Gastrointestinal Stromal Tumour

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Pathogens commonly affecting Small Intestine:

Ascariasis

Cryptosporidium

Cytomegalovirus infection

Giardiasis

Hookworm Infection

Isosporiasis

Microsporidia

Mycobacterium Avium Intracellulare

Schistosomiasis

Whipple's disease

Pulmonary Squamous Cell Carcinoma

Spindle cell squamous carcinoma

Basaloid carcinoma

Lymphoepithelioma-like carcinoma

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

- 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) 

Normal histology of the small intestine 

An approach to evaluation of small intestinal biopsy.

Tropical Sprue

Coeliac Disease

Enteropathy-associated T-cell lymphoma

Intestinal lymphangiectasia

Brunner's Gland Adenoma

Duodenal  Gangliocytic Paraganglioma

Lymphoma of the small intestine

Benign tumour and tumour- like lesions

Gastric Lymphoma

Gastric Carcinoid Tumour

Gastric Epithelial Dysplasia

Early Gastric Carcinoma

Gross Examination of the Gastrectomy Specimen 

Drug related lesions of the gastrointestinal tract

PULMONARY PATHOLOGY

Normal Anatomy and Histology of the Lung and Airways

Congenital Cystic Adenomatoid  Malformation

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Mycoplasma Pneumonia

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Lymphangioleiomyomatosis

Legionellosis 

Localized Fibrous Tumour of the Pleura

Biphasic Epithelial/ Mesenchymal Lung Tumours

Pulmonary Carcinosarcoma

Pulmonary Blastoma

Large Cell Neuroendocrine tumour

Pneumoconiosis

Silicosis

          

Visit: Esophageal Squamous Cell Carcinoma -Blog

 Superficial carcinoma:     

-Intramucosal carcinoma- Tumour does not invade beyond lamina propria.           
-Superficial or microinvasive carcinoma - Tumour does not invade beyond submucosa.
-Superficial spreading carcinoma- Lateral intramucosal spread of atleast 2 cm  or more beyond invasive lesion.
-Gross features of superficial carcinoma- Verrucous, polypoid, coarse, ulcerative and infiltrating.  
The polypoid variant is more likely  to infiltrate into the submucosa and are associated with metastasis.
-Metastases- In Carcinoma in-situ  and intramucosal carcinoma - Almost no evidence of nodal metastases.  5 year survival 100%.
In superficial carcinoma - 20-50% cases metastasize.  5 year survival 50%

Invasive Squamous cell carcinoma : 

Microscopic Image

Age- Usually in middle aged and elderly male (over 50 years).
Incidence- Highest incidence in  China, Iran, Russia and South Africa.
Etiological factors - Alcohol, tobacco,  betel chewing,  fungal contamination of food,  vitamin deficiency (A,  C, riboflavin, thiamine) , long standing esophagitis, achalasia, celiac disease, Plummer- Vinson syndrome,  tylosis (non epidermolytic palmoplantar keratoderma), human papillomavirus infection ( types 16 and 18).
Presentation- Dysphagia,obstruction, hemorrhage, sepsis secondary to ulceration,fistula formation into respiratory tree with aspiration.
Site- Upper esophagus (20%),middle (50%), lower (30%)
Macroscopic features   Exophytic polypoid (60%), circumferential, ulcerating , diffusely  infiltrative tumour.    Image Link(WebPath) -   Verrucous sqamous cell carcinoma - Large, warty mass with pushing margin.
Microscopic featues- Range from  well to poorly differentated squamous cell carcinoma.  Image Link1 ; Image Link2(WebPath)

Variants:   

 - Verrucous squamous cell carcinoma- Well differentiated bulbous proliferation of squamous  epithelium. Cells demonstrate minimal atypia.
-  Basaloid
squamous cell carcinoma (nests of cells with pale nuclei , microcystic spaces with containing  basophilic material, peripheral palisading is not prominent.  Prominent stromal hyalinization present in some cases). Foci of necrosis and numerous mitotic figures are present.

               

Histological classification of intraepithelial neoplasias and microinvasive squamous carcinoma of the esophagus. Am J Surg Pathol.1989 Aug;13(8):685-90

We reviewed a total of 119 resected esophagi with intraepithelial neoplasias of low grade (including slight or moderate dysplasias), high grade (including severe dysplasia and carcinoma in situ), or microinvasive squamous carcinoma (i.e., not invasive beyond the submucosa and without metastases in regional lymph nodes). Epithelial buds bulging into the stroma were noted in noninvasive intraepithelial lesions. The most severe degree of histological alteration was used to characterize each case. Of the 119 cases, five were low-grade, 38 were high-grade, and the remaining 76 specimens contained microinvasive squamous carcinoma. Of these, 23 invaded only the lamina propria. Nine invaded the muscularis mucosae, 16 invaded the inner half of the submucosa, and the remaining 28 invaded the outer half of the submucosa. Epithelial buds were divided according to their configuration into types I, II, and III. Grade I was characterized by regular epithelial buds of the same size, grade II had regular buds that varied in size, and grade III had irregular buds (i.e., buds of varying length and width with irregular contours). Our study of 66 specimens with microinvasive squamous carcinoma showed that one of the two specimens that had low grade dysplasia also had type III buds, while 56 of the remaining 64 (87.7%) with high grade dysplasia also had type III buds. Microinvasion originated at the tip of the type III epithelial buds in 12 specimens. Similar results have been demonstrated in experimental animals. We conclude that in the esophageal mucosa, there is a close relationship among the degree of squamous cellular atypia, the formation of epithelial buds, and the progression toward invasive carcinoma.

