Gastrointestinal Stromal Tumour

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     Dr Sampurna Roy MD

 
August 2009  
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The final diagnosis of granulomatous gastritis is based on morphological findings and detailed clinical history and laboratory data.                    

Clinicians must provide the following clinical details to the pathologist -  History of immunosuppression , intake of drugs, past history of tuberculosis, sarcoidosis, Crohn's etc.

Macrosopically there is thickening of the gastric wall (D/D infiltrating carcinoma).

Histopathology image

Differential diagnosis:

1. Infectious conditions: Tuberculosis, syphilis, histoplasmosis, mycobacterial infection.

2. Associated with malignancies:  Gastric carcinoma, lymphoma.

3. Foreign body granuloma:  Food granuloma, suture granuloma .

4. Miscellaneous: Crohn's,  sarcoidosis, chronic granulomatous disease of childhood,  allergic granulomatosis and vasculitis, Whipple's disease.

          

Tuberculosis: 
  
Usually the antrum is affected.
   Gross- Thickened wall, shallow ulcers.
   Microscopically- Confluent caseating
   granuloma. Acid fast organisms are
   demonstrated.

-   Syphilis:    
   
Gross: Starts as erosive or ulcerative
    lesion. In later stage the stomach is
    shrunken and fibrotic (leather-bottle)
    Perivascular cuffing;
    Dense plasmacytic infiltrate;
    Glandular destruction;
    Demonstration of spirochetes by silver
    stains.

-    Crohn's:    
    
Usually located in the Gastric antrum.
     In florid condition the following features
     may be present:
     Transmural inflammation
     Pit abscess
     Lymphoid aggregates and prominent 
     lymphoid follicles.       
     Ulcers
     Sarcoid like granuloma

-   Miscellaneous:   Multiple granulomas are observed in  sarcoidosis, Whipple's disease and vasculitis-associated cases.                             

 A clinicopathologic study of 42 patients with granulomatous gastritis. Is there really an "idiopathic" granulomatous gastritis?Am J Surg Pathol. 1996 Apr;20(4):462-70.
"(a) in most cases of granulomatous gastritis, a diagnosis of Crohn's disease or sarcoidosis could be established; (b) the background inflammatory pattern was helpful in suggesting a diagnostic category for granulomatous gastritis; (c) granulomatous gastritis is not associated with H. pylori per se; however, if known cases of Crohn's disease and sarcoidosis are excluded, an association between H. pylori and granulomatous gastritis cannot be ruled out; and (d) IGG, if it exists, is extremely rare. "

Abstracts:

Granulomatous gastritis: a clinicopathologic analysis of 18 biopsy cases. Am J Surg Pathol. 2004 Jul;28(7):941-5.

Granulomatous gastritis. Apropos of 2 cases.Ann Pathol. 2000 May;20(3):261-4.

Histology of the stomach and duodenum in Crohn's disease.Am J Surg Pathol. 1998 Apr;22(4):383-90.

High frequency of helicobacter negative gastritis in patients with Crohn's disease.Gut. 1996 Mar;38(3):379-83.

Granulomatous gastritis: a morphological and diagnostic approach.Histopathology. 1993 Jul;23(1):55-61.

Gastric syphilis. Primary diagnosis by gastric biopsy: report of four cases.Arch Pathol Lab Med. 1993 Aug;117(8):820-3

Granulomatous gastritis and Whipple's disease.Am J Gastroenterol. 1992 Apr;87(4):509-13.

               

 
Visit:  Infectious Granuloma of the Lung  ; Pathological Diagnosis of Granulomatous Lung Diseases ; Non-necrotising Granulomatous Inflammation of the lung ; An approach to Histopathological Examination of Pulmonary Granulomatous Inflammation ;
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 ;

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 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

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

Rosacea

Interstitial Granulomatous Dermatitis

Interstitial Granulomatous Drug Reaction

Granulomatous T-cell lymphoma


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