Difference between revisions of "Stomach"
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'''Stomach''' is an important organ for pathologists. It is often | [[Image:Gray1051.png|thumb|300px|A drawing of the stomach.]] | ||
'''Stomach''' is an important organ for pathologists. It is often inflamed and may be a site that cancer arises from. Gastroenterologists often biopsy the organ. Surgeons take-out the organ. It connects the [[esophagus]] to the [[duodenum]]. An introduction to gastrointestinal pathology is in the ''[[gastrointestinal pathology]]'' article. | |||
=Normal= | =Normal stomach= | ||
==Gross anatomy== | ==Gross anatomy== | ||
*Cardia - first part of the stomach; joins with [[esophagus]]. | *Cardia - first part of the stomach; joins with [[esophagus]]. | ||
Line 9: | Line 10: | ||
**[[AKA]] antrum. | **[[AKA]] antrum. | ||
Image | ===Image=== | ||
<gallery> | |||
Image:Illu_stomach.jpg | Stomach anatomy (WC) | |||
</gallery> | |||
==Microscopic== | ==Microscopic== | ||
===Foveolar cells | ===Foveolar cells versus intestinal goblet cells=== | ||
*Intestinal goblet cells - clear mucin. | *Intestinal goblet cells - clear mucin. | ||
*Foveolar cells - eosinophilic contents. | *Foveolar cells - eosinophilic contents. | ||
===Stomach | ===Stomach versus intestine=== | ||
{| class="wikitable" | A tabular comparison:<ref>ALS. 4 Feb 2009.</ref> <!-- I think this part may be screwed-up --> | ||
{| class="wikitable sortable" | |||
! Feature | |||
! Intestine | |||
! Stomach | |||
|- | |- | ||
|Spacing | |Spacing | ||
Line 36: | Line 41: | ||
|PAS-D | |PAS-D | ||
| -ve (???) | | -ve (???) | ||
| +ve | | +ve<ref>{{Cite journal | last1 = Rubio | first1 = CA. | title = Gastric duodenal metaplasia in duodenal adenomas. | journal = J Clin Pathol | volume = 60 | issue = 6 | pages = 661-3 | month = Jun | year = 2007 | doi = 10.1136/jcp.2006.039388 | PMID = 16837629 | PMC = 1955048 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955048/ }}</ref> | ||
|- | |- | ||
|Villin stain<ref name=pmid2459839>{{cite journal |author=Osborn M, Mazzoleni G, Santini D, Marrano D, Martinelli G, Weber K |title=Villin, intestinal brush border hydrolases and keratin polypeptides in intestinal metaplasia and gastric cancer; an immunohistologic study emphasizing the different degrees of intestinal and gastric differentiation in signet ring cell carcinomas |journal=Virchows Arch A Pathol Anat Histopathol |volume=413 |issue=4 |pages=303–12 |year=1988 |pmid=2459839 |doi= |url=}}</ref> | |Villin stain<ref name=pmid2459839>{{cite journal |author=Osborn M, Mazzoleni G, Santini D, Marrano D, Martinelli G, Weber K |title=Villin, intestinal brush border hydrolases and keratin polypeptides in intestinal metaplasia and gastric cancer; an immunohistologic study emphasizing the different degrees of intestinal and gastric differentiation in signet ring cell carcinomas |journal=Virchows Arch A Pathol Anat Histopathol |volume=413 |issue=4 |pages=303–12 |year=1988 |pmid=2459839 |doi= |url=}}</ref><ref>{{Cite journal | last1 = Braunstein | first1 = EM. | last2 = Qiao | first2 = XT. | last3 = Madison | first3 = B. | last4 = Pinson | first4 = K. | last5 = Dunbar | first5 = L. | last6 = Gumucio | first6 = DL. | title = Villin: A marker for development of the epithelial pyloric border. | journal = Dev Dyn | volume = 224 | issue = 1 | pages = 90-102 | month = May | year = 2002 | doi = 10.1002/dvdy.10091 | PMID = 11984877 }}</ref> | ||
| +ve | | +ve | ||
| -ve | | -ve | ||
Line 44: | Line 49: | ||
|Images | |Images | ||
|[http://commons.wikimedia.org/wiki/File:Tubular_adenoma_2_high_mag.jpg Tubular adenoma - goblet<br> cells on right of image (WC)] | |[http://commons.wikimedia.org/wiki/File:Tubular_adenoma_2_high_mag.jpg Tubular adenoma - goblet<br> cells on right of image (WC)] | ||
|[http://www.microscopy-uk.org.uk/mag/imgaug01/Fig8.jpg Gastric biopsy (microscopy-uk.org.uk)] | |[http://www.microscopy-uk.org.uk/mag/imgaug01/Fig8.jpg Gastric biopsy (microscopy-uk.org.uk)], <br>[http://commons.wikimedia.org/wiki/File:Gastric_signet_ring_cell_carcinoma_histopatholgy_%282%29_PAS_stain.jpg Stomach with cancer - PAS (WC)], [http://commons.wikimedia.org/wiki/File:Normal_gastric_mucosa_intermed_mag.jpg Stomach (WC)] | ||
|} | |} | ||
Notes: | Notes: | ||
*Intraepithelial lymphocytes in the gastric mucosa have a clear halo around 'em.<ref>Sternberg H4P 2nd Ed., P.484</ref> | *Intraepithelial lymphocytes in the gastric mucosa have a clear halo around 'em.<ref>Sternberg H4P 2nd Ed., P.484</ref> | ||
*Memory device: '''F''' | *Memory device: '''F'''oveolar cells have '''f'''riends, i.e. they are close to other foveolar cells. | ||
===Gastric antrum versus gastric body=== | |||
{| class="wikitable sortable" | |||
! Cell | |||
===Gastric antrum | ! Body | ||
{| class="wikitable" | ! Antrum | ||
! Histology | |||
! Image | |||
|- | |- | ||
| '''Parietal | | '''Parietal cell''' | ||
| abundant | | abundant | ||
| few or none | | few or none | ||
| parietal cells: intensely<br> eosinophilic cytoplasm | | parietal cells: intensely<br> eosinophilic cytoplasm | ||
| [ | | [[Image:Normal_gastric_mucosa_intermed_mag.jpg|thumb|center|60px|Parietal cells. (WC)]] | ||
|- | |- | ||
| '''Chief | | '''Chief cell''' | ||
| present | | present | ||
| absent | | absent | ||
| chief cells: basophilic cytoplasm, <br>[[IHC]]: +ve for ''pepsinogen I'' | | chief cells: basophilic cytoplasm, <br>[[IHC]]: +ve for ''pepsinogen I'' | ||
| [ | | [[Image:Chief_cells.JPG|thumb|center|100px|Chief cells. (WC)]] | ||
|- | |- | ||
| '''G | | '''G cell''' | ||
| absent | | absent | ||
| present | | present | ||
| fried egg appearance <br> | | fried egg appearance (clear cytoplasm,<br> round nucleus); look at high power - <br>usu. middle 1/3 of gland,<ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/CorePages/GIT/git.htm http://www.lab.anhb.uwa.edu.au/mb140/CorePages/GIT/git.htm]. Accessed on: 3 December 2010.</ref><br> IHC: +ve for ''gastrin''. | ||
| | | [[Image:G_cell_hyperplasia_-_very_high_mag.jpg|thumb|center|60px|G cell hyperplasia. (WC)]] | ||
|- | |- | ||
