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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. Helicobacter pylori associated(TypeB) Gastritis Reactive /Reflux/ Chemical Gastritis (Type C) Other Non-Neoplastic Gastric Lesions Benign tumour and tumour- like lesions Gastrointestinal Stromal Tumour |
Normal histology of the small intestine for anatomic pathologists An approach to evaluation of small intestinal biopsy. Malabsorption syndrome (causes and clinical investigations) Enteropathy-associated T-cell lymphoma
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A careful and systematic approach to
examination of gross specimen is essential for accurate interpretation
of the microscopic features.
Indications: |
| Handling
of specimen: - Specimen ideally received fresh after resection. - Paint the margins before opening the specimen - Stomach opened along greater curvature. (Opened along lesser curvature in case of focal lesion on greater curvature.) - Opened stomach pinned on corkboard. (Stomach kept under tension to avoid shrinkage artifact). - Corkboard floated on a bath containing 10% formalin for 24-48 hrs. Note: A diagram is useful to record the site of lesion and blocks, specially in case of more than one lesion. Blocks:- (see diagram --->) |
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following gross features must be recorded in the report: 1. Type of specimen: Total or partial gastrectomy specimen or esophagogastrectomy specimen. Mention whether spleen or pancreas is included. 2. Length of greater curvature. 3. Length of lesser curvature. 4. Length of esophagus and duodenum (if included). 5. Lesion: Site: (pylorus,antrum, body, O-G junction, lesser curve,greater curve, anterior wall or posterior wall) Dimensions: (length,width & thickness) Distance from resection margins: Gross subtypes: Advanced carcinoma (see diagram --->). Gross types of early gastric carcinoma: click Gross features of gastric stromal tumour: click Gross features in case of gastric dysplasia: click 6. Describe rest of the mucosa- Erosions : Acute gastritis: click Gastric ulcers : click Hemorrhagic folds (GAVE) ; Thickened rugal folds in Menetrier's disease. Mucosal atrophy- Autoimmune gastritis: click 7. Macroscopically enlarged lymphnode : Described - Site and dimension recorded. |
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Lymphnode examination in gastrectomy specimen:
D = Stands for
level of dissection of lymph node |
| Further reading:
Stomach. In: American Joint Committee on Cancer: AJCC Cancer Staging Manual. 6th Ed. New York, NY: Springer, 2002. pg 99-106. Reporting protocol (CAP): CLICK
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(click on the image for enlarged view)
Gross subtypes of advanced carcinoma (click on each image)
External Image Links: (Tumour Board.com;Webpath)
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 4.
GRANULAR CELL TUMOUR OF THE ESOPHAGUS
REPORTING OF ESOPHAGEAL RESECTION
SPECIMENS
SQUAMOUS EPITHELIAL DYSPLASIA INCLUDING
SQUAMOUS CELL CARCINOMA IN-SITU OF THE ESOPHAGUS
Lesions causing small bowel
obstruction and bleeding -
NORMAL HISTOLOGY OF ESOPHAGUS
Intussusception : Adhesions : Volvulus