Difference between revisions of "Stomach"

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'''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.  Surgeon take-out the organ.  It connects the [[esophagus]] to the [[duodenum]].  An introduction to gastrointestinal pathology is in the ''[[gastrointestinal pathology]]'' article.
[[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 stomach=
=Normal stomach=
Line 53: Line 54:
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'''olveolar cells have '''f'''riends, i.e. they are close to other foveolar cells.
*Memory device: '''F'''oveolar cells have '''f'''riends, i.e. they are close to other foveolar cells.


===Gastric antrum versus gastric body===
===Gastric antrum versus gastric body===
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===Sign out===
===Sign out===
====Short version====
====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>
<pre>
STOMACH, BIOPSY:
STOMACH, BIOPSY:
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====Sleeve gastrectomy====
====Sleeve gastrectomy====
*Indication: morbid [[obesity]].
{{Main|Sleeve gastrectomy}}
<pre>
STOMACH, GREATER CURVE, SLEEVE GASTRECTOMY:
- STOMACH WALL WITHIN NORMAL LIMITS.
</pre>


=Introduction=
=Introduction=
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{{Main|Intestinal metaplasia of the stomach}}
{{Main|Intestinal metaplasia of the stomach}}


==Inflammatory bowel disease & the stomach==
==Inflammatory bowel disease and the stomach==
:See ''[[inflammatory bowel disease]]''.
:See ''[[inflammatory bowel disease]]''.
*Histopathologic findings are usually non-specific.
*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>
*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===
===Microscopic===
Features:<ref>RK. 13 December 2010.</ref>
Features:<ref>Kirsch R. 13 December 2010.</ref>
*Focal inflammation.
*Focal inflammation.
**Common finding - non-specific.
**Common finding - non-specific.
*+/-[[Granulomas]].
*+/-[[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=
Line 247: Line 277:


==Collagenous gastritis==
==Collagenous gastritis==
===General===
{{Main|Collagenous gastritis}}
*Very rare.
*Associated with ''[[collagenous colitis]]''.
 
===Microscopic===
Features:
*Eosinophilic material (collagen) expands lamina propria.
**Band of collagen must be ~thick as RBC diameter.
***Proven by [[trichrome stain]] that highlights collagen.
 
DDx:
*[[Amyloidosis of the stomach]].


==Gastritis cystitis profunda==
==Gastritis cystitis profunda==
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*[[AKA]] ''xanthelasma''.
*[[AKA]] ''xanthelasma''.
*[[AKA]] ''stomach lipidosis''.
*[[AKA]] ''stomach lipidosis''.
===General===
{{Main|Gastric xanthoma}}
*Uncommon.
*Benign.
 
===Gross/endoscopic===
*Yellowish nodule or plaque.<ref name=Ref_GLP111>{{Ref GLP|111}}</ref>
**Classically lesser curvature and antrum.<ref name=pmid6284833/>
 
===Microscopic===
Features:<ref name=Ref_GLP111>{{Ref GLP|111}}</ref>
*Collections of gastric lamina propria with lipid-laden macrophages.
 
DDx:
*[[Signet ring cell carcinoma]].<ref name=pmid6284833>{{Cite journal  | last1 = Drude | first1 = RB. | last2 = Balart | first2 = LA. | last3 = Herrington | first3 = JP. | last4 = Beckman | first4 = EN. | last5 = Burns | first5 = TW. | title = Gastric xanthoma: histologic similarity to signet ring cell carcinoma. | journal = J Clin Gastroenterol | volume = 4 | issue = 3 | pages = 217-21 | month = Jun | year = 1982 | doi =  | PMID = 6284833 }}</ref>
*[[Whipple disease]].
*MAC infection.
 
====Images====
<gallery>
image:Xanthoma_histology.jpg | Xanthoma. (WC)
</gallery>
www:
*[http://www.flickr.com/photos/hemeguy/2911032670/in/photostream/ GX - low mag. (flickr.com)].
*[http://www.flickr.com/photos/hemeguy/2911031464/in/photostream GX - high mag. (flickr.com)].
 
