Gastrointestinal Stromal Tumour

www.histopathology-india.net/GIPath.htm

 SMALL INTESTINE

 LARGE INTESTINE

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- Normal Histology of the Large Intestine

- Interpretation of Large Intestinal Biopsies

- Assessment of abnormalities -1 (lumen, surface epithelium, subepithelial zone)

- Assessment of abnormalities - 2  (crypt density , architecture and epithelium)

- Assessment of abnormalities - 3 (changes in the lamina propria,muscularis mucosae and submucosa)

-Microscopic/ collagenous colitis ;  

- Pseudomembranous colitis ;

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Pathology of Amebic Colitis
 ;   

- Eosinophilic Gastroenteritis ;

- Drug related lesions of the Gastrointestinal Tract

- Gross examination of colorectal resection specimens in  non-neoplastic diseases

Pathology of the Intestinal Polyps

Gross examination of polypectomey specimens

Hyperplastic polyps and serrated adenomas

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Juvenile polyp ; Peutz-Jeghers polyp ; Inflammatory fibroid polyp ; Multiple Lymphomatous polyposis ;  Lymphoid polyp.

An outline of the anatomy and normal histology of the  stomach for pathologists.

Reporting of gastric biopsies (non-neoplastic gastric lesions).

Pathology and pathogenesis of peptic ulcer.

Acute Gastritis 

Chronic Gastritis

Helicobacter pylori associated Gastritis

Autoimmune Gastritis (Type A) 

Reactive /Reflux/ Chemical Gastritis (Type C)

Lymphocytic Gastritis

Collagenous Gastritis

Granulomatous Gastritis

Eosinophilic Gastritis

Gastric Xanthoma

Other Non-Neoplastic Gastric Lesions

Benign tumour and tumour- like lesions

Gastric Lymphoma

Gastric Carcinoid Tumour

Gastrointestinal Stromal Tumour

Gastric Epithelial Dysplasia

Early Gastric Carcinoma

Gross Examination of the Gastrectomy Specimen 

Drug related lesions of the gastrointestinal tract

Myxoid Tumours of Soft Tissue

Classification of Soft Tissue Tumour

Gross examination of soft tissue specimen          

A practical approach to histopathological reporting of soft tissue tumours

Grading of soft tissue tumours

Lipomatous tumours

Neural tumours

Myogenic tumours

Fibroblastic/Myofibroblastic tumours

Myofibroblastic tumours

Fibrohistiocytic tumours

ChondroOsseous tumours

Soft TissueTumours of Uncertain Differentiation               

Notochordal Tumour - Chordoma

Extra-adrenal Paraganglioma

Gastrointestinal Stromal Tumour

                   
Indication of gastric biopsies for  non-neoplastic conditions:

1.  Endoscopic evidence of chronic gastritis or peptic ulcer.
(Remember-  Normal endoscopic finding does not necessarily rule out histological gastritis).
2.  Patients with non-ulcer dyspepsia to assess the Helicobacter pylori status.
3.  Grading of gastritis.
4.  Report other forms of gastritis.
5.  Further biopsy is indicated to assess healing and to differentiate between regenerative changes and true dysplasia.
                   
Acute gastritis is rarely biopsied.
Biopsy sites to assess H. pylori associated gastritis:

-Two biopsies from middle antrum (on lesser and greater curvature, 2-3 cm  from  pylorus)
- Two biopsies from body (lesser curvature and middle of greater curvature)
- One biopsy from the incisura angulus.
 
A systematic approach is necessary for reporting gastric biopsies suspected of having inflammatory lesions.
Good communication between endoscopist and pathologist is necessary. Gastroenterologist and pathologist should jointly design a tissue submission form.
A diagram of the stomach is useful. The endoscopist can indicate the lesion on the diagram.

