Pathology of the Oesophagus and Stomach Flashcards
What are oesophageal webs?
Mucosal and sub-mucosal webs protruding into lumen
What is achalasia?
Oesophageal sphincter doesn’t open > oesophagus dilates
What is a hiatus hernia?
Part of stomach enters thoracic cavity via oesophageal hiatus in diaphragm
What can cause infective oesophagitis?
Candida
Viral
- CMV
- HSV
In what general types of conditions are numerous eosinophils seen?
Allergic conditions
Parasitic conditions
GORD
Eosinophilic oesophagitis
What is the microscopic appearance of eosinophilic oesophagitis?
Squamous mucosa without any glandular mucosa Acanthotic Moderate basal cell hyperplasia Many areas of oedema Eosinophils
What conditions would be considered if granulomas were present in the oesophagus?
TB
Sarcoidosis
Crohn’s disease
What is the typical age of patients with eosinophilic oesophagitis?
Young - 20s
What is the likely underlying cause of eosinophilic oesophagitis?
Food allergy
How may the patient present clinically with eosinophilic oesophagitis?
Dysphagia
Some may have burning in chest
What is the treatment for eosinophilic oesophagitis?
Avoid triggering food allergens
Immunosuppression with oral steroids if not settling
What part of the oesophagus is best to biopsy in the setting of GORD?
Distal
Compare the severity of GORD and eosinophilic oesophagitis if the middle and upper oesophagus are abnormal, too
GORD ascending disease - if middle and upper oesophagus affected > very severe disease
Eosinophilic oesophagitis affects whole oesophagus
What is the microscopic appearance of GORD?
Elongated stromal papillae
Mild basal cell hyperplasia
Scattered mixed inflammatory infiltrate
What condition can it be difficult to distinguish GORD from on pathology alone?
Eosinophilic oesophagitis, especially if many eosinophils present
What is the pathogenesis of GORD?
Gastric contents get into oesophagus due to relaxed sphincter
What are the risk factors for GORD?
Smoking Alcohol Increased abdominal pressure - Pregnancy - Obesity
How can patients present clinically with GORD?
Central chest pain
Sore throat, sometimes
What is the treatment for GORD?
Antacids
PPIs
What are the potential complications of GORD?
Glandular metaplasia - adaptive response to resist acidic contents of stomach
What does indefinite for dysplasia mean?
In some conditions, especially if inflammation present, unsure if dysplasia/reactive change to inflammation
In which epithelium of the gastrointestinal tract are goblet cells usually present?
Intestinal
What features need to be present for the diagnosis of Barretts’ oesophagus?
Intestinal mucosa - has goblet cells
What is the microscopic appearance of adenocarcinoma in the oesophagus?
Glands with columnar epithelium
Irregular invasive glands lined by cells with large, hyperchromatic nuclei with some loss of polarity and mitoses
What features present in an oesophageal biopsy indicate intestinal metaplasia?
Goblet cells
What features distinguish severe dysplasia from invasive adenocarcinoma?
If limited to crypts = dysplasia
If outside crypts = invasive carcinoma
What is the management of metaplasia, with no dysplasia in an oesophageal biopsy?
Endoscopic surveillance
What is the management of low grade dysplasia in an oesophageal biopsy?
Intensified surveillance
?Mucosal ablation
What is the management of high grade dysplasia in an oesophageal biopsy?
Endoscopic mucosal resection
Prophylactic mucosal ablation
What is the management of intramucosal carcinoma?
Curative treatment
?Endoscopic mucosal resection
What is the management of carcinoma in the submucosa and beyond?
Curative treatment
What are the main types of carcinoma of the oesophagus?
Adenocarcinoma
Squamous cell carcinoma
What are the risk factors for developing adenocarcinoma of the oesophagus?
Barretts’ oesophagus
What are the risk factors for developing squamous cell carcinoma of the oesophagus?
Alcohol
Smoking
Achalasia
What is the macroscopic appearance of candidiasis of the oesophagus?
Whitish plaques
How can the different regions of the stomach be distinguished histologically?
Fundus and body have parietal and chief cells
Antrum has mucus secreting cells
Does the lamina propria of the stomach normally contain many mononuclear inflammatory cells?
No, only a few
What features indicate that the gastric mucosa is specialised?
Presence of parietal and chief cells
Intestinal metaplasia is indicated by the presence of what main feature in the stomach?
Goblet cells
What does active chronic H pylori gastritis look like microscopically?
Inflammatory infiltrate
Occasional lymphoid aggregates in lamina propria
Numerous neutrophils
Occasional H pylori
What if a biopsy report is out of keeping with the clinical impression?
Where is the mistake?
What are the potential complications of H pylori?
Chronic gastritis
Dysphagia
Gastric carcinoma
Gastric lymphoma
Where in the intestine is iron absorbed?
Duodenum
What is melanosis coli?
Discolouration of mucosa
Common in people who take a lot of laxatives
Due to macrophages in lamina propria containing lipofuscin
What are the two main histopathological types of gastric adenocarcinoma?
Intestinal - papillar/tubular architecture
Diffuse - scattered cells
- Signet cells
- Mucinous type
What are the risk factors of gastric adenocarcinoma of the intestinal type?
H pylori gastritis
Consumption of smoked foods
Smoking
Alcohol
What is the first step in management of gastric adenocarcinoma?
Partial/total gastrectomy
What is the significance of perineural invasion of gastric adenocarcinoma?
Malignant cells can hide along nerves > can spread elsewhere in stomach
What is the significance of lymphovascular invasion of gastric adenocarcinoma?
Cancer can spread elsewhere
What are centrocyte and centroblast-like cells?
Major malignant cells in follicular lymphoma
What technique is used to determine if the cells are CD20, CD3, CD5, etc positive?
Immunohistochemistry
Flow cytometry
What types of lymphoma can occur in the gastrointestinal tract?
MALT - most common
Follicular
DBCL
What are two major contributors of prognosis in gastrointestinal stromal tumours (GIST)?
Mitotic rate
Size of tumour
What is CD117?
Growth factor receptor
What is the relevance to the management of GIST if it is CD117 positive?
Can be blocked by tyrosine kinase inhibitors; eg: Glivec
What is the proposed cell of origin of GIST, and what is its function?
Intestinal cells of Cajal
Intermediate between neural and muscle cells
Responsible for peristalsis