===IHC===
*CD68 +ve.
*Panker (AE1/AE3) -ve.


==Gastric ischemia==
==Gastric ischemia==
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==Portal hypertensive gastropathy==
==Portal hypertensive gastropathy==
*Abbreviated ''PHG''.
*Abbreviated ''PHG''.
===General===
{{Main|Portal hypertensive gastropathy}}
*Due to [[portal hypertension]].
**Usually secondary to [[liver cirrhosis]] which is typically due to [[alcoholism]].
***Reported in approximately 65% of cirrhotics with portal hypertension in one paper.<ref name=pmid15648238>{{Cite journal  | last1 = Mesihovic | first1 = R. | last2 = Prohic | first2 = D. | last3 = Gribajcevic | first3 = M. | last4 = Vanis | first4 = N. | last5 = Gornjakovic | first5 = S. | last6 = Sarac | first6 = A. | title = Portal hypertensive gastropathy (PHG). | journal = Med Arh | volume = 58 | issue = 6 | pages = 377-9 | month =  | year = 2004 | doi =  | PMID = 15648238 }}
</ref>
 
===Gross===
Features:<ref name=pmid12492178>{{Cite journal  | last1 = Thuluvath | first1 = PJ. | last2 = Yoo | first2 = HY. | title = Portal Hypertensive gastropathy. | journal = Am J Gastroenterol | volume = 97 | issue = 12 | pages = 2973-8 | month = Dec | year = 2002 | doi = 10.1111/j.1572-0241.2002.07094.x | PMID = 12492178 }}</ref>
*Mosaic-like pattern.
**May be referred to as [[Gastric snakeskin appearance|snakeskin-like pattern]].<ref name=pmid22211417/>
**Usu. body of stomach.
*+/-Red spots.
 
Note:
*May mimic eosinophilic gastritis.<ref name=pmid22211417>{{Cite journal  | last1 = Sikanderkhel | first1 = S. | last2 = Luthra | first2 = M. | last3 = Chavalitdhamrong | first3 = D. | title = Snakeskin-like pattern mimicking portal hypertensive gastropathy in patient with eosinophilic gastritis. | journal = Dig Endosc | volume = 24 | issue = 1 | pages = 53 | month = Jan | year = 2012 | doi = 10.1111/j.1443-1661.2011.01155.x | PMID = 22211417 }}</ref>
 
====Images====
<gallery>
Image:PHGastro.jpg | PHG. (WC/Samir)
</gallery>
 
===Microscopic===
Features:<ref name=Ref_GLP120-1>{{Ref GLP|120-1}}</ref>
*Dilated capillaries in the submucosa (prominent) and to a lesser extent in the lamina propria - '''key feature'''.
 
Notes:
*May be associated with [[hyperplastic polyp of the stomach|hyperplastic]]-like polyps.<ref name=pmid22002002>{{Cite journal  | last1 = Lam | first1 = MC. | last2 = Tha | first2 = S. | last3 = Owen | first3 = D. | last4 = Haque | first4 = M. | last5 = Chatur | first5 = N. | last6 = Gray | first6 = JR. | last7 = Yoshida | first7 = EM. | title = Gastric polyps in patients with portal hypertension. | journal = Eur J Gastroenterol Hepatol | volume = 23 | issue = 12 | pages = 1245-9 | month = Nov | year = 2011 | doi = 10.1097/MEG.0b013e32834c15cf | PMID = 22002002 }}</ref>
**Subepithelial [[granulation tissue]] and vascular proliferation.
*Findings in mucosal biopsies are often [[specificity|nonspecific]], i.e. not diagnostic.<ref name=Ref_GLP120-1>{{Ref GLP|120-1}}</ref>
 
DDx:
*[[Gastric antral vascular ectasia]] - have thrombi in the dilated blood vessels.
 