| '''Surface''' | | '''Surface''' | ||
Line 84: | Line 86: | ||
| blunted villi | | blunted villi | ||
| antrum is somewhat <br>duodenum-like | | antrum is somewhat <br>duodenum-like | ||
| [ | | [[Image:Normal_gastric_mucosa_intermed_mag.jpg |thumb|center|60px|Body - flat. (WC)]] | ||
|- | |- | ||
| '''Gastric glands <br>/ mucosa''' | | '''Gastric glands <br>/ mucosa''' | ||
Line 92: | Line 94: | ||
| [http://commons.wikimedia.org/wiki/File:Normal_gastric_mucosa_intermed_mag.jpg body - thick], [http://www.wjgnet.com/1007-9327/full/v16/i4/WJG-16-445-g001.htm body & antrum] | | [http://commons.wikimedia.org/wiki/File:Normal_gastric_mucosa_intermed_mag.jpg body - thick], [http://www.wjgnet.com/1007-9327/full/v16/i4/WJG-16-445-g001.htm body & antrum] | ||
|} | |} | ||
Notes: | |||
*G cells may superficially resemble intraepithelial lymphocytes. | |||
**G cell nucleus is usu. perfectly round and slightly larger (diameter of 12 micrometers?) than a lymphocyte nucleus (diameter ~ 9-10 micrometers?). | |||
===Sign out=== | |||
====Short version==== | |||
<pre> | |||
Stomach, Biopsy: | |||
- Antral-type gastric mucosa within normal limits. | |||
</pre> | |||
<pre> | |||
Stomach, Biopsy: | |||
- Body and antral-type gastric mucosa within normal limits. | |||
</pre> | |||
<pre> | |||
Stomach, Biopsy: | |||
- Antral-type gastric mucosa within normal limits. | |||
- NEGATIVE for Helicobacter-like organisms. | |||
</pre> | |||
=====Block letters===== | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS. | |||
</pre> | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS. | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
</pre> | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- ANTRAL-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS. | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
</pre> | |||
====Long version==== | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- BODY/ANTRAL-TYPE GASTRIC MUCOSA. | |||
- INFLAMMATION: ABSENT. | |||
- ATROPHY: ABSENT. | |||
- INTESTINAL METAPLASIA: ABSENT. | |||
- HELICOBACTER-LIKE ORGANISMS: NOT IDENTIFIED WITH ROUTINE STAINS. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
====Sleeve gastrectomy==== | |||
{{Main|Sleeve gastrectomy}} | |||
=Introduction= | =Introduction= | ||
==Useful stains for stomach== | ==Useful stains for stomach== | ||
*Cresyl violet stain<ref>[http://www.histology-world.com/stains/stains.htm http://www.histology-world.com/stains/stains.htm]</ref> - used to find H. pylori.<ref name=pmid10210995>{{cite journal |author=Goggin N, Rowland M, Imrie C, Walsh D, Clyne M, Drumm B |title=Effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease |journal=Arch. Dis. Child. |volume=79 |issue=6 |pages=502-5 |year=1998 |month=December |pmid=10210995 |pmc=1717771 |doi= |url=http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=10210995}}</ref> | *[[Cresyl violet stain]]<ref>[http://www.histology-world.com/stains/stains.htm http://www.histology-world.com/stains/stains.htm]</ref> - used to find H. pylori.<ref name=pmid10210995>{{cite journal |author=Goggin N, Rowland M, Imrie C, Walsh D, Clyne M, Drumm B |title=Effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease |journal=Arch. Dis. Child. |volume=79 |issue=6 |pages=502-5 |year=1998 |month=December |pmid=10210995 |pmc=1717771 |doi= |url=http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=10210995}}</ref> | ||
*Alcian blue - used to find mucin<ref>[http://www.histology-world.com/stains/stains.htm http://www.histology-world.com/stains/stains.htm]</ref> which is present in intestinal metaplasia | *[[Alcian blue stain]] - used to find mucin<ref>[http://www.histology-world.com/stains/stains.htm http://www.histology-world.com/stains/stains.htm]</ref> which is present in intestinal metaplasia | ||
**Other mucins stains:<ref>[http://www.histology-world.com/stains/stains.htm http://www.histology-world.com/stains/stains.htm]</ref> mucicarmine, PAS, PASD (doesn't stain glycogen) | **Other mucins stains:<ref>[http://www.histology-world.com/stains/stains.htm http://www.histology-world.com/stains/stains.htm]</ref> mucicarmine, [[PAS]], [[PAS-D stain|PASD]] (doesn't stain glycogen) | ||
==Things to look for...== | ==Things to look for...== | ||
Line 107: | Line 162: | ||
**Can be ''very'' easy to miss in some biopsies. | **Can be ''very'' easy to miss in some biopsies. | ||
*Inflammation + small bacteria = suspect H. pylori gastritis. | *Inflammation + small bacteria = suspect H. pylori gastritis. | ||
=Some patterns= | |||
==Gastric atrophy== | |||
===General=== | |||
*Has a wide differential diagnosis. | |||
===Microscopic=== | |||
Can take three general forms: | |||
#Intestinal metaplasia - see ''intestinal metaplasia'' section. | |||
#Pseudopyloric metaplasia; gastric body looks like gastric antrum. | |||
#*Characterized by ''foveolar hyperplasia''. | |||
#Cell loss without replacement. | |||
#*Clue is deep inflammation in the body. | |||
==Plasma cells in the stomach== | |||
DDx of plasmacytosis: | |||
*[[Plasma cell neoplasm]]. | |||
*[[Syphilis]]. | |||
*Chronic [[gastritis]]. | |||
==Granulomatous gastritis== | |||
*Usual DDx of granulomatous disease (see ''[[Basics]]'' article): | |||
**DNF AAII: | |||
***Drugs, Neoplasms, Foreign body, Autoimmune, Allergic, Infectious, Idiopathic. | |||
Important ones: | |||
*Autoimmune - [[Crohn's disease]]. | |||
*Infectious - [[Tuberculosis]]. | |||
*Idiopathic - [[Sarcoidosis]]. | |||
=Non-neoplastic disease= | =Non-neoplastic disease= | ||
== | ==Peptic ulcer disease== | ||
=== | *Abbreviated ''PUD''. | ||
:For duodenal manifestations see ''[[Peptic duodenitis]]''. | |||
===General=== | |||
*Benign. | |||
Complications: | |||
* | *Hemorrhage. | ||
*Obstruction. | |||
* | *Perforation - can be fatal. | ||
* | |||
=== | Etiology - typically:<ref name=pmid19683340>{{Cite journal | last1 = Malfertheiner | first1 = P. | last2 = Chan | first2 = FK. | last3 = McColl | first3 = KE. | title = Peptic ulcer disease. | journal = Lancet | volume = 374 | issue = 9699 | pages = 1449-61 | month = Oct | year = 2009 | doi = 10.1016/S0140-6736(09)60938-7 | PMID = 19683340 }}</ref> | ||
