemiology and causes of squamous cell carcinoma?
= commoner in males
Causes;
- vit A/zinc deficiency
- tannic acid/strong tea
- smoking, alcohol
- HPV
- oesophagitis
- genetic
describe the histological appearance of squamous cell carcinoma?
= Severe dysplasia a in squamous layer
what does squamous cell carcinoma cause?
= obstruction and dysphagia
what would you see macroscopically in squamous cell carcinoma?
- keratin formation
- invasive type squamous cells
where is adenocarcinoma of oesophagus most common?
- in lower 1/3 of oesophagus
- commoner in males/obese individuals
describe the pathogenesis of adenocarcinoma of oesophagus?
1) genetic factors, reflux diseases, others
2) chronic reflux oeosphagitis
3) Barret’s oesophagus (intestinal metaplasia)
4) low grade dysplasia
5) high grade dysplasia
6) adenocarcinoma
similarly to squamous cell carcinoma, what does adenocarcinoma cause?
= obstruction and dysphagia
what are the 3 mechanisms for metastases of carcinoma of oesophagus?
1) direct invasion
2) lymphatic permutation
3) vascular invasion
what may you present with if there is a carcinoma of oesophagus?
Dysphagia;
- due to tumour obstruction
General symptoms;
- anaemia
- weigh loss
- loss energy
= due to effects of metastases
what are 2 other oesophageal pathology?
1) mallory Weiss tear
2) oesophageal varices
what is the cancer most common to oral cavity ?
oral squamous cell carcinoma
what do oral squamous cell carcinomas present with and what are high risk and low risk sites?
- white, red, speckled, ulcers or lumps
High risk sites;
- floor of mouth
- lateral border of venture tongue
- soft palate
- retromolar pad
- tonsils pillars
RARE;
- on hard palate
- dorsum of tongue
what are the causes of oral squamous cell carcinomas?
1) Tobacco
2) Alcohol
3) Betel quid
4) Viral - HPV (p16)
5) Chronic infections
6) Nutritional deficiencies
7) Genetics
8) Post Transplant
9) Pt with history of primary oral SCC, increased risk of developing new second primary
what do ALL malignant squamous epithelium show?
= invasion and destruction of local tissues
what are variants of malignant squamous epithelium?
- verrucous and acantholytic
describe the differentiation of malignancy?
- Well-differentiated tumour cells very obviously squamous with ‘prickles’ and keratinization
- Moderately differentiated
- Poorly differentiated, may be difficult to identify tumour cells as epithelial
what are the features relating to prognosis of squamous cell carcinoma?
1) Tumour diameter
2) Depth of invasion
3) Pattern of invasion- cohesive versus non-cohesive front
4) Lymphovascular invasion
5) Neural invasion by tumour
6) Involvement of surgical margins
7) Metastatic disease
8) Extracapsular spread of lymph node metastases
what are the tumour stages of cancers?
= TNM system
T= greatest diameter of tumour, structures invaded N= lymph node status M= metastasis
Eg pT2N1MX
how do you treat it?
1) surgery
2) adjuvant therapy
LECTURE 2 - pathology of stomach
LECTURE 2 - pathology of stomach
what are 2 inflammatory disorders of the stomach?
1) acute gastritis
2) chronic gastritis
what is acute gastritis and what are 4 possible causes?
= irritant chemical injury
caused by;
- severe burns
- shock
- severe trauma
- head injury
what is chronic gastritis and what are 3 possible causes?
- auto-immune
- bacterial
- chemical
what are 3 rare inflammatory disorders of the stomach?
- lymphocytic
- eosinophilic
- granulomatous
what bacteria is associated with chronic gastritis?