===Sign out===
<pre>
STOMACH, BIOPSY:
- ANTRAL-TYPE AND BODY-TYPE GASTRIC MUCOSA WITH PROMINENT CAPILLARIES
AND MODERATE CHRONIC INACTIVE INFLAMMATION.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
 
COMMENT:
No fibrin thrombi are seen.  The findings are compatible with portal hypertension.
Clinical correlation is required.
</pre>


==Amyloidosis of the stomach==
==Amyloidosis of the stomach==
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===Stains===
===Stains===
*[[Congo red stain]] +ve.
*[[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=
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==Hyperplastic polyp of the stomach==
==Hyperplastic polyp of the stomach==
{{Main|Hyperplastic polyp}}
{{Main|Hyperplastic polyp of the stomach}}
*[[AKA]] ''gastric hyperplastic polyp''.
===General===
*Benign.
*Most common gastric polyp.<ref name=pmid19037727/>
 
===Microscopic===
Features:<ref>URL: [http://pathologyoutlines.com/stomach.html#hyperplastic http://pathologyoutlines.com/stomach.html#hyperplastic]. Accessed on: 26 July 2011.</ref>
*Abundant foveolar cells and elongated glands - '''key feature'''.
*+/-Gland dilation.
 
Negatives:
*No atypical nuclei.
*No hyperchromasia.
*No loss of pseudostratification.
 
Notes:
*No serrations - as in the colon.
 
DDx:
*[[Ménétrier's disease]]<ref name=pmid18384215>{{Cite journal  | last1 = Park | first1 = do Y. | last2 = Lauwers | first2 = GY. | title = Gastric polyps: classification and management. | journal = Arch Pathol Lab Med | volume = 132 | issue = 4 | pages = 633-40 | month = Apr | year = 2008 | doi = 10.1043/1543-2165(2008)132[633:GPCAM]2.0.CO;2 | PMID = 18384215 | url=http://www.archivesofpathology.org/doi/full/10.1043/1543-2165(2008)132%5B633:GPCAM%5D2.0.CO;2 }}</ref> (hyperplastic hypersecretory gastropathy).
*[[Juvenile polyp]]<ref name=pmid19037727>{{Cite journal  | last1 = Jain | first1 = R. | last2 = Chetty | first2 = R. | title = Gastric hyperplastic polyps: a review. | journal = Dig Dis Sci | volume = 54 | issue = 9 | pages = 1839-46 | month = Sep | year = 2009 | doi = 10.1007/s10620-008-0572-8 | PMID = 19037727 }}</ref> - abundant lamina propria, dilated glands may have neutrophils.<ref name=Ref_GLP102>{{Ref GLP|102}}</ref>
*[[Peutz-Jeghers polyp]] - thick superficial muscle.
*[[Fundic gland polyp]] - doesn't have foveolar hyperplasia.
 
====Images====
<gallery>
Image: Gastric_hyperplastic_polyp_%281%29_foveolar_type.jpg | Gastric hyperplastic polyp - low mag. (WC/KGH)
Image: Gastric_hyperplastic_polyp_%283%29_foveolar_type.jpg | Gastric hyperplastic polyp - high mag. (WC/KGH)
</gallery>
 
www:
*[http://www.flickr.com/photos/jian-hua_qiao_md/3953137621/ Gastric hyperplastic polyp (flickr.com)].
*[http://www.flickr.com/photos/jian-hua_qiao_md/3953138195/in/photostream/ Gastric hyperplastic polyp (flickr.com)].
 
===Sign out===
<pre>
POLYP, STOMACH (ANTRUM), EXCISION:
- HYPERPLASTIC POLYP.
</pre>
 
====Micro====
The sections show antral-type gastric mucosa with hyperplastic gastric pits.  No gland dilation is apparent. The epithelium matures to the surface. The lamina propria is not expanded.
 
Focal neutrophilic inflammation is present. No Helicobacter-like organisms are identified. No intestinal metaplasia is present. No mitotic activity or nuclear atypia is apparent.