* | *[[Helicobacter pylori]]. | ||
=== | ===Gross=== | ||
* | Features: | ||
** | *Typically in the [[duodenum]]; duodenum:stomach = ~4:1. | ||
**Epithelial defect with punched-out edges (suggestive of a benign process). | |||
Note: | |||
*Heaped edges - suggestive of [[stomach cancer|cancer]]. | |||
=== | ====Endoscopic image==== | ||
<gallery> | |||
Image:Deep_gastric_ulcer.png | Gastric ulcer. (WC) | |||
</gallery> | |||
| | |||
=== | ===Microscopic=== | ||
Features: | |||
* | *Loss of epithelium. | ||
* | *Inflammation. | ||
* | *+/-Helicobacter organisms - ''see [[Helicobacter gastritis]]''. | ||
==Gastritis== | |||
{{Main|Gastritis}} | |||
{{Main|Chronic gastritis}} | |||
{| | {{Main|Acute gastritis}} | ||
| | |||
|} | |||
==Helicobacter gastritis== | ==Helicobacter gastritis== | ||
{{Main|Helicobacter gastritis}} | |||
== | ==Intestinal metaplasia of the stomach== | ||
{{Main|Intestinal metaplasia of the stomach}} | |||
==Inflammatory bowel disease and the stomach== | |||
:See ''[[inflammatory bowel disease]]''. | |||
* | *Histopathologic findings are usually non-specific. | ||
* | *Conventional thinking ''was'' upper GI involvement = [[Crohn's disease]]; this is changing.<ref name=pmid20962621>{{cite journal |author=Lin J, McKenna BJ, Appelman HD |title=Morphologic findings in upper gastrointestinal biopsies of patients with ulcerative colitis: a controlled study |journal=Am. J. Surg. Pathol. |volume=34 |issue=11 |pages=1672–7 |year=2010 |month=November |pmid=20962621 |doi=10.1097/PAS.0b013e3181f3de93 |url=}}</ref> | ||
=== | ===Endoscopic/gross=== | ||
Features - Crohn's:<ref name=Ref_GLP80>{{Ref GLP|80}}</ref> | |||
* | *+/-Linear fissures, erosions, ulcers, cobblestoning. | ||
*May mimic ''[[linitis plastica]]''. | |||
* | |||
== | ===Microscopic=== | ||
Features:<ref>Kirsch R. 13 December 2010.</ref> | |||
*Focal inflammation. | |||
* | **Common finding - non-specific. | ||
*+/-[[Granulomas]]. | |||
Note: | |||
* | *Granulomas in Crohn's gastritis present 7-34% of the time.<ref name=Ref_GLP80>{{Ref GLP|80}}</ref> | ||
=== | ====Images==== | ||
<gallery> | |||
Image: Crohn's gastritis -- low mag.jpg | CG - low mag. (WC) | |||
Image: Crohn's gastritis -- intermed mag.jpg | CG - intermed. mag. (WC) | |||
Image: Crohn's gastritis -- high mag.jpg | CG - high mag. (WC) | |||
Image: Crohn's gastritis -- very high mag.jpg | CG - very high mag. (WC) | |||
</gallery> | |||
=Miscellaneous= | =Miscellaneous= | ||
This is a grab bag of stuff seen in the stomach. Some of it is quite rare. | This is a grab bag of stuff seen in the stomach. Some of it is quite rare. | ||
==Gastric antral vascular ectasia== | ==Gastric antral vascular ectasia== | ||
{{Main|Gastric antral vascular ectasia}} | |||
== | ==Reactive gastropathy== | ||
{{Main|Reactive gastropathy}} | |||
==Autoimmune metaplastic atrophic gastritis== | |||
*[[AKA]] ''autoimmune gastritis''. | |||
*[ | {{Main|Autoimmune metaplastic atrophic gastritis}} | ||
== | ==Collagenous gastritis== | ||
{{Main|Collagenous gastritis}} | |||
== | ==Gastritis cystitis profunda== | ||
*[[AKA]] ''Gastritic cystica profunda''.{{fact}} | |||
===General=== | ===General=== | ||
*May be | *May be associated with glandular proliferation as well.<ref>URL: [http://www.springerlink.com/content/u2v2525241754557/ http://www.springerlink.com/content/u2v2525241754557/] Accessed on: 19 November 2010.</ref> (???) | ||
*Super rare. | |||
*Similar to ''[[cystitis cystica]]''. | |||
* | |||
* | |||
===Microscopic=== | ===Microscopic=== | ||
Features | Features: | ||
*Cystic spaces lined by foveolar epithelium. | |||
==Ménétrier's disease== | |||
{{Main|Ménétrier's disease}} | |||
==Gastric xanthoma== | |||
* | *Abbreviated ''GX''. | ||
* | *[[AKA]] ''xanthelasma''. | ||
*[[AKA]] ''stomach lipidosis''. | |||
{{Main|Gastric xanthoma}} | |||
==Gastric | ==Gastric ischemia== | ||
:''Gastric necrosis'' redirects here. | |||
===General=== | ===General=== | ||
* | *Rare. | ||
*May arise due to: | |||
**Small bowel obstruction.<ref name=pmid18209748>{{Cite journal | last1 = Steen | first1 = S. | last2 = Lamont | first2 = J. | last3 = Petrey | first3 = L. | title = Acute gastric dilation and ischemia secondary to small bowel obstruction. | journal = Proc (Bayl Univ Med Cent) | volume = 21 | issue = 1 | pages = 15-7 | month = Jan | year = 2008 | doi = | PMID = 18209748 | PMC = 2190544}}</ref> | |||
**Therapeutic embolization.<ref name=pmid22020717/> | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | |||
*+/-Pseudomembrane formation.<ref name=pmid21360426>{{Cite journal | last1 = Herman | first1 = J. | last2 = Chavalitdhamrong | first2 = D. | last3 = Jensen | first3 = DM. | last4 = Cortina | first4 = G. | last5 = Manuyakorn | first5 = A. | last6 = Jutabha | first6 = R. | title = The significance of gastric and duodenal histological ischemia reported on endoscopic biopsy. | journal = Endoscopy | volume = 43 | issue = 4 | pages = 365-8 | month = Apr | year = 2011 | doi = 10.1055/s-0030-1256040 | PMID = 21360426 }}</ref> | |||
*[[Necrosis]] of the epithelium lining the gastric pits. | |||
== | Image: | ||
=== | *[https://www.thieme-connect.com/media/endoscopy/2011S02/097cl2.jpg Gastric necrosis (thieme-connect.com)].<ref name=pmid22020717>{{Cite journal | last1 = Papanikolaou | first1 = IS. | last2 = Foukas | first2 = PG. | last3 = Sioulas | first3 = A. | last4 = Beintaris | first4 = I. | last5 = Panagopoulos | first5 = P. | last6 = Karamanolis | first6 = G. | last7 = Panayiotides | first7 = IG. | last8 = Dimitriadis | first8 = G. | last9 = Triantafyllou | first9 = K. | title = A case of gastric ischemic necrosis. | journal = Endoscopy | volume = 43 Suppl 2 UCTN | issue = | pages = E342 | month = | year = 2011 | doi = 10.1055/s-0030-1256795 | PMID = 22020717 }}</ref> | ||
== | ==Portal hypertensive gastropathy== | ||
*Abbreviated ''PHG''. | |||
{{Main|Portal hypertensive gastropathy}} | |||
== | ==Amyloidosis of the stomach== | ||
*[[AKA]] ''gastric amyloidosis''. | |||
{{Main|Amyloidosis}} | |||
===General=== | ===General=== | ||
* | *Very rare. | ||
