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          Dr Sampurna Roy MD

 

August 2009

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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

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 GASTRO-INTESTINAL 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 

Drug related lesions of the gastrointestinal tract

- 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

                      
Inflammatory polyps are the most common type of polyp in Inflammatory bowel disease. These polyps usually occur in patients with moderate to severe colitis but persist in patients with quiescent disease.
Inflammatory polyps also occur in association with Crohn's disease and other inflammatory disorders of the GI tract such as ischemic colitis or infectious colitis. These polyps may occur in infective conditions such as amoebiasis, schistosomiasis and bacillary dysentery.
A special form of inflammatory polyp develops in the colon at the site of ureteric implantation where probably due to chemical irritation there is localized expansion of lamina propria and cystic dilatation of glands.
In order to determine the underlying disease it is necessary to examine non-polypoid mucosa, which should be biopsied at the same time.

Formation of inflammatory polyps:

These are developed as a regenerative response to localized or diffuse inflammation and ulceration of the mucosa followed by regeneration of the intervening non-ulcerated epithelium. Eventually the regenerated mucosa become completely re-epithelized and persists above the level of the surrounding mucosa as inflammatory polyps.
Sometimes inflammatory polyps represent spared mucosa surrounding areas of deep ulceration.
Some polyps decrease in size , most remain stable a few may continue to grow if they undergo torsion or prolapse.

Gross:                                          

May be sessile, pedunculated or may consist of long finger-like projection referred to as 'filliform'. These polyps may be single or numerous in number and the size range between 0.5 - 1.0 cm.
'Giant Inflammatory polyps' may cause bleeding, obstruction, prolapse or intussusception.

Histopathological features:

- The inflammatory polyps are characterized by :

Inflamed lamina propria ; distorted colonic epithelium - tortuous, branched, elongated and cystic crypts; surface erosion ; congestion ; haemorrhage ; crypt abscesses.

- In some cases pseudosarcomatous changes are noted characterized by :          

Enlarged spindle or epithelioid shaped multinucleated  bizarre stromal cells.; present at the surface of ulcerated  polyp.

[ D/D - Sarcoma ;  1) These lesions lack atypical mitosis 2) Located within granulation tissue and below areas of ulcerataion 3) Positive for endothelial & myofibroblastic markers].


- Rarely dysplasia or carcinoma may develop in inflammatory polyps. However, the risk of developing dysplasia is very low and these polyps are not considered pre-neoplastic lesions.   ImageLink

                Inflammatory cap polyps:

           Images:  

Inflammatory cap polyps are defined as an inflammatory polyp either with or without prolapse-related changes that contain an overlying 'cap' of necroinflammatory debris and granulation tissue.
These inflammatory polyps may develop in inflammatory bowel disease either primarily or secondarily as a result of peristalsis or trauma induced mucosal prolapse. This may lead to traction & twisting of polyps causing localized ischemic damage, regeneration & repair of the lamina propria & epithelium & the development of an inflammatory polyp. There may be associated diverticular disease.
These polyps are usually isolated lesions, but can be numerous in number -( 'cap polyposis').
Cap polyps are usually located in the sigmoid colon & rectum of adults. These are sessile haemorrhagic polyps, present on the crest of mucosal folds and are less than 1 cm in diameter.
The patients present with rectal bleeding & mucous diarrhea.
In some cases these are also seen in the small intestine complicating carcinoid tumour.

                         

               Polypoid mucosal prolapse:  

- Classical solitary ulcer(mucosal prolapse) can be polypoid.
- May be present in diverticular disease
on the apices of mucosal folds.
- Subsequent to previous surgery (Eg: stomas or pelvic ileal reservoir)
- Inflammatory Cloacogenic polyps- At the anorectal junction. There is florid villiform epithelial hyperplasia. Associated with haemorrhoids and pelvic descent syndromes.
- Inflammatory Myoglandular polyps- Usually in sigmoid colon.

 

Abstracts:

Prolapsing mucosal polyps: an underrecognized form of colonic polyp--a clinicopathological study of 15 cases.Am J Gastroenterol. 2002 Feb;97(2):370-6.

The solitary rectal ulcer today. A review of the literature. Minerva Chir. 1998 Nov;53(11):919-34.

Protruded variants in solitary ulcer syndrome of the rectum. Acta Pathol Jpn. 1988 Apr;38(4):471-8.

Solitary rectal ulcer syndrome. Its clinical and pathological underdiagnosis.Am J Surg Pathol. 1985 Jun;9(6):411-21.

