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Benign Tumours and Tumour - Like Lesions of Stomach

Dr Sampurna Roy MD


GI Path Online- Home Page Gastric Pathology - Home Page

August  2015

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

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Normal Histology of Esophagus

An approach to the reporting of esophageal biopsies

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 gastrointestinal tract.

 

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

 

- 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 ;

-
Pathology of Amebic Colitis
 ;   

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

               
Histopathology report of a gastric polyp should comment on the following:

- Biopsy or excision specimen

- Histological features of the polyp:

 - Presence of cystic dilatation

 - Lining epithelium of the cyst

 - Presence of muscle fibres in the lamina propria.

 - Inflammatory inflltrate ( Example: presence of eosinophils. )  

- Mention the type of polyp - (Neoplastic or non-neoplastic)

- Presence or absence of dysplasia or malignancy.

- Finally comment on whether the excision is complete. (Not possible in a small biopsy )

A polyp is applied to any nodule or mass that projects above the level of the surrounding mucosa.

Gastric polyps are rare and are found  in 0.4% of adult autopsies and 3-5% of Japanese adults.

Classification: 

1) Regenerative (hyperplastic)

2) Hamartomatous (Example: Peutz- Jeghers, juvenile polyp )

3) Neoplastic (adenomatous polyp).

Note: Some neoplastic lesions present as gastric polyps.

Further reading:

- Gastric epithelial polyps (first part).

- Gastric epithelial polyps (part two).

Visit sites Gastric Carcinoid ; Gastric Lymphoma  ; Gastric Stromal tumour

Non-neoplastic  lesion presenting as as a gastric polyp - Inflammatory fibroid polyp.


Inflammatory Fibroid Polyps:  

Site:  Antrum

Gross: Well circumscribed small sessile or peduculated lesion.

Microscopy :

Blood vessels surrounded by spindle cells (CD34 positive) and chronic  inflammatory cells (mainly eosinophils). Multinucleated giant cells may be  present.

Differential Diagnosis:

Eosinophilic gastritis (diffusely thickened , deformed antrum, eosinophils in peripheral blood). Eosinophilic granuloma (parasitic infection).

Visit: Inflammatory Fibroid Polyp of the Esophagus:

Further reading:

- Inflammatory fibroid polyp of the stomach: a special reference to an immunohistochemical profile of 42 cases. 

- CD34 expression by inflammatory fibroid polyps of the stomach.  


Gastritis Cystica Polyposa:

Site: At the site of gastroenterostomy stoma.

Gross: Multiple sessile polyp around the stoma.

Microscopy:

Resemble hyperplastic polyp.Cystically dilated glands extend through the muscularis mucosae into the submucosa.

Intestinal metaplasia may be present. No evidence of any atypia.
May be associated with development of gastric stump carcinoma.

Further reading:

-Gastritis cystica polyposa: report of 7 cases and literature review.

-Pathologic features and mucin histochemistry of primary gastric stump carcinoma associated with gastritis cystica polyposa: a study of six cases.


Fundic Gland Polyps:   

Common in patients treated with proton pump inhibitors.

May also occur in patients with familial adenomatous polyposis.

These are not premalignant lesions.

Site:  Body and fundus.

Gross:  Multiple transparent, sessile polyps usually less than 1cm in diameter.

Microscopy:

Cystically dilated glands lined by gastric body type mucosa.

Irregular shortened foveolae, smooth muscle fibres around the dilated glands.

Hypertrophy and hyperplasia of parietal cells in patients treated with proton pump inhibitors.

Further reading: 

-Chief cell hyperplasia with structural and nuclear atypia: a variant of fundic gland polyp.

-Gastric fundic polyps: a morphology study using mucin histochemistry, stereometry and MIB1 histochemistry using.

-Sporadic fundic gland polyps: an immunohistochemical study of their antigenic profile.

-The histopathology of fundic gland polyps of the stomach.


                                                   

Hyperplastic polyps:  

Most common type of gastric polyp. (Type I and II).

Polyp formation related to:

-Helicobacter - associated  gastritis.

-Pernicious anaemia

-Adjacent to ulcers and erosions.

-Gastroenterostomy stoma.

Gross:   Sessile or pedunculated.

Less than 2 cm in diameter.

Type I :  Solitary . In the antrum.
Type II : Multiple. In distal fundic mucosa (junction of body and antrum).

Central dimple noted in some cases.

Microscopic feature:

Elongated, tortuous glands, irregular branching.

Glands lined by hyperplastic foveolar-type epithelium.

Cystic changes may be present.

Other features:  Smooth muscle fibres present in lamina propria. ;   Stroma edematous and inflamed. ; Pseudo-invasion may be present.

In Type II hyperplastic polyp, superficial glands show onion-skin like arrangement.

Further reading:

Why is the hyperplastic polyp a marker for the precancerous condition of the gastric mucosa?  

Cardiac glands hyperplastic polyp of the stomach.

A case of gastric hyperplastic polyp with malignant transformation.  


Hamartomatous polyps: Rare in stomach.

Peutz Jeghers polyp: Hyperplastic glands lined by foveolar epithelium. Broad bands of smooth  muscle fibres branch out. 

Juvenile polyp:  Antrum. May be associated with juvenile polyposis. Histologically, the glands are tortuous, elongated, and cystically dilated . Backround mucosa is  edematous and inflamed. 

Polyps in Cronkhite Canada syndrome: (associated  with nail atrophy, alopecia or hyperpigmentation)

Polyps in Cowden's disease: Elongated cystically dilated glands with papillary infoldings. Connective tissue component - neural or muscular.


Pancreatic heterotopia:

May occur as a mass in the pylorus or antrum. Central depression noted on the mucosal surface.

Histological feature : Normal pancreatic acini and ducts are noted.

Further: Pancreatic (acinar)  metaplasia of the gastric mucosa. Histology, ultrastructure, immunocytochemistry, and clinicopathologic correlations of 101 cases.


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