Gastrointestinal Stromal Tumour

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 SMALL INTESTINE

 LARGE INTESTINE

 

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           Atypical Fibroxanthoma

           Dr Sampurna Roy MD

 
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 April2007
Small Intestinal Pathology

      

http://www.histopathology-india.net/SmallIntestinePath.htm

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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(TypeB) Gastritis 

Autoimmune Gastritis (Type A) 

Reactive /Reflux/ Chemical Gastritis (Type C)

Lymphocytic Gastritis

Collagenous Gastritis

Granulomatous Gastritis

Eosinophilic Gastritis

Gastric Xanthoma/Xanthelasma

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

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

                      

                 

1. Menetrier's disease (hyperplastic or hypertrophic gastropathy, giant rugal hypertrophy):

Characterized by hypertrophic rugae (1-3 cm in height).

Site: Proximal greater curvature of the stomach or generalized in the body and fundus.

Histological features: Foveolar hyperplasia, glandular atrophy. Elongated, tortuous, dilated gastric pits are lined by mucous secreting cells. Pits extend to the mucosa where they became cystic. Some cystically dilated glands extend into the submucosa, producing gastritis cystica profunda. Lamina propria edematous, infiltrated by smooth muscle  fibers.

Abstracts:

- The natural history of hypertrophic gastropathy (Menetrier's disease). Report of a case with 16 year follow up and review of 120 cases from the literature. Am J Med 1977; 63: 644-652

- Hyperplastic gastropathy. Clinicopathologic correlation. Am J Surg Pathol. 1991;15: 577-585

- Menetrier's disease:  a form of hypertrophic gastropathy or gastritis? Gastroenterology. 1993: 1310-1319

2.  Gastric varices : 

Patients with cirrhosis and portal hypertension. Surround the cardioesophageal junction. In portal hypertensive gastropathy there is mucosal and submucosal capillary and venous ectasia.
Other features: ulceration, erosion, multiple petechiae.

GASTRIC VARISES: Image link (endo)- Gastrolab

3. Gastric  Diverticulum:

Subcardial region. Anatomically weak area. Outpouching of the full thickness of gastric wall. Food impaction and occasionally haemorrhage occurs.

Abstracts:

- Gastric diverticulum. A case report with long-term follow-up and a review of the literature.Minerva Chir. 2003 Aug;58(4):607-13. 

- An unusual case of gastric diverticulosis. Am J Gastroenterol. 1991; 86: 1817-1819

-Stomach diverticula and their clinical significance.Z Gesamte Inn Med. 1988 Apr 1;43(7):193-5.

4. Bezoars:
Foreign bodies in the stomach. (Trichobezoar : hair. Phytobezoar:  vegetable matter).
5. Dieulafoy lesion (calibre persistent artery):

Middle aged & elderly men. On lesser curve of the stomach within 6 cm of gastro-esophageal junction . Histologically, abnormal, large muscular artery , 1.5 mm in diameter, run  through submucosa and approach mucosa. Superficial erosion often present.

Abstracts:
- Gastric hemorrhage due to ruptured arteriovenous malformation (Dieulafoy's disease). Pathology 1986; 18: 54-57

Multiple arterial caliber persistence resulting in hematomas and fatal rupture of the gastric wall.  Am J Surg Pathol. 1982; 6:83-86

- Fatal rupture of gastric aneurysm.  Arch Pathol. 1955 ; 59: 363-371

6. Angiodysplasia :

Dilated , distorted and dysplastic vessels lined by endothelium.  Small amount of smooth muscle fibre maybe present.  The vessels have an abnormal distribution and aberrant morphology. Vascular channels are separated from the gastric lumen by single layer of endothelial cells.

 ANGIODYSPLASIA OF STOMACH :Image link (endo)- Gastrolab

7. Gastric Amyloid :

Rare lesion. Differential diagnosis: Elastosis & elastofibromatous changes.

Abstracts:

-Elastosis and elastofibromatous change in the gastrointestinal tract: a clinicopathologic study of 13 cases and a review of the literature.Am J Clin Pathol. 2004 Aug;122(2):232-7.

-Laceration of gastric mucosa associated with dialysis-related amyloidosis.Clin Nephrol. 2005 Dec;64(6):448-51.

-A case report of localized gastric amyloidosis.World J Gastroenterol. 2003 Nov;9(11):2632-4.

- Localised primary amyloidosis of stomach presenting with gastric haemorrhage. Acta Med Scand 1987;221:115-119

- Amyloid tumors of the gastrointestinal tract. A report of two cases and review of the literature. Am J Gastroenterol 1985; 80: 784-786
 

                       

8. Gastric xanthoma/ xanthelasma
 
9. Gastric Antral Vascular Ectasia (GAVE) "watermelon stomach".

Telangiectatic lesions on the  parallel longitudinal rugal folds of the antrum. Endoscopically: Distinctive parallel, intensely red stripes.

Histological features: Stripes correspond to markedly dilated tortuous mucosal capillaries. Vessels contain fibrin thrombi. Fibrohyalinosis with fibromuscular hyperplasia of the lamina propria  may be present.

Abstracts:

-Histopathologic changes are not specific for diagnosis of gastric antral vascular ectasia (GAVE) syndrome: a review of the pathogenesis and a comparative image analysis morphometric study of GAVE syndrome and gastric hyperplastic polyps. Am J Clin Pathol. 1998 May;109(5):558-64.

- Gastric antral vascular ectasia. Hum Pathol 1991 ; 22: 1053-1055

- Gastric antral vascular ectasia. A histologic and morphometric study of "the watermelon stomach" Am J Surg Pathol 1987 ; 11: 750-757

1.IMAGE LINK:click(NEJM) ;2.IMAGE LINK:click(MUSC);

3.IMAGE LINK:click(Greensonlab) ;4.IMAGE LINK click(Greensonlab)
Soft Tissue Pathology;

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 ;Vascular tumours ; Fibroblastic/ Myofibroblastic tumours ; Myofibroblastic tumours ;  Fibrohistiocytic tumours ; ChondroOsseous tumours ; Soft TissueTumours of Uncertain Differentiation ; Notochordal Tumour -Chordoma ;Extra-adrenal Paraganglioma ; Gastrointestinal Stromal Tumour ;

 
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