Clinicopathologic comparison of eroded polypoid hyperplasia and solitary rectal ulcer syndrome. J Korean Med Sci. 1994 Aug;9(4):319-27.

Polypoid prolapsing mucosal folds in diverticular disease.Am J Surg Pathol. 1991 Sep;15(9):871-8.

Inflammatory cloacogenic polyp. A unique inflammatory lesion of the anal transitional zone.Am J Surg Pathol. 1981 Dec;5(8):761-6.

Inflammatory cloacogenic polyp: relationship to solitary rectal ulcer syndrome/mucosal prolapse and other bowel disorders.Hum Pathol. 1987 Nov;18(11):1120-5.

Inflammatory cloacogenic polyp in a child: part of the spectrum of solitary rectal ulcer syndrome.Pediatr Pathol. 1993 Jul-Aug;13(4):409-14.

Inflammatory myoglandular polyps of the colon and rectum. A clinicopathological study of 32 pedunculated polyps, distinct from other types of polyps.Am J Surg Pathol. 1992 Aug;16(8):772-9.

Angiogenic polypoid proliferation adjacent to ileal carcinoid tumors: a nonspecific finding related to mucosal prolapse.Mod Pathol. 2001 Sep;14(9) :821-7.

Prolapse- induced inflammatory polyps of the colorectum and anal transitional  zone. Histopathology. 1993;23(1):63-7.

Eroded polypoid hyperplasia of the rectosigmoid.Am J Gastroenterol. 1990 Aug;85(8):975-80.

Filliform polyposis of the colon in chronic inflammatory bowel disease ( so called giant inflammatory polyps).
Z Gastroenterol. 2000 Oct;38(10):845-6, 848-54.

Localized giant inflammatory polyposis of the cecum associated with distal ulcerative colitis.J Gastroenterol. 2003;38(9):880-3.

Filiform polyposis: a case report describing clinical, morphological, and immunohistochemical findings.Clin Investig. 1992 Jun;70(6):520-8.

Polypoid and pseudopolypoid manifestations of inflammatory bowel disease.Radiographics. 1991 Mar;11(2):293-304.

Pseudosarcomatous changes in inflammatory pseudopolyps of the colon.Arch Pathol Lab Med. 1986 Sep;110(9):833-6

Cap polyposis: further experience and review.Dis Colon Rectum. 2004 Jul;47(7):1208-15. Epub 2004 Jun 3

Cap polyposis occurring in the postoperative course of pelvic surgery.Gut. 1994 Nov;35(11):1670-2.

Cap polyposis--an unusual cause of diarrhoea.Gut. 1993 Apr;34(4):562-4

                 

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Pathology of the Intestinal Polyps

Gross examination of polypectomey specimens

Hyperplastic polyps and serrated adenomas

Juvenile polyp ; Peutz-Jeghers polyp ; Inflammatory fibroid polyp ; Multiple Lymphomatous polyposis ;  Lymphoid polyp 

Normal histology of the small intestine for anatomic pathologists

An approach to evaluation of small intestinal biopsy.

Malabsorption syndrome  

Tropical Sprue

Coeliac Disease

Enteropathy-associated T-cell lymphoma

Intestinal lymphangiectasia

Lesions causing small bowel obstruction and bleeding - 
Intussusception : Adhesions : Volvulus

Meckel's diverticulum

Ischemic bowel disease 

Brunner's Gland Adenoma

Duodenal  Gangliocytic Paraganglioma

Lymphoma of the small intestine

Pathogens commonly affecting Small Intestine:

Ascariasis

Cryptosporidium

Cytomegalovirus infection

Giardiasis

Hookworm Infection

Isosporiasis

Microsporidia

Mycobacterium Avium Intracellulare

Schistosomiasis

Whipple's disease

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

Fibroblastic/Myofibroblastic tumours

Myofibroblastic tumours

Fibrohistiocytic tumours

ChondroOsseous tumours

Soft TissueTumours of Uncertain Differentiation               

Notochordal Tumour - Chordoma

Extra-adrenal Paraganglioma

Gastrointestinal Stromal Tumour

Herpes Virus(Herpesviridae)

Herpes Simplex Virus Infection

Herpes Zoster Virus (Shingles)

Histoplasmosis 

Hookworm Infection

Human Papilloma Virus in Cervical Cancer

Impetigo

Infectious Mononucleosis

Lupus Vulgaris

Lyme Disease(Lyme Borreliosis)

Lymphocytic choriomeningitis

Lymphogranuloma Venereum

Malaria


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