Gastrointestinal Stromal Tumour

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

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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

 7.FIBROVASCULAR POLYPS

REPORTING  OF  ESOPHAGEAL  RESECTION SPECIMENS

                
Clinical significance of gastric xanthoma:  This lesion may be confused with a malignant tumour.

Associated with pathological lesions such as chronic gastritis & intestinal metaplasia, atrophic gastritis, and gastric ulcer .

Lipid islands are more common in certain conditions, such as diabetes mellitus, cholesterolosis of the gallbladder, obesity, and arteriosclerosis.  Visit: Dermatopathology Case 30

Age & sex : More frequent in women and its incidence increases with age.

Site: Usually located at the antral and the lesser curvature, but occasionally present in the body or fundus. These lesions are rare in other parts of the gastrointestinal tract. Cases have been reported  in the small intestine, esophagus, and large intestine.

Gross: Single or multiple, round to oval shaped well circumscribed, pale yellow nodule or plaque (1 - 2 mm in diameter).

Microscopic features : Collection of mature lipid laden macrophages within the lamina propria.

 Image Link1 ; Image Link2 ; Image Link3 ; Image Link4

Visit:  Verruciform Xanthoma ; Xanthelasma

Differential diagnosis:  

Signet ring carcinoma : Isolated tumour cells may be present in the lamina propria . The tumour is positive for mucicarmine and cytokeratin. Gastric xanthoma: Positive with Sudan black, oil red O (on frozen section), and CD68, and are negative for PAS/alcian blue, mucicarmine and cytokeratin.

Clear cell carcinoid tumour of stomach : Chromogranin A positive. Packaged appearance of the cells and vascular stroma in xanthoma may mimick neuroendocrine tumour.

Whipple disease and Mycobacterium auium-intracellulare are rare infections of the stomach. Special stains (periodic acid Schiff with diastase and acid-fast bacilli) helps in establishing the diagnosis.

                     

Abstracts:      

Gastric xanthoma: a diagnostic problem on brushing cytology smears.Acta Cytol. 2006 Jan-Feb;50(1):74-9. 

Gastric xantoma: histological findings and clinico endoscopic characteristics in the "Hospital Nacional 2 de Mayo" (1999-2005).Rev Gastroenterol Peru. 2005 Jul-Sep;25(3):268-71.

Xanthelasmas of the upper gastrointestinal tract. J Gastroenterol. 2004;39(3):215-9.

A close relationship between Helicobacter pylori infection and gastric xanthoma.Scand J Gastroenterol. 1999 Apr;34(4):346-52.

Clear cell carcinoid tumor of stomach. A variant mimicking gastric xanthelasma.Arch Pathol Lab Med. 1997 Oct;121(10):1100-3.

Helicobacter pylori infection in gastric xanthomas: immunohistochemical analysis of 145 lesions.Pathol Int. 1996 Aug;46(8):589-93.

Gastric xanthelasma associated diffuse signet ring carcinoma. A potential diagnostic problem. Histopathology 1994 ; 25: 581-582

Gastric xanthelasma in hyperplastic gastric polyposis. Arch Pathol Lab Med 1989; 113: 428-430

Gastric xanthoma: histologic similarity to signet ring cell carcinoma.J Clin Gastroenterol. 1982 Jun;4(3):217-21.

Gastric xanthoma.Am J Gastroenterol. 1976 Apr;65(4):311-7.

                       

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