* | *Etiologies: various - see [[amyloidosis]]. | ||
=== | ===Gross/endoscopy=== | ||
*Red/swollen gastric folds.<ref name=pmid22863214>{{Cite journal | last1 = Kamata | first1 = T. | last2 = Suzuki | first2 = H. | last3 = Yoshinaga | first3 = S. | last4 = Nonaka | first4 = S. | last5 = Fukagawa | first5 = T. | last6 = Katai | first6 = H. | last7 = Taniguchi | first7 = H. | last8 = Kushima | first8 = R. | last9 = Oda | first9 = I. | title = Localized gastric amyloidosis differentiated histologically from scirrhous gastric cancer using endoscopic mucosal resection: a case report. | journal = J Med Case Rep | volume = 6 | issue = 1 | pages = 231 | month = | year = 2012 | doi = 10.1186/1752-1947-6-231 | PMID = 22863214 | PMC = 3438062 | URL = http://www.jmedicalcasereports.com/content/6/1/231 }} </ref> | |||
* | Endoscopic DDx: | ||
*[[Stomach cancer]].<ref name=pmid14606114>{{Cite journal | last1 = Wu | first1 = D. | last2 = Lou | first2 = JY. | last3 = Chen | first3 = J. | last4 = Fei | first4 = L. | last5 = Liu | first5 = GJ. | last6 = Shi | first6 = XY. | last7 = Lin | first7 = HT. | title = A case report of localized gastric amyloidosis. | journal = World J Gastroenterol | volume = 9 | issue = 11 | pages = 2632-4 | month = Nov | year = 2003 | doi = | PMID = 14606114 }}</ref><ref name=pmid22814919>{{Cite journal | last1 = Sawada | first1 = T. | last2 = Adachi | first2 = Y. | last3 = Akino | first3 = K. | last4 = Arimura | first4 = Y. | last5 = Ishida | first5 = T. | last6 = Ishii | first6 = Y. | last7 = Endo | first7 = T. | title = Endoscopic features of primary amyloidosis of the stomach. | journal = Endoscopy | volume = 44 Suppl 2 UCTN | issue = | pages = E275-6 | month = | year = 2012 | doi = 10.1055/s-0032-1309750 | PMID = 22814919 | URL = https://www.thieme-connect.com/DOI/DOI?10.1055/s-0032-1309750 }}</ref> | |||
== | |||
=== | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
* | *Lamina propria expanded by amorphous paucicellular material. | ||
Image: | |||
* | *[http://www.jmedicalcasereports.com/content/6/1/231/figure/F5 Stomach amyloidosis (jmedicalcasereports.com)].<ref name=pmid22863214/> | ||
===Stains=== | |||
* | *[[Congo red stain]] +ve. | ||
== | ==Eosinophilic gastritis== | ||
{{Main|Eosinophilic gastritis}} | |||
== | ==Proton pump inhibitor effect== | ||
*Abbreviated ''PPI effect''. | |||
* | {{Main|Proton pump inhibitor effect}} | ||
=Gastric polyps= | =Gastric polyps= | ||
Line 354: | Line 354: | ||
DDx polyp (similar to colon & rectum): | DDx polyp (similar to colon & rectum): | ||
*Hyperplastic - most common, characterised by abundant elongated foveola + glands. | *Hyperplastic - most common, characterised by abundant elongated foveola + glands. | ||
*Hamartomatous - weriod stuff. | *[[Hamartomatous polyps|Hamartomatous]] - weriod stuff. | ||
*Inflammatory fibroid polyp - inflammation, myxoid stroma. | *[[Inflammatory fibroid polyp]] - inflammation, [[myxoid stroma]]. | ||
*Fundic gland polyp - cystic dilation, flat epithelium. | *[[Fundic gland polyp]] - cystic dilation, flat epithelium. | ||
* | *[[Gastric adenoma]] - polypoid [[gastric dysplasia]]. | ||
== | ==Inflammatory fibroid polyp== | ||
{{Main|Inflammatory fibroid polyp}} | |||
==Hyperplastic polyp of the stomach== | |||
{{Main|Hyperplastic polyp of the stomach}} | |||
== | ==Fundic gland polyp== | ||
{{Main|Fundic gland polyp}} | |||
= | =Neoplastic= | ||
The spectrum from benign to malignant is divided into five:<ref name=pmid10680883>{{Cite journal | last1 = Rugge | first1 = M. | last2 = Correa | first2 = P. | last3 = Dixon | first3 = MF. | last4 = Hattori | first4 = T. | last5 = Leandro | first5 = G. | last6 = Lewin | first6 = K. | last7 = Riddell | first7 = RH. | last8 = Sipponen | first8 = P. | last9 = Watanabe | first9 = H. | title = Gastric dysplasia: the Padova international classification. | journal = Am J Surg Pathol | volume = 24 | issue = 2 | pages = 167-76 | month = Feb | year = 2000 | doi = | PMID = 10680883 }}</ref> | |||
#Benign. | |||
#Indefinite for gastric epithelial dysplasia. | |||
#Low-grade gastric epithelial dysplasia. | |||
#High-grade gastric epithelial dysplasia. | |||
#Gastric carcinoma. | |||
== | ==Gastric dysplasia== | ||
{{Main|Stomach adenoma}} | |||
== | ==Gastric neuroendocrine tumour== | ||
*[[AKA]] ''neuroendocrine tumour of the stomach'' and ''gastric NET''. | |||
===General=== | ===General=== | ||
* | *Behaviour dependent on the subtype. | ||
*Uncommon. | |||
* | |||
====Overview of subtypes==== | |||
Divided into four types:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/StomachNET_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/StomachNET_11protocol.pdf]. Accessed on: 29 March 2012.</ref> | |||
{| class="wikitable sortable" | |||
!Tumour type | |||
!Relative prevalence | |||
!Multifocality | |||
!Tumour size | |||
!Typical location | |||
!Clinical | |||
!Other | |||
!Histology | |||
|- | |||
|Type 1 | |||
| ~75% | |||
| yes | |||
| small (5-10 mm) | |||
| body | |||
| benign typically, female:male ~ 4:1, 50-60 years | |||
| chronic atrophic gastritis - usu. autoimmune | |||
| WDNET, WDNEC | |||
|- | |||
|Type 2 | |||
| rare | |||
| yes | |||
| small ~15 mm | |||
| body | |||
| aggressive, ~50 years old | |||
| assoc. [[MEN I]], hyperchlorhydia | |||
| WDNEC, WDNET | |||
|- | |||
|Type 3 | |||
| 10-15% | |||
| no | |||
| small and large | |||
| variable location | |||
| aggressive if >2.0 cm, males > females | |||
| normal gastrin levels | |||
| WDNET | |||
|- | |||
|Type 4 | |||
| extremely rare | |||
| no | |||
| large | |||
| variable location | |||
| aggressive (mets usu. at time of Dx), males > females | |||
| elevated gastrin d/t parietal cell dysfunction | |||
| PDNEC | |||
|- | |||
|} | |||
Notes: | Notes: | ||
* | *WDNET = well-differentiated neuroendocrine tumour. | ||
*WDNEC = well-differentiated neuroendocrine carcinoma. | |||
*PDNEC = poorly-differentiated neuroendocrine carinoma. | |||
* | |||
* | |||
===Microscopic=== | ===Microscopic=== | ||
:''See [[neuroendocrine tumours]]'' | |||
=Neoplastic rare= | =Neoplastic rare= | ||