==Fundic gland polyp==
==Fundic gland polyp==
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==Gastric dysplasia==
==Gastric dysplasia==
:''Gastric adenoma'' directs here.
{{Main|Stomach adenoma}}
*[[AKA]] ''gastric columnar dysplasia''.
===General===
*Lesions that protrude into the lumen ''and'' are macroscopically apparent are known as: ''adenomas''.<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>
*Polypoid forms are grouped various ways.<ref name=pmid18384215>{{Cite journal  | last1 = Park | first1 = do Y. | last2 = Lauwers | first2 = GY. | title = Gastric polyps: classification and management. | journal = Arch Pathol Lab Med | volume = 132 | issue = 4 | pages = 633-40 | month = Apr | year = 2008 | doi = 10.1043/1543-2165(2008)132[633:GPCAM]2.0.CO;2 | PMID = 18384215 | url=http://www.archivesofpathology.org/doi/full/10.1043/1543-2165(2008)132%5B633:GPCAM%5D2.0.CO;2 }}</ref>
 
====Grading====
Like in the colon - they are divided into:
*Low grade.
*High grade.
 
====Subclassification====
One subclassification:<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/gastric-adenoma/printable.html http://surgpathcriteria.stanford.edu/gitumors/gastric-adenoma/printable.html]. Accessed on: 18 December 2012.</ref>
*Intestinal: goblet cells or Paneth cells.
**Not associated with FAP.
*Gastric: foveolar epithelium.
**Associated with [[familial adenomatous polyposis]] (FAP).
 
===Microscopic===
*Histologic criteria similar to columnar dysplasia in the [[esophagus]].
**The threshold is much lower than in the colon and rectum.
 
====Foveolar type====
Features:
*Hyperchromasia at the surface - '''key feature'''.
*Cytoplasm with (shortened) champagne flute-like luminal aspect (apical mucin caps).
*Nuclear changes:
**Hyperchromasia.
**Enlargement.
*No intestinal metaplasia.
 
DDx:
*[[Gastric carcinoma]].
*[[Reactive changes]].
 
====Intestinal type====
Features - intestinal:
*[[Intestinal metaplasia of the stomach|Intestinal metaplasia]].
*Hyperchromasia of cytoplasm.
*Nuclear changes:
**Loss of nuclear polarity.
**Increased [[NC ratio]].
**Elongation of nucleus and pseudostratification.
 
DDx:
*[[Gastric carcinoma]].
*[[Reactive changes]].
*[[Intestinal metaplasia of the stomach|Intestinal metaplasia]].
 
=====Images=====
<gallery>
Image:Gastric_adenoma_(1).jpg | Gastric adenoma. (WC/KGH)
Image:Gastric_adenoma_(2).jpg | Gastric adenoma. (WC/KGH)
</gallery>
www:
*[http://www.sciencedirect.com/science/article/pii/S1756231710001878 Gastric polyps - several images (sciencedirect.com)].
*[http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282008%29132%5B633%3AGPCAM%5D2.0.CO%3B2 Gastric polyps - several images (achivesofpathology.org)].
 
====Grading====
=====Low-grade gastric dysplasia=====
Features:
*Nuclear changes:
**Nuclear crowding/pseudostratification with hyperchromasia.
**Elongation of nuclei (cigar-shaped nuclei).
**Nuclear stratification intact; nuclei close to the basement membrane.
*Architecture:
**Focal irregularities in the glandular contours.
 
Negatives:
*No desmoplasia.
*No necrosis.
*No surface maturation.
 
DDx:
*Indefinite for dysplasia.
*High-grade gastric columnar dysplasia - see below.
**The threshold is much lower than in the colon and rectum!
 
Images:
*[http://path.upmc.edu/cases/case431.html Low-grade gastric columnar dysplasia - several images (upmc.edu)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204467/figure/F4/ Gastric low-grade dysplasia (nih.gov)].<ref name=pmid22076218>{{Cite journal  | last1 = Kushima | first1 = R. | last2 = Kim | first2 = KM. | title = Interobserver Variation in the Diagnosis of Gastric Epithelial Dysplasia and Carcinoma between Two Pathologists in Japan and Korea. | journal = J Gastric Cancer | volume = 11 | issue = 3 | pages = 141-5 | month = Sep | year = 2011 | doi = 10.5230/jgc.2011.11.3.141 | PMID = 22076218 }}</ref>
=====High-grade gastric dysplasia=====
Features:
*Nuclear changes:
**Round hyperchromatic nuclei.
**Loss of normal nuclear stratification.
*Architecture:
**Irregularities in the glandular contours.
**Back-to-back glands.
**Cribriforming of the glands.
**+/-Necrosis.
 