The request form should include the following information:
- Age and sex
- Symptoms
- Clinical impression
- Endoscopic findings
- Site is crucial. Example-
-Gastritis of antrum and pangastritis have different clinical connotations and risk potential. ( Antral gastritis associated with duodenal ulcer. Pangastritis with  gastric ulcer/cancer ).
-Metaplasia in body type mucosa and loss of specialised cells (due to inflammation) can cause it to look as antral mucosa.
- H/O  intake of drugs  (eg NSAIDS) 
- History of pernicious anaemia
- History of immunosuppression - The history prompts the pathologist to carefully examine the biopsy for infection  (eg. cytomegalovirus).
- Relevant surgical operation.
- Family history of gastric carcinoma or familial adenomatous polyposis
- Results of previous gastric biopsies
 
ASSESSMENT OF THE BIOPSY:

-
Type of mucosa included in the biopsy. In gastritis, antral and corpus biopsies are to be assessed separately.

Biopsy  >   Normal  or  Abnormal

- Abnormal biopsy >   Focal  or   Diffuse lesion (ie. involve surface epithelium, glandular component or stroma., or all three)

- Inflammation : 

i) Type (acute, chronic, mixed,  lymphocytic, plasmacytic, eosinophilic). ii) Site (surface epithelium, pits, stroma, glands).

- Ulceration > Present or absent

- Presence of gastritis:  

-
Ratio of stroma to glands >   Normal or abnormal 
 
Ratio altered due to i) too much stroma  ii) loss of normal mucosal component  iii) due to increased cellularity.

- Expansion of mucosa > i) pit expansion, ii) glandular expansion, iii) expansion by inflammatory infiltrate,  iv) abnormal cellular infiltrate

- Distortion of glands - Note whether the glands are lined up parallel to each other . Branching and irregularity  noted in chemical gastritis & Menetrier's disease.

- Metaplasia -  Intestinal, pyloric, pancreatic , ciliated

-
Blood vessels > Normal or abnormal
   Abnormal features:  Vascular ectasia in chemical gastritis, thrombosed, thickened, atypical features, tumour emboli.

- Microorganisms - Fungi, viral inclusions

- Regenerative changes- Further levels done to  rule out dysplasia.

SPECIAL STAINS:
PAS-  Highlight Candida albicans or other fungi.
AB/PAS-  Intestinal metaplasia is demonstratrated.
High iron diamine/alcian blue- To classify the type of intestinal metaplasia on the basis of mucin type.
Cresyl fast violet, Gimenez, Giemsa,  half Gram, toluidene blue, Warthin starry - To demonstrate Helicobacter pylori

Immunohistochemistry:
  
- To demonstrate specific inclusions (CMV , herpes virus)
   - Anti H. pylori antibody-   Not used routinely.
   ( Used when organisms are few in number) 
 

                  

NOTES ON REPORTING OF GASTRIC BIOPSIES: 

1.  Antral and corpus biopsies reported separately

2. Gastritis classified into:
     
Acute
      Chronic

      Special-  
Reactive/chemical,
                       Lymphocytic
                       Granulomatous
                       Eosinophilic

3. Variables to be graded:
         
          
Chronic inflammation
           Neutrophils (sign of activity)
           Atrophy
           Intestinal metaplasia

4 Non-graded variables:
                   
Haemorrhage
                    Granuloma
                    Erosions
                    Epithelial degeneration
          
5.  A short summary at the end of the report   should include:
         
Etiology (if known)
          Topography (antrum, corpus or 
          pangastritis)
          Morphology (including the variables)         
GRADING:

1. Chronic inflammation:  Increase in lymphocytes and plasma cells in the lamina propria .
Grading: Mild, moderate & severe increase in density.

2.  Activity:  Neutrophil polymorph infiltration of the lamina propria, pits or surface epithelium.
Grading: Mild: Less than 1/3rd of pits & surface infiltrated .
Moderate: 1/3rd   to  2/3rd            "         "
Severe:   More than  2/3 rd           "         "   

3.  Atrophy:   Loss of specialised glands from corpus or antrum. Grading: Mild, moderate or severe loss. Gastric mucosal atrophy: interobserver consistency using new criteria for classification and grading.Aliment Pharmacol Ther. 2002 Jul;16(7):1249-59.