==Gastric calcifying fibrous tumour== | ==Gastric calcifying fibrous tumour== | ||
{{Main|Calcifying fibrous tumour}} | |||
=Gastric cancer= | =Gastric cancer= | ||
* | *[[Gastrointestinal stromal tumour]] (GIST). | ||
* | *[[Gastric adenocarcinoma]]. | ||
*MALT lymphoma. | *[[MALT lymphoma]]. | ||
==Gastric lymphoma== | ==Gastric lymphoma== | ||
Line 454: | Line 461: | ||
Features: | Features: | ||
*Sheets of lymphoid cells. | *Sheets of lymphoid cells. | ||
*"Lymphoepithelial lesion" - gastric crypts invaded by a monomorphous population of lymphocytes.<ref> | *"[[Lymphoepithelial lesion]]" - gastric crypts invaded by a monomorphous population of lymphocytes.<ref>Bailey, D. 6 August 2010.</ref> | ||
**Features: | **Features: | ||
**# Cluster of lymphocytes - three cells or more - '''key feature'''. | **# Cluster of lymphocytes - three cells or more - '''key feature'''. | ||
Line 461: | Line 468: | ||
**Associated with MALT lymphoma;<ref name=pmid1452124>{{Cite journal | last1 = Papadaki | first1 = L. | last2 = Wotherspoon | first2 = AC. | last3 = Isaacson | first3 = PG. | title = The lymphoepithelial lesion of gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT): an ultrastructural study. | journal = Histopathology | volume = 21 | issue = 5 | pages = 415-21 | month = Nov | year = 1992 | doi = | PMID = 1452124 }}</ref> however, not specific. | **Associated with MALT lymphoma;<ref name=pmid1452124>{{Cite journal | last1 = Papadaki | first1 = L. | last2 = Wotherspoon | first2 = AC. | last3 = Isaacson | first3 = PG. | title = The lymphoepithelial lesion of gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT): an ultrastructural study. | journal = Histopathology | volume = 21 | issue = 5 | pages = 415-21 | month = Nov | year = 1992 | doi = | PMID = 1452124 }}</ref> however, not specific. | ||
=== | DDx: | ||
*Reactive lymphoid hyperplasia. | |||
*[[Syphilis]].<ref name=pmid20021615>{{Cite journal | last1 = Kim | first1 = K. | last2 = Kim | first2 = EJ. | last3 = Kim | first3 = MJ. | last4 = Song | first4 = HJ. | last5 = Lee | first5 = YS. | last6 = Jung | first6 = KW. | last7 = Yu | first7 = E. | title = Clinicopathological features of syphilitic gastritis in Korean patients. | journal = Pathol Int | volume = 59 | issue = 12 | pages = 884-9 | month = Dec | year = 2009 | doi = 10.1111/j.1440-1827.2009.02462.x | PMID = 20021615 }}</ref><ref name=pmid7661178>{{Cite journal | last1 = Long | first1 = BW. | last2 = Johnston | first2 = JH. | last3 = Wetzel | first3 = W. | last4 = Flowers | first4 = RH. | last5 = Haick | first5 = A. | title = Gastric syphilis: endoscopic and histological features mimicking lymphoma. | journal = Am J Gastroenterol | volume = 90 | issue = 9 | pages = 1504-7 | month = Sep | year = 1995 | doi = | PMID = 7661178 }}</ref> | |||
===IHC=== | |||
*Panker -- most useful. | *Panker -- most useful. | ||
Others: | Others: | ||
*CD3 | *CD3 (T cells) - scatter positivity. | ||
*[[CD20]] (B cells) +ve. | |||
*CD138 (plasma cells). | |||
*kappa, lambda -- often one is predominant, suggesting clonality. | |||
*BCL2 +ve. | |||
===Treatment=== | ===Treatment=== | ||
Line 473: | Line 488: | ||
Review paper: PMID 16950858. | Review paper: PMID 16950858. | ||
== | ==Hereditary gastric cancer== | ||
=== | Several syndromes are associated with gastric cancer:<ref>{{Cite journal | last1 = Sereno | first1 = M. | last2 = Aguayo | first2 = C. | last3 = Guillén Ponce | first3 = C. | last4 = Gómez-Raposo | first4 = C. | last5 = Zambrana | first5 = F. | last6 = Gómez-López | first6 = M. | last7 = Casado | first7 = E. | title = Gastric tumours in hereditary cancer syndromes: clinical features, molecular biology and strategies for prevention. | journal = Clin Transl Oncol | volume = 13 | issue = 9 | pages = 599-610 | month = Sep | year = 2011 | doi = | PMID = 21865131 }}</ref> | ||
{| class="wikitable sortable" | |||
! Disease | |||
! Gene | |||
! Histology | |||
! Other | |||
|- | |||
=== | | [[Hereditary diffuse gastric cancer syndrome|Hereditary diffuse gastric cancer (HDGC) syndrome]] | ||
| CDH1 (E-cadherin)<ref>{{OMIM|192090}}</ref> | |||
| diffuse - more specifically [[signet ring cell carcinoma]] | |||
| most important; assoc. [[invasive lobular carcinoma]]<ref name=pmid9537325>{{Cite journal | last1 = Guilford | first1 = P. | last2 = Hopkins | first2 = J. | last3 = Harraway | first3 = J. | last4 = McLeod | first4 = M. | last5 = McLeod | first5 = N. | last6 = Harawira | first6 = P. | last7 = Taite | first7 = H. | last8 = Scoular | first8 = R. | last9 = Miller | first9 = A. | title = E-cadherin germline mutations in familial gastric cancer. | journal = Nature | volume = 392 | issue = 6674 | pages = 402-5 | month = Mar | year = 1998 | doi = 10.1038/32918 | PMID = 9537325 }}</ref> | |||
|- | |||
=== | | [[Lynch syndrome]] | ||
| MSH2, MLH1, others | |||
| ? | |||
| colorectal carcinoma, endometrial carcinoma | |||
|- | |||
| [[Familial adenomatous polyposis]] | |||
| APC | |||
| ? | |||
| adenomatous polyps | |||
|- | |||
| [[Peutz-Jeghers syndrome]] | |||
| STK11 | |||
| ? | |||
| stomach hamartomas - not precursor | |||
|- | |||
| [[Li-Fraumeni syndrome]] | |||
| TP53 (p53) | |||
| ? | |||
| [[AKA]] SBLA syndrome = sarcomas, breast, brain, leukemia, laryngeal, lung, adrenocortical carcinoma | |||
|- | |||
| Familial breast and ovarian cancer 2<ref name=omim600185>{{OMIM|600185}}</ref> | |||
| [[BRCA2]] | |||
| ? | |||
| ? | |||
|} | |||
== | ==Gastric carcinoma== | ||
:Includes ''gastric adenocarcinoma''. | |||
{{Main|Gastric carcinoma}} | |||
=See also= | =See also= | ||
*[[Esophagus]]. | *[[Esophagus]]. | ||
*[[Duodenum]]. | |||
*[[Granulation tissue]]. | |||
*[[Intestinal polyps]]. | *[[Intestinal polyps]]. | ||
=References= | =References= |
Latest revision as of 15:51, 26 January 2022
Stomach is an important organ for pathologists. It is often inflamed and may be a site that cancer arises from. Gastroenterologists often biopsy the organ. Surgeons take-out the organ. It connects the esophagus to the duodenum. An introduction to gastrointestinal pathology is in the gastrointestinal pathology article.
