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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 stomach= | |||
==Gross anatomy== | ==Gross anatomy== | ||
*Cardia - first part of the stomach; joins with [[esophagus]]. | *Cardia - first part of the stomach; joins with [[esophagus]]. | ||
*Fundus - superior portion - not attached directly to the esophagus. | *Fundus - superior portion - not attached directly to the esophagus. | ||
*Body - contains parietal cells. | *Body - contains parietal cells. | ||
*Pylorus - distal (think ''pyloric stenosis''). | *Pylorus - distal (think ''pyloric stenosis''); it joins with the [[duodenum]]. | ||
**[[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=== | ||
A tabular comparison:<ref>ALS. 4 Feb 2009.</ref> <!-- I think this part may be screwed-up --> | |||
{| class="wikitable sortable" | |||
! Feature | |||
! Intestine | |||
{| class="wikitable" | ! Stomach | ||
|- | |- | ||
|Spacing | |Spacing | ||
|Goblets cell - spaced | |Goblets cell - spaced | ||
| | |Foveolar cells - beside one another | ||
|- | |- | ||
|Morphology of epithelial cells | |Morphology of epithelial cells | ||
Line 39: | 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 | ||
|- | |- | ||
|Images | |Images | ||
|[http://commons.wikimedia.org/wiki/File:Tubular_adenoma_2_high_mag.jpg Tubular adenoma - goblet 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 | |||
! Body | |||
! Antrum | |||
! Histology | |||
! Image | |||
|- | |||
| '''Parietal cell''' | |||
| abundant | |||
| few or none | |||
| parietal cells: intensely<br> eosinophilic cytoplasm | |||
| [[Image:Normal_gastric_mucosa_intermed_mag.jpg|thumb|center|60px|Parietal cells. (WC)]] | |||
|- | |||
| '''Chief cell''' | |||
| present | |||
| absent | |||
| chief cells: basophilic cytoplasm, <br>[[IHC]]: +ve for ''pepsinogen I'' | |||
| [[Image:Chief_cells.JPG|thumb|center|100px|Chief cells. (WC)]] | |||
|- | |||
| '''G cell''' | |||
| absent | |||
| present | |||
| 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''' | |||
| flat | |||
| blunted villi | |||
| antrum is somewhat <br>duodenum-like | |||
| [[Image:Normal_gastric_mucosa_intermed_mag.jpg |thumb|center|60px|Body - flat. (WC)]] | |||
|- | |||
| '''Gastric glands <br>/ mucosa''' | |||
| thick | |||
| thin | |||
| not so useful for <br>discrimination | |||
| [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= | |||
==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 71: | Line 163: | ||
*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= | ||
==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== | ||
{{Main|Helicobacter gastritis}} | |||
==Intestinal metaplasia== | ==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=== | ===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= | |||
This is a grab bag of stuff seen in the stomach. Some of it is quite rare. | |||
==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=== | |||
*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=== | ||
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 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=== | ||
Features:<ref> | 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/ | ===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 | 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:<ref>{{ | 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= | |||
Similar to colonic polyps - see [[intestinal polyps]]. | |||
DDx polyp (similar to colon & rectum): | |||
*Hyperplastic - most common, characterised by abundant elongated foveola + glands. | |||
*[[Hamartomatous polyps|Hamartomatous]] - weriod stuff. | |||
*[[Inflammatory fibroid polyp]] - inflammation, [[myxoid stroma]]. | |||
*[[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: | |||
*WDNET = well-differentiated neuroendocrine tumour. | |||
*WDNEC = well-differentiated neuroendocrine carcinoma. | |||
*PDNEC = poorly-differentiated neuroendocrine carinoma. | |||
=== | ===Microscopic=== | ||
:''See [[neuroendocrine tumours]]'' | |||
=Neoplastic rare= | |||
==Gastric calcifying fibrous tumour== | |||
{{Main|Calcifying fibrous tumour}} | |||
=Gastric cancer= | |||
* | *[[Gastrointestinal stromal tumour]] (GIST). | ||
* | *[[Gastric adenocarcinoma]]. | ||
*MALT lymphoma. | *[[MALT lymphoma]]. | ||
==Gastric lymphoma== | ==Gastric lymphoma== | ||
{{main| | {{main|MALT lymphoma}} | ||
===General=== | ===General=== | ||
*Associated with helicobacter infection.<ref name=pmid19273142>{{Cite journal | last1 = Mbulaiteye | first1 = SM. | last2 = Hisada | first2 = M. | last3 = El-Omar | first3 = EM. | title = Helicobacter Pylori associated global gastric cancer burden. | journal = Front Biosci | volume = 14 | issue = | pages = 1490-504 | month = | year = 2009 | doi = | PMID = 19273142 }} | *Associated with helicobacter infection.<ref name=pmid19273142>{{Cite journal | last1 = Mbulaiteye | first1 = SM. | last2 = Hisada | first2 = M. | last3 = El-Omar | first3 = EM. | title = Helicobacter Pylori associated global gastric cancer burden. | journal = Front Biosci | volume = 14 | issue = | pages = 1490-504 | month = | year = 2009 | doi = | PMID = 19273142 }} | ||
</ref> | </ref> | ||
*Usually ''MALT lymphoma'' (mucosa-associated lymphoid tissue lymphoma). | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*"Lymphoepithelial lesion" - gastric crypts invaded by a monomorphous population of lymphocytes | *Sheets of lymphoid cells. | ||
*# Cluster of lymphocytes - three cells or more. | *"[[Lymphoepithelial lesion]]" - gastric crypts invaded by a monomorphous population of lymphocytes.<ref>Bailey, D. 6 August 2010.</ref> | ||
*#* Single lymphocytes don't count. | **Features: | ||
*# Clearing around the lymphocyte cluster. | **# Cluster of lymphocytes - three cells or more - '''key feature'''. | ||
**#* Single lymphocytes don't count. | |||
**# Clearing around the lymphocyte cluster. | |||
**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 | ===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 313: | Line 488: | ||
Review paper: PMID 16950858. | Review paper: PMID 16950858. | ||
==Gastric | ==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= | |||
*[[Esophagus]]. | *[[Esophagus]]. | ||
*[[Duodenum]]. | |||
*[[Granulation tissue]]. | |||
*[[Intestinal polyps]]. | *[[Intestinal polyps]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastrointestinal pathology]] | [[Category:Gastrointestinal pathology]] |
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