Pathology of the GI tract

Question 1

Histopathologist: questions to answer

What should you question about a tissue specimen that you have received?

What should a histopathology report include?

Answer 1

Is the specimen suitable for analysis?

• Is there a lesion? • Is it inflammatory or neoplastic?
• If neoplastic, is this lesion benign, borderline or malignant?
• If the lesion is malignant, what is its prognosis (grade and stage)?

Clinical details • Gross description of the specimen

• Microscopy findings

– Description of the lesions

– Answering the questions precisely (presence of, absence of,..)

• Comment, conclusion and diagnosis

Question 2

What is the general technique done before reporting a specimen?

How is material usually received?

Answer 2

Fixation

• Gross description and sampling
• Processing – Dehydration (– usually overnight – Formalin, alcohol 75, alcohol 90, alcohol 95, xylene, liquid paraffin)

– Embedding in paraffin wax – Cutting thin sections – Staining

• Reporting

Material usually received by the following:

Endoscopic biopsies +++ • Cytology (brushing) • Surgical resection specimens

Question 3

How do you perserve the following tissues?

Cytology

Bioposy

Surgical Specimen?

Question 4

What is this specimen showing

Question 5

What is the pathology of 1 and 2

Answer 5

1) Hepatocellular carcinoma
2) Metastatic deposit of colorectal adenocarcinoma in the liver

Question 6

this is from the stomach what is it

Answer 6

Small gastric soft tissue tumour, 5 g, 3 cm

Question 7

What is this?

Answer 7

Large gastric sarcoma tumour, 2500g, 25 x 25 x 20 cm

Question 8

What can be used to predict drug response in the following:

GIST

Breast adenocarcinoma

Colorectal adenocarcinomas?

Answer 8

KIT in GIST;

EGFR2 in breast adenocarcinoma;

RAS in colorectal adenocarcinomas

Question 9

Which parts of the upper GI are these corresponding to?

What symptoms do you normally get with upper GI problems?

Answer 9

Abdominal or chest pain • Dysphagia • Regurgitation • Discomfort • Bleeding

Question 10

Which lower GI areas are these constituted to?

What are the main symptoms you can get with lower GI pathology?

Answer 10

• Change in bowel habit
• Diarrhoea
• Pain
• Bleeding
• Constipation

Question 11

What is this histology specimen showing?

Answer 11

Gastro-oesophageal reflux • Grading • Ulcerative with/without candida superinfection – Rare etiology • Herpes virus • Human papillomavirus Exclude: - an ulcerated cancer: repeat endoscopy advised -presence of Barrett’s mucosa.