Peptic Ulcer Disease

Question 1

What is this?
• Describe it.

Answer 1

Peptic Ulcer
• Well circumscribed, punched out lesion without tissue mounding up around it

• Can’t tell just by looking whether its pylori or not

Question 2

What is this? (taken from GI tract)
• Key Features?

Answer 2

Top: Cellular Debris

Bottom: Granulation Tissue with Deposition of CT, Dilated Blood Vessels, and Edema

Between: Fibrinoid Necrosis

Question 3

What defines Active Gastritis?
• Clinically?
• Histologically?

Answer 3

Remember that its ACTIVE GASTRITIS NOT ACUTE Gastritis

Clinically you CANNOT make a diagosis of Gastritis, this is only a Histologic Diagnosis

You need to see:
• Neutrophils actually ATTACKING the CRYPTS (see below where neutrophils are attacking the crypts
***You can actually see H. Pylori in the Cypts here**

Question 4

Where do biopsies for H. pylori need to be taken from?
• How do you expect H. pylori to appear on gram stain?

Answer 4

MUST get the sample from the antrum of the stomach if you want to rule out H. pylori.

• May see Seagulls in the Crypts on H and E

Question 5

What special stains can be used to identify H. Pylori?

Answer 5

Silver Stains or IHC can be used to identify H. Pylori

• Silver Stain is shown below

Question 6

What is shown here?
• Key Features

Answer 6

Shown here is:
• Reactive/Chemical Gastrophy

Key Features:
• Squiggly glands
• Absence of neutrophils and Inflammation

**Compare to normal below

Question 7

What is shown here? (note: this was taken from antrum)
• what is a key thing to remember about H. pylori and tissue like this?

Answer 7

Shown here is:
• Intestinal Metaplasia

**H. pylori cannot live in areas of intestinal metaplasia

Question 8

Shown in the bottom left is IHC staining for H. pylori. What does this mean the tissue is on the right?

Answer 8

Tissue on the right is Chronic Follicular Gastritis (from H. pylori) => because we don’t know whether the proliferation is monoclonal, we can’t call it cancer

Question 9

What is seen here?

Answer 9

This is probably a lymphoma because we see **sheets of cells invading the Crypts

****
I still think you would have to see light chain restriction to call it

Question 10

What freature of intestinal MALT lymphoma is shown here?

Answer 10

Diffuse thinking of the wall due to the MALT lymphoma

**Shown below is white nodules on a serosal surface that is indicative of a MALT lymphoma in the GI tract

Question 11

What stains are key in identifying Lymphomas?

Answer 11

MALT Lymphomas are typically positive for CD19 and CD20 and negative for CD5 and CD10 (aka B cells lymphomas).
They may be positive or negative for CD19 and CD20

Question 12