Gastrointestinal Stromal Tumour

www.histopathology-india.net/GIPath.htm

                                     HISTOPATHOLOGY INDIA.COM

       Squamous Epithelial Dysplasia
including Squamous cell
carcinoma-in-situ

            Dr Sampurna Roy MD

 
 SMALL INTESTINE

 LARGE INTESTINE

December 2009
Surgical-Pathology.com

Histopathology-India.net

diagnostichistopathology. blogspot.com

Pathopedia-India.com

Pathology-India.com

Pancreatic Pathology Online

Gall Bladder Pathology Online

Paediatric Pathology Online

Paraganglioma-Online

Endocrine Pathology Online

Eye Pathology Online

Ear Pathology Online

Cardiac Path Online

Lung Tumour-Online

Mesothelioma-Online

Pulmonary Pathology Online

Nutritional Pathology Online

Environmental Pathology Online

Pathology Quiz Online

Dermpath-India

GI Path Online

Soft Tissue Pathology

Case Index

Infectious Disease Online; INDEX: A-D ; INDEX: E-L ; INDEX: M-P INDEX: Q-Z ; FUNGAL DISEASE ; VIRAL DISEASE.

E-book - History of  Medicine with special reference to India

Basic Pathology Blog.

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) 

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

               

Invasive esophageal squamous cell carcinoma evolves through a series of preinvasive lesions, known as dysplasias or intraepithelial neoplasias.

Esophagus has its own unique types which may differ from those occurring in other squamous sites, such as cervix and skin.

According to some studies these precursor lesions were more common in high cancer-risk areas than in the low-risk areas. There is an increased proliferation of cells in the upper layers of the esophageal squamous epithelium in people who live in these areas.

Although lower grades of dysplasia are usually described as partial-thickness abnormalities, involving less than half of the epithelial thickness and higher grades as involving more than half, separating grades of dysplasia on the basis of level of involvement is not always reliable. Also, separating one grade of dysplasia from another is frequently difficult, since there are no clear lines of demarcation. As a result, even with a two-grade system that includes low and high grades, there are occasional dysplasias that seem to be borderline or intermediate between the two grades. In the future, all intraepithelial proliferations might be grouped into a spectrum that could be designated esophageal intraepithelial neoplasia (EIN), comparable to the terms in use for the uterine cervix, the vagina, and the vulva, or into a two-grade dysplasia system comparable to that used in ulcerative colitis.

The lesion is visible endoscopically and is confirmed histologically

Microscopic features : 

The preinvasive lesions, or dysplasias, contain abnormal epithelia which vary from that closely resembling the normal squamous mucosa to epithelium so disorganized that its malignant cytologic and architectural features are obvious.

There are atypical squamous cells with disorganized architecture and abnormal differentiation within the epithelium. These features are obvious in high grade dysplasia. The nuclei are larger and more hyperchromatic than normal, and there is increased mitotic activity  . The lower grades of dysplasia have a larger component of mature-appearing squamous cells, some of which may be keratinized, and the abnormal cells are often limited to the lower half of the epithelium .

 The highest grade of dysplasia is squamous cell carcinoma in situ or intraepithelial carcinoma.

             .

The histological variants:

1.Basal squamous dysplasia  2.Pagetoid squamous dysplasia   

The lesion may  present as a single lesion in the absence of invasive tumour or as a peripheral component in the backround squamous mucosa , with  invasive squamous carcinoma.

Images: (pathologyoutlines.com)- Image Link1 ; Image Link2 ; Image Link3 ; Image Link4 ; Image Link5 ; Image Link6 ; Image Link7; Image Link8 ; Image Link9 ; Image Link10; Image Link11; Image Link12.

Images of Basal squamous dysplasia: Image Link1; Image Link2 ; Image Link3 ; Image Link4 ; Image Link5 ; Image Link6 ; Image Link7.

Squamous esophageal histology and subsequent risk of squamous cell carcinoma of the esophagus. A prospective follow-up study from Linxian,China.Cancer.1994Sep15;74(6):1686-92.

BACKGROUND. Linxian, China, has some of the highest rates of esophageal cancer in the world. Previous authors have proposed that esophagitis, atrophy, and dysplasia may be precursor lesions of esophageal cancer in such high risk populations. METHODS. To examine the relationship between squamous esophageal histology and subsequent esophageal cancer in Linxian, the authors prospectively followed 682 participants of a 1987 endoscopic survey for 3.5 years and compared their initial biopsy diagnoses with the occurrence of squamous cell carcinoma during this follow-up period. RESULTS. Squamous cell carcinoma of the esophagus was identified in 52 (7.6%) of the participants during the follow-up period. After adjusting for potential confounding factors, relative risks (95% confidence intervals) for squamous cell carcinoma incidence by initial histologic diagnoses were as follows: normal, 1.0 (reference); basal cell hyperplasia, 2.1 (0.4-9.8); mild dysplasia, 2.2 (0.7-7.5); moderate dysplasia, 15.8 (5.9-42.2); severe dysplasia, 72.6 (29.8-176.9); dysplasia not otherwise specified, 22.9 (6.7-78.0); and carcinoma in situ, 62.5 (24.1-161.9). CONCLUSION. In this study, moderate dysplasia, severe dysplasia, and carcinoma in situ were the only histologic lesions associated with a significantly increased risk of developing squamous cell carcinoma of the esophagus within 3.5 years after endoscopy. Increasing grades of dysplasia were associated with increasing risk, but severe dysplasia were associated with increasing risk, but severe dysplasia and carcinoma in situ had similar degrees of risk, findings that suggest a continuous spectrum of esophageal intraepithelial neoplasia, without morphologically distinguishable dysplasia and in situ carcinoma. A longer follow-up will be necessary to fully evaluate the less severe diagnostic categories, which may take more than 3.5 years to affect the occurrence of squamous cell carcinoma in this high risk population.

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.

 
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

     

Risk factors for oesophageal squamous dysplasia in adult inhabitants of a high risk region of China.
Gut. 2005 Jun;54(6):759-63.

Esophageal papillomatosis complicated by squamous cell carcinoma in situ.Dis Esophagus.2004;17(4):345-7.

Esophageal squamous dysplasia.Semin Diagn Pathol.2002 Feb;19(1):2-11.

Esophageal squamous dysplasia (ESD) appears to be the most important precursor for squamous cell carcinoma (SCC), and this observation is supported by early molecular findings. Pathologists in high incidence areas of the world, such as China, frequently may encounter ESD during surveillance cytology and biopsy screenings of high risk populations. ESD in low risk areas, such as the United States, is more commonly seen in esophagi resected for squamous cell carcinoma. As at other sites, ESD can be graded histologically depending on the thickness of epithelial involvement and cytologically based largely on nuclear size and chromatin features. Most ESD lesions are endoscopically visible, especially if the esophageal mucosa is sprayed with iodine, allowing for directed biopsy. Several studies have shown that important differences in histologic and cytologic diagnosis and grading exist between Western pathologists and those in China or Japan. Despite these findings, the risk of developing invasive SCC is closely correlated to the severity of ESD encountered. Correct recognition of ESD thus is important.

Myofibroblastic tumours

Fibrohistiocytic tumours

ChondroOsseous tumours

Soft TissueTumours of Uncertain Differentiation               

Notochordal Tumour - Chordoma

Extra-adrenal Paraganglioma

Gastrointestinal Stromal Tumour


                                                   Disclaimer  Privacy Policy  ; Advertising Policy  ;  E-mail  .         

                                                                  Copyright 2009  histopathology-india.net
                                                                                  All rights reserved