Systemic Pathology Series for MBChB III, Gastritis, Ulcers, Tumours and other Gastric

Lesions Dr Edwin Walong MBChB Mmed

(Pathology)11th February 2014

Anatomy

Anatomy

Clinical Manifestations

• Epigastric pain, tenderness• Nausea, vomiting• Bloating, feeling of ‘fullness’ distension• Upper GI Bleeding – Melena Stool,

haematemesis• Nutritional deficiencies, B12

Overview

• Gastritis– Acute– Chronic– Atrophic (Pernicious

Anaemia)– Eosinophilic– Lymphocytic– Sydney Classification

• Peptic Ulcer Disease (including perforation)

• Gastric Neoplasms– Polyps (hyperplastic,

adenomatous)– Gastric Adenocarcinoma– Gastrointestinal Stromal

Tumours– Gastric Lymphomas,

Carcinoids– Metastatic Neoplasms

• Other Gastric Lesions– pyloric stenosis

Gastritis - acute

• Chemical: alkali, acid ingestion

• Dietary - spices• Drugs: Alcohol, NSAIDS

(cox 1), Corticosteroids, Tobacco

• Iatrogenic – instrumentation

• Infections (viral, bacterial)

• Stress – burns, severe illness

Acute haemorrhagic gastritis

Acute haemorrhagic gastritis

Acute Haemorrhagic Gastritis

Infectous Gastritis, EBV

Gastritis - Chronic

• Characterised by chronic inflammation• Aetiology: infections eg Helicobacter pylori.• Exposures as in acute gastritis – reflux,

chemicals, alcohol, etc• Chronic Granulomatous inflammatory lesions• Autoimmune gastritis• Exposure to exessive gastric enzymes,

Zollinger Ellison syndrome, gastric carcinoids

Chronic gastritis

Helicobacter pylori associated gastritis

Helicobacter pylori, Warthin Starry

Helicobacter heilmanii

Helicobacter spp

• Helicobacter heilmanii• Helicobacter felis• Acquired, contamination of contaminated

water, usually in childhood• Strains that produce Cag A are associated with

severe pathology and malignant neoplasms (MALT lymphoma, Gastric Adenocarcinoma

Granulomatous gastritis

Atrophic Gastritis

Gross pathology, atrophic gastritis

Intestinal Metaplasia

Eosinophilic Gastritis

Lymphocytic Gastritis

Systems Grading

Biopsy Sites

Histology Sydney Classification

Overview

• Gastritis– Acute– Chronic– Atrophic (Pernicious

Anaemia)– Eosinophilic– Lymphocytic– Sydney Classification

• Peptic Ulcer Disease (including perforation)

• Gastric Neoplasms– Polyps (hyperplastic,

adenomatous)– Gastric Adenocarcinoma– Gastrointestinal Stromal

Tumours (GIST)– Gastic Lymphomas,

Carcinoids– Metastatic Neoplasms

• Other Gastric Lesions– pyloric stenosis

Peptic Ulcer Disease

Gastric Neoplasms, Benign

Gastric Adenocarcinoma, ulcerated

Gastric Adenocarcinoma, Exophytic

Gastric Carcinoma

Gastric Dysplasia

Gastric Adenocarcinoma

Gastric Adenocarcinoma, Nodal Staging

Histology

• Gastric Adenocarcinoma• Signet Ring Gastric Adenocarcinoma

Gastrointestinal Stromal Tumours

GIST

GIST

• Interstitial cell of Cajal• C – kit mutations (CD 117), Amenable to

targeted therapy (imatinib mesylate)• DOG 1 IHC

Others

• Lymphomas – MALT• Carcinoids, Neuroendocrine Neoplasms• Metastatic Gastric Neoplasms

Overview

• Gastritis– Acute– Chronic– Atrophic (Pernicious

Anaemia)– Eosinophilic– Lymphocytic– Sydney Classification

• Peptic Ulcer Disease (including perforation)

• Gastric Neoplasms– Polyps (hyperplastic,

adenomatous)– Gastric Adenocarcinoma– Gastrointestinal Stromal

Tumours (GIST)– Gastic Lymphomas,

Carcinoids– Metastatic Neoplasms

• Other Gastric Lesions– pyloric stenosis

Congenital – Pyloric Stenosis

Congenital lesions

• Associated with trisomy 21, 9q, etc• Pyloric Atresia, Antral Web, Gastric

Duplication

Hyperplastic lesions- Menetrier’s disease

Museum Specimens, Slide demonstrations