= H. pylori
how would you identify chronic gastritis?
red, inflamed stomach
what happens in auto-immune chronic gastritis and what does it result in? (rare)
= anti-parietal and anti-intrinsic factor antibodies attack causing atrophy and intestinal metaplasia in body of stomach
Resulting in;
= pernicious anaemia, microcytic, due to B12 deficiency
+ increased risk of malignancy
- SACDC
what happens in H. pylori associated chronic gastritis? (most common)
= bacteria inhabits a niche between epithelial cell surface and mucous barrier
- excites early acute inflammatory response
- if not cleared, then a chronic active inflammation ensures
what is critical in H. pylori associated chronic gastritis?
IL8
what type of bacteria is H. pylori involved in chronic gastritis?
= gram negative curvilinear rod like.
what produces anti- H. pylori antibodies and what does it increase the risk of?
= lamina propria plasma cells
Increasing risk of;
- of duodenal ulcers
- of gastric ulcers
- of gastric carcinoma
- of gastric lymphoma
what is chemical gastritis due to?
- NSAIIDS
- alcohol
- bile regluc
what happens in chemical gastritis?
= direct injury to mucus layer by fat solvents
what is chemical gastritis marked by?
= epithelial regeneration, hyperplasia, congestion and little inflammation
- may produce erosion and ulcers
what is peptic ulceration?
a breach in gastro-intestinal mucosa as a result of acid and pepsin attack
what are chronic peptic ulcers and what are 4 common sites for them?
= ulceration which is longstanding and deep
Common sites;
- duodenum (1st part)
- stomach (junction of body and antrum)
- oesophagi-gastric junction
- stomal ulcers
describe the pathogenesis of chronic duodenal ulcers?
= increased attack and failure of defence
- increased acid in duodenum produces gastric metaplasia, and leads to H. pylori infection, inflammation, epithelial damage and ulceration
ALSO - failure of mucosal defence
describe the morphology of peptic ulcers?
2-10cm across
- edges clear cut, punched out
describe the microscopic appearance of peptic ulcers?
- layered appearance
- Floor of necrotic fibrinopurulent debris
- Base of inflamed Granulation tissue
- Deepest layer is fibrotic scar tissue
what are 5 complications of peptic ulcers?
1) perforation
2) penetration
3) haemorrhage
4) stenosis
5) intractable pain
what are 2 examples of benign (polyps) gastric tumours?
1) hyperplastic polyps
2) cystic fundic gland polyps
what are 3 examples of malignant (tumour) gastric tumours?
1) carcinomas - adenocarcinomas
2) lymphomas
3) gastrointestinal stromal tumours (GISTs)
what is the major cause of gastric adenocarcinomas?
= H. pylori
patients with H. pylori infections/anti-bodies have higher risk of cancer
describe the pathogenesis of gastric adenocarcinomas?
1) H. pylori infection
2) chronic gastris
3) intestinal metaplasia/atrophy
4) dysplasia
5) carcinoma
what are 4 other pre-malignant conditions associated with gastric adenocarcinoma?
1) pernicious anaemia
2) partial gastrectomy
3) HNPC/Lynch syndrome
4) menetrier’s disease
what are 2 sub-types of gastric adenocarcinomas?
1) intestinal type
- exophytic/polypoid mass
2) diffuse type
- expands/infiltrates stomach wall
describe the appearance of gastric adenocarcinomas?
= raised rolled edges
what does benign peptic ulcers mimic?
= cancer but is more punched out and lacks raised rolled edges
describe the histological appearance of adenocarcinomas intestinal type?
= gland formation
describe histological appearance of gastric adenocarcinomas - diffuse type?
= red and bloody
what are 3 possible histological appearance of gastric adenocarinnomas - in diffuse form?
1) linitis plastica
2) signed ring type
3) sclerosis
what is the difference between intestinal and diffuse gastric adenocarcinoma?
Intestinal = slightly better prognosis
where does gastric adenocarcinoma spread to locally?
= into other organs and peritoneal cavity and ovaries … Kruckenberg
= lymph nodes
= haematogenous (liver)
describe gastric lymphoma?
= maltoma
- associated with H. pylori infection
- continuous inflammation inducing an evolution into a clonal B cell proliferation… low grade lymphoma
- if unchecked into evolves into a high grade B cell lymphoma