Superficial esophageal carcinoma: a report of 27 cases in Japan.Am J Gastroenterol.1991 Dec;86(12):1723-8.

Twenty-seven patients with superficial esophageal carcinoma were investigated to determine their clinical and pathological features. All 21 male patients were habitual drinkers, and 17 were heavy smokers. Histological examination showed that three tumors were intraepithelial, five were mucosal, and 19 were submucosal. Fifteen of the 27 patients were asymptomatic, including seven of the eight with intraepithelial or mucosal carcinoma. Twelve of the 13 patients with polypoid tumors had submucosal invasion, whereas two patients with flat tumors and four of the seven with erosive tumors had either intraepithelial or mucosal carcinoma. Six of the eight patients with intraepithelial or mucosal carcinoma had normal routine radiological studies. All these eight patients had no lymph node involvement, whereas four of the 19 with submucosal carcinoma had lymph node metastases. An aggressive approach to endoscopy in asymptomatic high-risk individuals (middle-aged male drinkers and smokers) may increase the detection of early esophageal carcinoma, although the cost-effectiveness should be evaluated further. In addition, in the interest of prevention, our results show that encouraging people to stop smoking and limit their alcohol intake to an occasional drink might be an important factor in lessening the risk for esophageal carcinoma.

Superficial squamous cell carcinoma of the esophagus. A report of 76 cases and review of the literature.Am J Surg Pathol.1989 Jul;13(7):535-46.

Superficial squamous carcinoma of the esophagus, defined as carcinoma limited to mucosa or submucosa regardless of lymph node status, is being increasingly recognized in the Western hemisphere. Seventy-six cases of this entity are herein presented. Five macroscopic types were recognized: normal flat (eight cases), coarse (21 cases), verrucous (25 cases), polypoid (17 cases), and ulcerating infiltrating (five cases). Histological typing included 65 conventional squamous cell carcinomas, six squamous carcinomas with spindle cell features, and five adenoid cystic carcinomas. Four cases were strictly intraepithelial, 10 cases were confined to the mucosa, nine cases encroached onto the muscularis mucosae, and 53 extended into the submucosa. Cases with intraepithelial and infiltrating carcinomas confined to the mucosa showed no lymph node involvement. Thirty percent of cases extending into the submucosa developed lymph node metastases. Thirty-eight patients survived surgical resection from 1 to 96 months; 34 of these 38 were free of neoplastic disease. Fourteen patients had an associated bronchial or oropharyngolaryngeal carcinoma either simultaneously or asynchronously. We conclude that patients with superficial squamous carcinoma of the esophagus can benefit from early diagnosis and prompt surgery.

Basaloid-squamous carcinoma of the esophagus. A clinicopathologic, DNA ploidy, and immunohistochemical study of seven cases. Am J Surg Pathol.1996 Apr;20(4):453-61.

Basaloid-squamous carcinoma (BSC) of the esophagus is a rare but interesting neoplasm that occurs primarily in the upper aerodigestive tract. In this study, we reviewed 371 cases of esophageal malignancies and detected seven cases (1.9%) of BSC. The clinicopathologic features, light and electron microscopic findings, and immunohistochemical localization of various differentiation-related antigens, including cytokeratin (CK) subtypes, p53, and epidermal growth factor receptor (EGFR), were examined. DNA ploidy was also determined in an effort to characterize the biologic features of these tumors. The tumors were classified as stage I (n = 1), IIB (n = 3), III (n = 2) or IV (n = 1). Six patients had lymph node metastasis, in four the metastatic carcinoma exhibited basaloid components. Histologically, all the tumors displayed a biphasic pattern of basaloid and squamous components. The former predominated in three cases, the latter in four cases. All the tumors contained solid growth of basaloid cells with microcystic patterns and stromal hyalinosis as well as palisading of cells. Ultrastructurally, markedly replicated basement membrane was observed. Immunohistochemistry revealed staining with only CK 14 and CK 19 antibodies in the periphery of the basaloid tumor nests. These antibodies were also positive in the basal layer of normal esophagus. Diffuse immunoreactivity for EGFR was demonstrated in all the tumors. Five tumors displayed p53 nuclear immunoreactivity. All of the basaloid components demonstrated aneuploidy by DNA image cytometry. We conclude that BSC is a distinct type of esophageal carcinoma that should be differentiated from the usual types of esophageal carcinoma and may be associated with aggressive biologic behavior.

                   

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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

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REPORTING  OF  ESOPHAGEAL  RESECTION SPECIMENS

SQUAMOUS  EPITHELIAL  DYSPLASIA INCLUDING SQUAMOUS CELL CARCINOMA IN-SITU OF THE ESOPHAGUS

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DRUG  RELATED  LESIONS  OF  THE GASTROINTESTINAL TRACT

MESOTHELIOMA-ONLINE

Aetiology and Pathogenesis of Mesothelioma

Gross features of Mesothelioma

Microscopic features of Mesothelioma

Cytological Diagnosis of Mesothelioma

Histochemistry and Immunohistochemistry in the diagnosis of  Mesothelioma

Variants of  Mesothelioma

WELL DIFFERENTIATED PAPILLARY MESOTHELIOMA

LOCALIZED MALIGNANT MESOTHELIOMA

MULTICYSTIC MESOTHELIOMA

ADENOMATOID TUMOUR

Electron microscopy of  Mesothelioma

Pseudo-mesotheliomatous Adenocarcinoma

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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.

Acute Gastritis 

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