Week 1: Pathology of the stomach Flashcards
1
Q
Chronic gastritis aka H pylori gastritis or Type B chronic gastritis
A
- 50% in over 50 year olds
- pathology: lymphoplasmacytic infiltration in superficial mucosa, predominantly in antrum, may involve body
- reactive lymphoid hyperplasia with lymphoid follicle formation, “lumpy bumpy” appearance
- dx by endoscopy and biopsy
- PMNs seen in lamina propria and antrum mucous glands
- H. pylori in surface mucous layer: Giemsa and silver stain may demonstrate organisms
- intestinal metaplasia may be seen
2
Q
Chronic atrophic gastritis, autoimmune type associated with pernicious anemia, aka Type A
A
- T cell mediated against parietal cells. (not due to antibodies against intrinsic factor, which are present and use as markers)
- lack of intrinsic factor leads to pernicious anemia due to lack of Vit B12
- achlorhydria: don’t have acid produced
- pathology: lymphoplamacytic infiltration around parietal cells. Decreased parietal cels. Rarely see PMNs. Fundus/body type mucosa thins and becomes predominantly mucous cells. intestinal metaplasia present. Absent H. pylori
- gross: flattened mucosa
3
Q
Complications of chronic atrophic gastritis, autoimmune type
A
- hyperplasia of neuroendocrine cells (increase gastrin secretion)
- multiple small carcinoid tumors form
- mild increased risk of gastric adenocarcinoma
4
Q
Acute gastritis
A
- acute mucosal inflammation
- clinical: asymptomatic or assoc. with mild dyspepsia, moderate or severe epigastric pain, nausea and vomiting. Hematemesis and melena.
- mechanism unknown
- causes: NSAIDs, corticosteroids, smoking, EtOH, bile reflux, stress/trauma, intracranial swelling, chemo, ischemia, systemic infections, nasogastric tube, uremia
5
Q
Pathology of acute gastritis
A
- gross: diffuse hyperemia, multiple small superficial erosions or ulcers
- histopath: erosion, lamina propria hemorrhage,
- complication: ulceration with perforation rare
6
Q
Menetrier Disease
A
- rugal hypertrophy
- clinical: rare, males over 40. overproduction of gastric mucin leads to protein loss in intestines
- hypochlorhydria or achlorhydria
- gross: large rugal folds, may have many polyps
- histopath: hyperplasia and cystic dilatation of mucous glands, smooth muscle proliferation in muscularis mucosae
7
Q
peptic ulcer disease: clinical
A
- definition: ulcer is a defect that extends through the mucosa and the muscular mucosa into the submucosa, or deeper at any part of GI tract exposed to gastric acid juice
- cause: helicobacter pylori gastritis increases risk by 10x of PUD over normal
- M>F, over 50 yo
8
Q
Peptic ulcer disease: gross Pathology
A
- solitary large lesion greater than 1cm
- punched out appearance
- mucosa folds radiating out from ulcer. Clean base
- commonly on lesser curvature or between body and antrum
9
Q
Peptic ulcer disease: histopath
A
- ulcer base has necrotic fibrous debris over acute inflammation over granulation tissue (PMNs)
- chronic ulcers: extensive fibrosis deep to granulation tissue, often into muscular wall
- leading edge of ulcer: epithelium shows regenerative hyperplasia and cytologic atypia. Can be confused with malignancy
- biopsy needed
10
Q
Complication of peptic ulcer disease
A
- occult bleeding->iron deficiency anemia
- erosion into large vessel leading to hematemesis and melena
- 10% of deaths in PUD from hemorrhage - perforation: 5% of PUD patients
- chemical peritonitis with board abdominal pain and board like rigidity
- 70% of deaths - Pyloric obstruction: ulceration in pyloric canal or first part of duodenum can lead to fibrosis
- leads to severe vomiting and hypochloremic alkalosis - penetration: ulceration into adjacent organs
- no perforation
11
Q
Mucosal polyps
A
any nodule or mass lesion arising in mucosa that projects above the level of surrounding mucosa
- Hyperplastic polyps (80%). Nil risk of carcinoma. associated with chronic gastritis. small multiple sessile polyps. inflamed lamina propr., hyper plastic reactive changes of gastric pits with serrated lumen. abundant apical mucin.
- Fundic gland polyps (10%): hamartomas. nil risk of carcinoma.
- cystically dilated gastric glands lined by parietal and chief cells or mucous neck cells - Adenomatous polyps (5%): true neoplasms. moderate risk of carcinoma.
- carcinoma occurs away from polypectomy site
12
Q
Gastric adenocarcinoma: overview
A
- most common cancer of stomach (90-95%)
- higher incidence in Japan
- over 50 yos
- more common in blood group A
- precancerous lesions for intestinal variant: chronic atrophic gastritis with pernicious anemia, H. pylori gastritis, adenomatous polyps, dietary nitrites, salt, smoked/pickled foods
- diffuse variant: E cadherin mutation, undefined
- most common in antropyloric region, then cardiac, fundic/body. lesser curvature more common.
13
Q
Gastric adenocarcinoma: pathology
A
- Early: restricted to mucosa and submucosa. small flat mucosal thickening, minimally polypoid and ulcerative. may be months to years before invasion of muscular externa.
- advanced: invaded muscularis externa. most common stage diagnosed. Gross: fungating mass protruding into lumen. Malignant ulcer with raised everted edges. excavated ulcer. infiltrating lesion.
- well-differentiated: well formed glandular pattern, may have solid or papillary areas. columnar to cuboidal, not much intracytoplasmic mucin
- diffuse/poorly differentiated: less common. more among young. infiltrative growth pattern, fibrous or mucoid stroma between cells. intracytoplasmic mucin. may have signet ring
14
Q
Spread of gastric cancer
A
- spread to adjacent organs
- on serosal surface of stomach, can spread throughout peritoneal cavity by seeding or transcoelomic spread
- lymphatic spread to lymph nodes
- hematogenous spread to liver and lungs
- recurrence after gastrectomy is high 20-50%
15
Q
Clinical features of adenocarcinoma of stomach
A
- early: asymptomatic
- late: anorexia, anemia, weight loss, early satiety, hematemesis, melena, gastric outlet obstruction, enlarged firm left supraclavicular lymph node (virchow’s node)
