Gastrointestinal Stromal Tumour

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        Dr Sampurna Roy MD

 
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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 

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

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

                                    
LOCATION
-Left upper quandrant
-Inferior to the diaphragm
-Upper portion is posterior to the liver
-May descent to the pelvis

Anatomically divided into 4 regions:

-Cardiac region: Surrounded by esophageal sphincter .
-
Fundus:
Lies against the diaphragm.
-
Body (corpus):

- Pylorus (pyloric antrum): Ends at the pyloric sphincter which is a thickening of the muscle walls.
Types of cells present in the stomach:

Mucous secreting cells (goblet cells)-
Line the luminal surface of the stomach and gastric pits and gastric glands. Produce  mucus and bicarbonate.

Mucous neck cells-
Present in the neck of the gland. Produce mucin.

Parietal cells (oxyntic cells)- Distributed throughout the length of the gland , but numerous in the middle portion. Large, rounded cells with eosinophilic cytoplasm and centrally located nucleus. Produce gastric acid.

Chief cells (peptic or zymogenic cells)-
Clustered at the base of the gland. Identified by basally located nuclei and strongly basophilic granular cytoplasm.
Produce pepsinogen, digests protein.
 

                

Normal Histological Features:

The gastric mucosa consists of surface epithelium, gastric pits and gastric glands.

The gastric glands extend from the muscular mucosae to extend into the stomach lumen via gastric pits.

The foveolar cells lining the surface and gastric pits are identical throughout the stomach
Glands  differ in different regions of the stomach.
Gastric pits occupy approximately 25% of the mucosa. Pits lie parallel to one another. These are separated by the lamina propria. There is more lamina propria separating the pits than between the glands.

In normal gastric biopsy degree of  pit and glandular separation should be same throughout the biopsy.

Cardia- 
Small area of predominantly mucus secreting glands surrounding the entrance of the esophagus. Glands are less coiled than in the antral glands.The pits are shorter than the antropyloric pits.

Fundus and  body- 
Major histological region. Consists of straight, tubular glands. Strands of muscularis mucosae extend between the glands from the base. The glands secrete gastric juices as well as protective mucus.

Pylorus-
Branched glands open into deep irregular shaped pits. Composed of mucus secreting cells. Mucus secreted by pyloric glands lubricate and protect entrance to the duodenum.
Scattered 'G' cells (endocrine cells), secrete gastrin.

Note: 

Gastric mucosa forms a barrier to diffusion of gastric acid from the gastric lumen.
Damage of gastric mucosa > back diffusion of luminal acid > tissue acidosis > vascular compromise>mucosal congestion and necrosis.

Damaged gastric mucosa> regenerates from generating zone (mucous neck region)
     1. Cells pass upwards to differentiate into foveolar cells
     2. Cells pass downwards to differentiate into glandular cells.

                 

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Normal Histology Images:

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