4.  Intestinal metaplasia: 
  Grading: Mild: Less than 1/3rd of mucosa involved
  Moderate: 1/3rd - 2/3rd                 "       "
  Severe:  More than 2/3rd               "       "

5.   Helicobacter pylori: 
Grading:   Mild colonisation: Scattered organisms covering less than 1/3rd of the surface.
Moderate: 1/3rd - 2//3rd  of the surface
Severe: Large clusters or continuous layer over more than 2/3rd  of the surface.
 Histopathology of gastroduodenal inflammation: the impact of Helicobacter pylori. Histopathology . 1995 Jan;26(1):1-15. 

Further reading:

Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994.Am J Surg Pathol 1996; 20: 1161-81

Observer variation in the assessment of chronic gastritis according to the Sydney system.Histopathology. 1994 Oct;25(4):317-22.

                         

 
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   Gastrointestinal Stromal Tumour

   

www.histopathology-india.net/GIPath.htm

NORMAL HISTOLOGY OF ESOPHAGUS

AN APPROACH TO THE  REPORTING  OF ESOPHAGEAL BIOPSIES

BARRETT'S   ESOPHAGUS   (INTESTINAL METAPLASIA  DYSPLASIA  &   ADENOCARCINOMA)

BENIGN TUMOURS AND  TUMOUR - LIKE CONDITIONS  OF  ESOPHAGUS

 1. SQUAMOUS PAPILLOMA OF THE ESOPHAGUS

 2. INFLAMMATORY FIBROID POLYP OF THE ESOPHAGUS

 3. LEIOMYOMA OF THE ESOPHAGUS

 4. GRANULAR CELL TUMOUR OF THE ESOPHAGUS

 5. ESOPHAGEAL CYSTS

 6. GLYCOGENIC ACANTHOSIS

REPORTING  OF  ESOPHAGEAL  RESECTION SPECIMENS

SQUAMOUS  EPITHELIAL  DYSPLASIA INCLUDING SQUAMOUS CELL CARCINOMA IN-SITU OF THE ESOPHAGUS

SMALL CELL CARCINOMA OF THE ESOPHAGUS

DRUG  RELATED  LESIONS  OF  THE GASTRO-INTESTINAL TRACT

Normal histology of the small intestine for anatomic pathologists

An approach to evaluation of small intestinal biopsy.

Malabsorption syndrome (causes  and clinical investigations)

Tropical Sprue

Coeliac Disease

Enteropathy-associated T-cell lymphoma

Intestinal lymphangiectasia

Pathogens commonly affecting Small Intestine

Ascariasis

Cryptosporidium

Cytomegalovirus infection

Giardiasis

Hookworm Infection

Isosporiasis

Microsporidia

Mycobacterium Avium Intracellulare

Schistosomiasis

Whipple's disease

Lesions causing small bowel obstruction and bleeding - 
Intussusception : Adhesions : Volvulus

Meckel's diverticulum

Ischemic bowel disease 

Brunner's Gland Adenoma

Duodenal  Gangliocytic Paraganglioma

Lymphoma of the small intestine

MESOTHELIOMA-ONLINE

Aetiology and Pathogenesis of Mesothelioma

Gross features of Mesothelioma

Microscopic features of Mesothelioma

Cytological Diagnosis of Mesothelioma

Histochemistry and Immunohistochemistry in the diagnosis of  Mesothelioma

Variants of  Mesothelioma

WELL DIFFERENTIATED PAPILLARY MESOTHELIOMA

LOCALIZED MALIGNANT MESOTHELIOMA

MULTICYSTIC MESOTHELIOMA

ADENOMATOID TUMOUR

Electron microscopy of  Mesothelioma

Pseudo-mesotheliomatous Adenocarcinoma

Mesothelioma of Atrioventricular Node

PULMONARY PATHOLOGY

Acute Respiratory Distress Syndrome

Emphysema

Bronchiectasis

Bronchial Asthma

Pulmonary Alveolar Proteinosis

Pulmonary edema


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