Normal stomach
Gross anatomy
- Cardia - first part of the stomach; joins with esophagus.
- Fundus - superior portion - not attached directly to the esophagus.
- Body - contains parietal cells.
- Pylorus - distal (think pyloric stenosis); it joins with the duodenum.
- AKA antrum.
Image
Microscopic
Foveolar cells versus intestinal goblet cells
- Intestinal goblet cells - clear mucin.
- Foveolar cells - eosinophilic contents.
Stomach versus intestine
A tabular comparison:[1]
Feature | Intestine | Stomach |
---|---|---|
Spacing | Goblets cell - spaced | Foveolar cells - beside one another |
Morphology of epithelial cells | columnar | tall columnar (Champagne flute) |
Vesicle at luminal surface | touching/small opening | wide open |
PAS-D | -ve (???) | +ve[2] |
Villin stain[3][4] | +ve | -ve |
Images | Tubular adenoma - goblet cells on right of image (WC) |
Gastric biopsy (microscopy-uk.org.uk), Stomach with cancer - PAS (WC), Stomach (WC) |
Notes:
- Intraepithelial lymphocytes in the gastric mucosa have a clear halo around 'em.[5]
- Memory device: Foveolar cells have friends, i.e. they are close to other foveolar cells.
Gastric antrum versus gastric body
Cell | Body | Antrum | Histology | Image |
---|---|---|---|---|
Parietal cell | abundant | few or none | parietal cells: intensely eosinophilic cytoplasm |
|
Chief cell | present | absent | chief cells: basophilic cytoplasm, IHC: +ve for pepsinogen I |
|
G cell | absent | present | fried egg appearance (clear cytoplasm, round nucleus); look at high power - usu. middle 1/3 of gland,[6] IHC: +ve for gastrin. |
|
Surface | flat | blunted villi | antrum is somewhat duodenum-like |
|
Gastric glands / mucosa |
thick | thin | not so useful for discrimination |
body - thick, body & antrum |
Notes:
- G cells may superficially resemble intraepithelial lymphocytes.
- G cell nucleus is usu. perfectly round and slightly larger (diameter of 12 micrometers?) than a lymphocyte nucleus (diameter ~ 9-10 micrometers?).
Sign out
Short version
Stomach, Biopsy: - Antral-type gastric mucosa within normal limits.
Stomach, Biopsy: - Body and antral-type gastric mucosa within normal limits.
Stomach, Biopsy: - Antral-type gastric mucosa within normal limits. - NEGATIVE for Helicobacter-like organisms.
Block letters
STOMACH, BIOPSY: - BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS.
STOMACH, BIOPSY: - BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS. - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
STOMACH, BIOPSY: - ANTRAL-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS. - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
Long version
STOMACH, BIOPSY: - BODY/ANTRAL-TYPE GASTRIC MUCOSA. - INFLAMMATION: ABSENT. - ATROPHY: ABSENT. - INTESTINAL METAPLASIA: ABSENT. - HELICOBACTER-LIKE ORGANISMS: NOT IDENTIFIED WITH ROUTINE STAINS. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
Sleeve gastrectomy
Introduction
Useful stains for stomach
- Cresyl violet stain[7] - used to find H. pylori.[8]
- Alcian blue stain - used to find mucin[9] which is present in intestinal metaplasia
Things to look for...
- Parietal cells (indicate you're in the body of the stomach) - pink (eosinophilic) cytoplasm.
- Lack of parietal cells -- DDx: Bx of antrum (pylorus), Bx of cardia, pernicious anemia.
- Goblet cells = intestinal metaplasia.
- Architectural distortion of gastric glands - suspect cancer.
- Signet ring cells = (usually) gastric carcinoma.
- Can be very easy to miss in some biopsies.
- Inflammation + small bacteria = suspect H. pylori gastritis.
Some patterns
Gastric atrophy
General
- Has a wide differential diagnosis.
Microscopic
Can take three general forms:
- Intestinal metaplasia - see intestinal metaplasia section.
- Pseudopyloric metaplasia; gastric body looks like gastric antrum.
- Characterized by foveolar hyperplasia.
- Cell loss without replacement.
- Clue is deep inflammation in the body.
Plasma cells in the stomach
DDx of plasmacytosis:
- Plasma cell neoplasm.
- Syphilis.
- Chronic gastritis.
Granulomatous gastritis
- Usual DDx of granulomatous disease (see Basics article):
- DNF AAII:
- Drugs, Neoplasms, Foreign body, Autoimmune, Allergic, Infectious, Idiopathic.
- DNF AAII:
Important ones:
- Autoimmune - Crohn's disease.
- Infectious - Tuberculosis.
- Idiopathic - Sarcoidosis.
Non-neoplastic disease
Peptic ulcer disease
- Abbreviated PUD.
- For duodenal manifestations see Peptic duodenitis.
General
- Benign.
Complications:
- Hemorrhage.
- Obstruction.
- Perforation - can be fatal.
Etiology - typically:[11]
Gross
Features:
- Typically in the duodenum; duodenum:stomach = ~4:1.