Negatives:
*No [[desmoplasia]].
 
DDx:
*Low-grade gastric columnar dysplasia.
*[[Gastric adenocarcinoma]].
 
=====Images=====
<gallery>
Image:High_grade_gastric_dysplasia_-_low_mag.jpg | High grade gastric dysplasia - low mag. (WC/Nephron)
Image:High_grade_gastric_dysplasia_-_very_high_mag.jpg | High grade gastric dysplasia - very high mag. (WC/Nephron)
</gallery>
www:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404600/figure/F8/ Gastric high-grade dysplasia - probably (nih.gov)].<ref name=pmid22188910>{{Cite journal  | last1 = Correa | first1 = P. | last2 = Piazuelo | first2 = MB. | title = The gastric precancerous cascade. | journal = J Dig Dis | volume = 13 | issue = 1 | pages = 2-9 | month = Jan | year = 2012 | doi = 10.1111/j.1751-2980.2011.00550.x | PMID = 22188910 }}</ref>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204467/figure/F7/ Gastric high-grade dysplasia - probably (nih.gov)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204467/figure/F6/ Gastric high-grade dysplasia (nih.gov)].<ref name=pmid22076218/>
 
===Sign out===
====Indefinite for dypslasia====
<pre>
STOMACH, ANTRUM, BIOPSIES:
- ANTRAL-TYPE MUCOSA INDEFINITE FOR DYSPLASIA WITH MODERATE CHRONIC INFLAMMATION.
- EXTENSIVE INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANSIMS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====Intestinal type====
<pre>
STOMACH, ANTRUM, BIOPSIES:
- ANTRAL-TYPE MUCOSA WITH FOCUS OF LOW-GRADE DYSPLASIA (INTESTINAL TYPE).
- EXTENSIVE INTESTINAL METAPLASIA.
- MODERATE CHRONIC INFLAMMATION.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANSIMS.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
====Foveolar type====
<pre>
STOMACH POLYP, BIOPSY:
- ADENOMATOUS POLYP, FOVEOLAR TYPE.
- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
</pre>


==Gastric neuroendocrine tumour==
==Gastric neuroendocrine tumour==
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Features:
Features:
*Sheets of lymphoid cells.
*Sheets of lymphoid cells.
*"Lymphoepithelial lesion" - gastric crypts invaded by a monomorphous population of lymphocytes.<ref>Bailey, D. 6 August 2010.</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'''.
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Others:
Others:
*CD3 (T cells) - scatter positivity.
*CD3 (T cells) - scatter positivity.
*CD20 (B cells) +ve.
*[[CD20]] (B cells) +ve.
*CD138 (plasma cells).
*CD138 (plasma cells).
*kappa, lambda -- often one is predominant, suggesting clonality.
*kappa, lambda -- often one is predominant, suggesting clonality.
Line 721: Line 496:
! Other
! Other
|-
|-
| Hereditary diffuse gastric cancer (HDGC) syndrome  
| [[Hereditary diffuse gastric cancer syndrome|Hereditary diffuse gastric cancer (HDGC) syndrome]]
| CDH1 (E-cadherin)<ref>{{OMIM|192090}}</ref>
| CDH1 (E-cadherin)<ref>{{OMIM|192090}}</ref>
| diffuse - more specifically [[signet ring cell carcinoma]]
| diffuse - more specifically [[signet ring cell carcinoma]]
Line 747: Line 522:
|-
|-
| Familial breast and ovarian cancer 2<ref name=omim600185>{{OMIM|600185}}</ref>
| Familial breast and ovarian cancer 2<ref name=omim600185>{{OMIM|600185}}</ref>
| BRCA2
| [[BRCA2]]
| ?
| ?
| ?
| ?
|}
|}


==Gastric adenocarcinoma==
==Gastric carcinoma==
===General===
:Includes ''gastric adenocarcinoma''.
Epidemiology:
{{Main|Gastric carcinoma}}
*Prognosis is often poor as it is discovered at a late stage.
*Higher prevalence in countries in the far east (e.g. Japan) - thought to be environmental, e.g. diet.
 
