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August 2009
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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 |
| Pathogens commonly affecting Small Intestine |
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Hyperplastic polyp is "defined as mucosal
excrescence characterized by elongated serrated crypts lined by
proliferative epithelium in the bases with infolded epithelial tufts and
enlarged goblet cells in the upper crypts and on the luminal surfaces,
imparting a saw-toothed outline". These are the commonest polyps of the sigmoid colon and rectum. These polyps are present in almost 30% - 50% of adult individuals . Small hyperplastic polyps are often found incidentally either on endoscopy or in surgical specimens.
Gross: They are
characteristically sessile and of small size and rarely exceed 5mm in
diameter and are often situated on the crest of the mucosal folds.
Polyps are paler than the backround mucosa. Recent evidence suggests that hyperplastic polyps are neoplastic.High frequency of ras mutations and p53 over expression is present in hyperplastic polyp. Microscopic features:
Images Hyperplastic polyps have a characteristic serrated upper crypts lined by mature cells. The nuclei are ovoid shaped and are basally located. The collagen table is thickened. (Note: The collagen table is not thickened in an adenomatous polyp). Abstracts: |
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Inverted Hyperplastic Polyp:
These are large hyperplastic polyps usually in the right colon of women. These polyps are related to lympho-glandular complexes suggesting micro-anatomical defects as one of the factors that leads to epithelial misplacement. Histologically there is florid epithelial misplacement, inflammation, haemorrhage, in some cases mucin hypersecretion with formation of submucosal mucinous cysts.
Abstracts: Inverted hyperplastic polyposis of the colon.J Clin Pathol. 1993 Jan;46(1):56-60. Inverted hyperplastic polyps of the colon.Am J Surg Pathol. 1985 Apr;9(4):265-72. |
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Hyperplastic Polyposis:
Multiple
hyperplastic polyps occur in relatively young patients. These polyps are
usually more than 50 in number, frequently larger in size and are evenly
distributed throughout the large bowel. The risk of malignancy in all patients with multiple metaplastic polyps relates to the presence of adenomatous change in the polyps and this seems to occur especially in polyps over 1cm. It is important that all such lesions are subjected to histological assessment. Abstracts: Hyperplastic polyposis and the risk of colorectal cancer.Dis Colon Rectum. 2004 Dec;47(12):2101-4. |
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Serrated
Adenoma:
Serrated
adenoma differs from classic hyperplastic polyps in showing unequivocal
epithelial dysplasia , exaggerated serration, crypt dilatation that is
more prominent at the base, horizontal crypts (just above the muscularis
mucosae), absence of thickened subepithelial collagen plate, increased
mucin secretion and large areas without endocrine cells. Summary of histological findings in serrated adenoma:
Images: -Abnormal proliferation/ dysmaturation Abstracts: My approach to serrated polyps of the colorectum.J Clin Pathol. 2004 Jul;57(7):682-6. Hyperplastic polyps and serrated adenomas: colonoscopic surveillance? Surgeon. 2004; 2(2):112-114. |
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Serration can occur in a variety of conditions outside hyperplastic
polyp and serrated adenoma:
1. Solitary ulcer syndrome (polypoid
variant)
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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 4. GRANULAR CELL TUMOUR OF THE ESOPHAGUS REPORTING OF ESOPHAGEAL RESECTION SPECIMENS SQUAMOUS EPITHELIAL DYSPLASIA INCLUDING SQUAMOUS CELL CARCINOMA IN-SITU OF THE ESOPHAGUS |
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- 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 ;
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Pseudomembranous colitis; - Drug related lesions of the Gastrointestinal Tract - Gross examination of colorectal resection specimens in non-neoplastic diseases |
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Pathology
of the Intestinal Polyps
Gross examination of polypectomey
specimens |
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
Lesions causing small bowel
obstruction and bleeding - |
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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 Fibroblastic/Myofibroblastic tumours |