- Epithelial defect with punched-out edges (suggestive of a benign process).
Note:
- Heaped edges - suggestive of cancer.
Endoscopic image
Microscopic
Features:
- Loss of epithelium.
- Inflammation.
- +/-Helicobacter organisms - see Helicobacter gastritis.
Gastritis
Helicobacter gastritis
Intestinal metaplasia of the stomach
Inflammatory bowel disease and the stomach
- Histopathologic findings are usually non-specific.
- Conventional thinking was upper GI involvement = Crohn's disease; this is changing.[12]
Endoscopic/gross
Features - Crohn's:[13]
- +/-Linear fissures, erosions, ulcers, cobblestoning.
- May mimic linitis plastica.
Microscopic
Features:[14]
- Focal inflammation.
- Common finding - non-specific.
- +/-Granulomas.
Note:
- Granulomas in Crohn's gastritis present 7-34% of the time.[13]
Images
Miscellaneous
This is a grab bag of stuff seen in the stomach. Some of it is quite rare.
Gastric antral vascular ectasia
Reactive gastropathy
Autoimmune metaplastic atrophic gastritis
- AKA autoimmune gastritis.
Collagenous gastritis
Gastritis cystitis profunda
- AKA Gastritic cystica profunda.[citation needed]
General
- May be associated with glandular proliferation as well.[15] (???)
- Super rare.
- Similar to cystitis cystica.
Microscopic
Features:
- Cystic spaces lined by foveolar epithelium.
Ménétrier's disease
Gastric xanthoma
Gastric ischemia
- Gastric necrosis redirects here.
General
Microscopic
Features:
Image:
Portal hypertensive gastropathy
- Abbreviated PHG.
Amyloidosis of the stomach
- AKA gastric amyloidosis.
General
- Very rare.
- Etiologies: various - see amyloidosis.
Gross/endoscopy
- Red/swollen gastric folds.[19]
Endoscopic DDx:
Microscopic
Features:
- Lamina propria expanded by amorphous paucicellular material.
Image:
Stains
- Congo red stain +ve.
Eosinophilic gastritis
Proton pump inhibitor effect
- Abbreviated PPI effect.
Gastric polyps
Similar to colonic polyps - see intestinal polyps.
DDx polyp (similar to colon & rectum):
- Hyperplastic - most common, characterised by abundant elongated foveola + glands.
- Hamartomatous - weriod stuff.
- Inflammatory fibroid polyp - inflammation, myxoid stroma.
- Fundic gland polyp - cystic dilation, flat epithelium.
- Gastric adenoma - polypoid gastric dysplasia.
Inflammatory fibroid polyp
Hyperplastic polyp of the stomach
Fundic gland polyp
Neoplastic
The spectrum from benign to malignant is divided into five:[22]
- Benign.
- Indefinite for gastric epithelial dysplasia.
- Low-grade gastric epithelial dysplasia.
- High-grade gastric epithelial dysplasia.
- Gastric carcinoma.
Gastric dysplasia
Gastric neuroendocrine tumour
- AKA neuroendocrine tumour of the stomach and gastric NET.
General
- Behaviour dependent on the subtype.
- Uncommon.
Overview of subtypes
Divided into four types:[23]
Tumour type | Relative prevalence | Multifocality | Tumour size | Typical location | Clinical | Other | Histology |
---|---|---|---|---|---|---|---|
Type 1 | ~75% | yes | small (5-10 mm) | body | benign typically, female:male ~ 4:1, 50-60 years | chronic atrophic gastritis - usu. autoimmune | WDNET, WDNEC |
Type 2 | rare | yes | small ~15 mm | body | aggressive, ~50 years old | assoc. MEN I, hyperchlorhydia | WDNEC, WDNET |
Type 3 | 10-15% | no | small and large | variable location | aggressive if >2.0 cm, males > females | normal gastrin levels | WDNET |
Type 4 | extremely rare | no | large | variable location | aggressive (mets usu. at time of Dx), males > females | elevated gastrin d/t parietal cell dysfunction | PDNEC |
Notes:
- WDNET = well-differentiated neuroendocrine tumour.
- WDNEC = well-differentiated neuroendocrine carcinoma.
- PDNEC = poorly-differentiated neuroendocrine carinoma.
Microscopic
Neoplastic rare
Gastric calcifying fibrous tumour
Gastric cancer
Gastric lymphoma
General
- Associated with helicobacter infection.[24]
- Usually MALT lymphoma (mucosa-associated lymphoid tissue lymphoma).
Microscopic
Features:
- Sheets of lymphoid cells.
- "Lymphoepithelial lesion" - gastric crypts invaded by a monomorphous population of lymphocytes.[25]
- Features:
- Cluster of lymphocytes - three cells or more - key feature.
- Single lymphocytes don't count.
- Clearing around the lymphocyte cluster.
- Cluster of lymphocytes - three cells or more - key feature.
- Associated with MALT lymphoma;[26] however, not specific.
- Features:
DDx:
IHC
- Panker -- most useful.
Others:
- CD3 (T cells) - scatter positivity.
- CD20 (B cells) +ve.
- CD138 (plasma cells).
- kappa, lambda -- often one is predominant, suggesting clonality.
- BCL2 +ve.
Treatment
- Triple therapy (two antibiotics, proton pump inhibitor (PPI)).[29]
- Surgery - if triple therapy fails.
Review paper: PMID 16950858.
Hereditary gastric cancer
Several syndromes are associated with gastric cancer:[30]
Disease | Gene | Histology | Other |
---|---|---|---|
Hereditary diffuse gastric cancer (HDGC) syndrome | CDH1 (E-cadherin)[31] | diffuse - more specifically signet ring cell carcinoma | most important; assoc. invasive lobular carcinoma[32] |
Lynch syndrome | MSH2, MLH1, others | ? | colorectal carcinoma, endometrial carcinoma |
Familial adenomatous polyposis | APC | ? | adenomatous polyps |
Peutz-Jeghers syndrome | STK11 | ? | stomach hamartomas - not precursor |
Li-Fraumeni syndrome | TP53 (p53) | ? | AKA SBLA syndrome = sarcomas, breast, brain, leukemia, laryngeal, lung, adrenocortical carcinoma |
Familial breast and ovarian cancer 2[33] | BRCA2 | ? | ? |
Gastric carcinoma
- Includes gastric adenocarcinoma.
See also
References
- ↑ ALS. 4 Feb 2009.
- ↑ Rubio, CA. (Jun 2007). "Gastric duodenal metaplasia in duodenal adenomas.". J Clin Pathol 60 (6): 661-3. doi:10.1136/jcp.2006.039388. PMC 1955048. PMID 16837629. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955048/.
- ↑ Osborn M, Mazzoleni G, Santini D, Marrano D, Martinelli G, Weber K (1988). "Villin, intestinal brush border hydrolases and keratin polypeptides in intestinal metaplasia and gastric cancer; an immunohistologic study emphasizing the different degrees of intestinal and gastric differentiation in signet ring cell carcinomas". Virchows Arch A Pathol Anat Histopathol 413 (4): 303–12. PMID 2459839.