Risk factors:
*Associated with helicobacter infections, i.e. [[Helicobacter gastritis]].
*[[Alcohol]] - heavy use.<ref name=pmid21993435>{{Cite journal  | last1 = Duell | first1 = EJ. | last2 = Travier | first2 = N. | last3 = Lujan-Barroso | first3 = L. | last4 = Clavel-Chapelon | first4 = F. | last5 = Boutron-Ruault | first5 = MC. | last6 = Morois | first6 = S. | last7 = Palli | first7 = D. | last8 = Krogh | first8 = V. | last9 = Panico | first9 = S. | title = Alcohol consumption and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. | journal = Am J Clin Nutr | volume = 94 | issue = 5 | pages = 1266-75 | month = Nov | year = 2011 | doi = 10.3945/ajcn.111.012351 | PMID = 21993435 }}</ref>
*Genetic syndromes - see [[hereditary gastric cancer]].
 
Note:
*Possible association with tobacco use - dependent on the study.<ref>{{Cite journal  | last1 = Nomura | first1 = A. | last2 = Grove | first2 = JS. | last3 = Stemmermann | first3 = GN. | last4 = Severson | first4 = RK. | title = Cigarette smoking and stomach cancer. | journal = Cancer Res | volume = 50 | issue = 21 | pages = 7084 | month = Nov | year = 1990 | doi =  | PMID = 2208177 | URL = http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=2208177}}</ref>
 
Treatment:
*Surgical excision. 
**Proximal tumours may require a complete gastrectomy as the stomach is innervated from its proximal part.
 
====Classification====
*Two different classification schemes.
**Lauren<ref name=pmid14320675>{{cite journal |author=LAUREN P |title=THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND  SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION |journal=Acta Pathol Microbiol Scand |volume=64 |issue= |pages=31–49 |year=1965 |pmid=14320675 |doi= |url=}}</ref> - two types:
***Intestinal type (mass forming).
***Diffuse type (infiltrative).
**WHO classification - 6 subtypes for adenocarcinoma:<ref name=Ref_PBoD823>{{Ref PBoD |823}}</ref>
**#Papillary carcinoma.
**#Tubular carcinoma.
**#Mucinous carcinoma.
**#Signet-ring carcinoma.
**#Undifferentiated carcinoma.
**#[[Adenosquamous carcinoma]].
 
Lame memory device ''STOMACH'':
*'''S'''ignet ring, '''T'''ubular, '''O'''h papillary, '''M'''ucinous, '''A'''denosquamouas, '''C'''rappy '''H'''igh grade (Undifferentiated).
 
===Gross===
Location:
*Large carcinomas preferentially involve the lesser curvature.<ref name=pmid2550682>{{Cite journal  | last1 = Yamagawa | first1 = H. | last2 = Onishi | first2 = T. | title = [A clinicopathological study of early gastric cancers with a diameter larger than five centimeters]. | journal = Gan No Rinsho | volume = 35 | issue = 10 | pages = 1114-8 | month = Sep | year = 1989 | doi =  | PMID = 2550682 }}</ref>
*Ulceration with heaped (raised) edges.
**Appearance of the typical intestinal type tumour.
*Diffuse wall thickening with loss of the rugae - called ''linitis plastica''.
**Typically due to diffuse carcinoma.
 
Main DDx of ulcer:
*[[Peptic ulcer disease]] - have a "punched-out" appearance: sharp edge, no granularity of surrounding mucosa.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Linitis_plastica.jpg Linitis plastica - endoscopic image (WC)].
*[http://commons.wikimedia.org/wiki/File:Adenocarcinoma_of_the_stomach.jpg Ulcerating gastric carcinoma (WC)].
*[http://commons.wikimedia.org/wiki/File:Adenocarcinoma,_stomach,_gross_pathology_IMG0037a_lores.jpg Ulcerating gastric carcinoma (WC)].
 