- ↑ Braunstein, EM.; Qiao, XT.; Madison, B.; Pinson, K.; Dunbar, L.; Gumucio, DL. (May 2002). "Villin: A marker for development of the epithelial pyloric border.". Dev Dyn 224 (1): 90-102. doi:10.1002/dvdy.10091. PMID 11984877.
- ↑ Sternberg H4P 2nd Ed., P.484
- ↑ URL: http://www.lab.anhb.uwa.edu.au/mb140/CorePages/GIT/git.htm. Accessed on: 3 December 2010.
- ↑ http://www.histology-world.com/stains/stains.htm
- ↑ Goggin N, Rowland M, Imrie C, Walsh D, Clyne M, Drumm B (December 1998). "Effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease". Arch. Dis. Child. 79 (6): 502-5. PMC 1717771. PMID 10210995. http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=10210995.
- ↑ http://www.histology-world.com/stains/stains.htm
- ↑ http://www.histology-world.com/stains/stains.htm
- ↑ Malfertheiner, P.; Chan, FK.; McColl, KE. (Oct 2009). "Peptic ulcer disease.". Lancet 374 (9699): 1449-61. doi:10.1016/S0140-6736(09)60938-7. PMID 19683340.
- ↑ Lin J, McKenna BJ, Appelman HD (November 2010). "Morphologic findings in upper gastrointestinal biopsies of patients with ulcerative colitis: a controlled study". Am. J. Surg. Pathol. 34 (11): 1672–7. doi:10.1097/PAS.0b013e3181f3de93. PMID 20962621.
- ↑ 13.0 13.1 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 80. ISBN 978-0443066573.
- ↑ Kirsch R. 13 December 2010.
- ↑ URL: http://www.springerlink.com/content/u2v2525241754557/ Accessed on: 19 November 2010.
- ↑ Steen, S.; Lamont, J.; Petrey, L. (Jan 2008). "Acute gastric dilation and ischemia secondary to small bowel obstruction.". Proc (Bayl Univ Med Cent) 21 (1): 15-7. PMC 2190544. PMID 18209748. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190544/.
- ↑ 17.0 17.1 Papanikolaou, IS.; Foukas, PG.; Sioulas, A.; Beintaris, I.; Panagopoulos, P.; Karamanolis, G.; Panayiotides, IG.; Dimitriadis, G. et al. (2011). "A case of gastric ischemic necrosis.". Endoscopy 43 Suppl 2 UCTN: E342. doi:10.1055/s-0030-1256795. PMID 22020717.
- ↑ Herman, J.; Chavalitdhamrong, D.; Jensen, DM.; Cortina, G.; Manuyakorn, A.; Jutabha, R. (Apr 2011). "The significance of gastric and duodenal histological ischemia reported on endoscopic biopsy.". Endoscopy 43 (4): 365-8. doi:10.1055/s-0030-1256040. PMID 21360426.
- ↑ 19.0 19.1 Kamata, T.; Suzuki, H.; Yoshinaga, S.; Nonaka, S.; Fukagawa, T.; Katai, H.; Taniguchi, H.; Kushima, R. et al. (2012). "Localized gastric amyloidosis differentiated histologically from scirrhous gastric cancer using endoscopic mucosal resection: a case report.". J Med Case Rep 6 (1): 231. doi:10.1186/1752-1947-6-231. PMC 3438062. PMID 22863214. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438062/.
- ↑ Wu, D.; Lou, JY.; Chen, J.; Fei, L.; Liu, GJ.; Shi, XY.; Lin, HT. (Nov 2003). "A case report of localized gastric amyloidosis.". World J Gastroenterol 9 (11): 2632-4. PMID 14606114.
- ↑ Sawada, T.; Adachi, Y.; Akino, K.; Arimura, Y.; Ishida, T.; Ishii, Y.; Endo, T. (2012). "Endoscopic features of primary amyloidosis of the stomach.". Endoscopy 44 Suppl 2 UCTN: E275-6. doi:10.1055/s-0032-1309750. PMID 22814919.
- ↑ Rugge, M.; Correa, P.; Dixon, MF.; Hattori, T.; Leandro, G.; Lewin, K.; Riddell, RH.; Sipponen, P. et al. (Feb 2000). "Gastric dysplasia: the Padova international classification.". Am J Surg Pathol 24 (2): 167-76. PMID 10680883.
- ↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/StomachNET_11protocol.pdf. Accessed on: 29 March 2012.
- ↑ Mbulaiteye, SM.; Hisada, M.; El-Omar, EM. (2009). "Helicobacter Pylori associated global gastric cancer burden.". Front Biosci 14: 1490-504. PMID 19273142.
- ↑ Bailey, D. 6 August 2010.
- ↑ Papadaki, L.; Wotherspoon, AC.; Isaacson, PG. (Nov 1992). "The lymphoepithelial lesion of gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT): an ultrastructural study.". Histopathology 21 (5): 415-21. PMID 1452124.
- ↑ Kim, K.; Kim, EJ.; Kim, MJ.; Song, HJ.; Lee, YS.; Jung, KW.; Yu, E. (Dec 2009). "Clinicopathological features of syphilitic gastritis in Korean patients.". Pathol Int 59 (12): 884-9. doi:10.1111/j.1440-1827.2009.02462.x. PMID 20021615.
- ↑ Long, BW.; Johnston, JH.; Wetzel, W.; Flowers, RH.; Haick, A. (Sep 1995). "Gastric syphilis: endoscopic and histological features mimicking lymphoma.". Am J Gastroenterol 90 (9): 1504-7. PMID 7661178.
- ↑ Zullo, A.; Hassan, C.; Andriani, A.; Cristofari, F.; De Francesco, V.; Ierardi, E.; Tomao, S.; Morini, S. et al. (Aug 2009). "Eradication therapy for Helicobacter pylori in patients with gastric MALT lymphoma: a pooled data analysis.". Am J Gastroenterol 104 (8): 1932-7; quiz 1938. doi:10.1038/ajg.2009.314. PMID 19532131.
- ↑ Sereno, M.; Aguayo, C.; Guillén Ponce, C.; Gómez-Raposo, C.; Zambrana, F.; Gómez-López, M.; Casado, E. (Sep 2011). "Gastric tumours in hereditary cancer syndromes: clinical features, molecular biology and strategies for prevention.". Clin Transl Oncol 13 (9): 599-610. PMID 21865131.
- ↑ Online 'Mendelian Inheritance in Man' (OMIM) 192090
- ↑ Guilford, P.; Hopkins, J.; Harraway, J.; McLeod, M.; McLeod, N.; Harawira, P.; Taite, H.; Scoular, R. et al. (Mar 1998). "E-cadherin germline mutations in familial gastric cancer.". Nature 392 (6674): 402-5. doi:10.1038/32918. PMID 9537325.
- ↑ Online 'Mendelian Inheritance in Man' (OMIM) 600185