===Microscopic===
Features - variable, either of the two following:
#"Typical adenocarcinoma":
#*Gland-forming lesion that infiltrates into the lamina propria or beyond.
#*Nuclear pleomorphism - common.
#+/-Signet ring carcinoma.
#*Scattered single cells in the lamina propria or beyond with:
#**Abundant cytoplasm containing one large (mucin-filled) vacuole.
#**A peripheral nucleus (displaced by the vacuole).
 
DDx:
*[[Gastric xanthoma]] - may mimic signet ring cell carcinoma.
 
Images:
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Gastric_adenocarcinoma.jpg Gastric adenocarcinoma (WC)].
**[http://commons.wikimedia.org/wiki/File:Signet_ring_cells_5.jpg SRC - breast (WC)].
**[http://en.wikipedia.org/wiki/File:Gastric_signet_ring_cell_carcinoma_histopatholgy_%282%29_PAS_stain.jpg Gastric SRC - PAS stain (WC)].
*www:
**[http://path.upmc.edu/cases/case196.html Gastric adenocarcinoma - several images (upmc.edu)].
 
===Stains===
*Mucicarmine +ve.
 
===IHC===
*CK7 +ve.
*CK20 -ve, occasionally +ve.
 
Others:
*p53 +ve in upto 75% of cases.<ref name=pmid21772890>{{Cite journal  | last1 = Zali | first1 = MR. | last2 = Moaven | first2 = O. | last3 = Asadzadeh Aghdaee | first3 = H. | last4 = Ghafarzadegan | first4 = K. | last5 = Ahmadi | first5 = KJ. | last6 = Farzadnia | first6 = M. | last7 = Arabi | first7 = A. | last8 = Abbaszadegan | first8 = MR. | title = Clinicopathological significance of E-cadherin, β-catenin and p53 expression in gastric adenocarinoma. | journal = J Res Med Sci | volume = 14 | issue = 4 | pages = 239-47 | month = Jul | year = 2009 | doi =  | PMID = 21772890 }}</ref>
 
===Molecular===
*May have HER2 over expression - more common in intestinal-type tumours.<ref name=pmid22213295>{{Cite journal  | last1 = Romiti | first1 = A. | last2 = Di Rocco | first2 = R. | last3 = Milione | first3 = M. | last4 = Ruco | first4 = L. | last5 = Ziparo | first5 = V. | last6 = Zullo | first6 = A. | last7 = Duranti | first7 = E. | last8 = Sarcina | first8 = I. | last9 = Barucca | first9 = V. | title = Somatostatin receptor subtype 2 A (SSTR2A) and HER2 expression in gastric adenocarcinoma. | journal = Anticancer Res | volume = 32 | issue = 1 | pages = 115-9 | month = Jan | year = 2012 | doi =  | PMID = 22213295 }}</ref>
**Poor prognosis - like in breast cancer.
**Scoring system different than in breast cancer - complete membrane staining is not required.
 
===Sign out===
====Biopsy====
=====Intestinal type=====
<pre>
STOMACH, BIOPSY:
- INVASIVE ADENOCARCINOMA, INTESTINAL TYPE, MODERATELY DIFFERENTIATED.
- Gastric mucosa with moderate chronic active inflammation and extensive
  intestinal metaplasia.
- Benign small bowel mucosa with erosions.
</pre>
 
=====Diffuse type=====
<pre>
STOMACH, BIOPSY:
- INVASIVE ADENOCARCINOMA, DIFFUSE TYPE.
 
COMMENT:
A pankeratin immunostain demonstrates single (infiltrating) epithelial cells in the
lamina propria.
</pre>
 
=====Micro=====
The tumour consists of single cells with abundant foamy-appearing cytoplasm and eccentric
nuclei with mild nuclear atypia.


=See also=
=See also=
Michael
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