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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. |
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| =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]]. |
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| **[[AKA]] antrum. | | **[[AKA]] antrum. |
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| |
|
| Image: [http://en.wikipedia.org/wiki/File:Illu_stomach.jpg Stomach anatomy (WP)]. | | ===Image=== |
| | <gallery> |
| | Image:Illu_stomach.jpg | Stomach anatomy (WC) |
| | </gallery> |
|
| |
|
| ==Microscopic== | | ==Microscopic== |
| ===Foveolar cells vs. intestinal goblet 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. |
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| |
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| ===Stomach vs. intestine<ref>ALS. 4 Feb 2009.</ref> <!-- I think this may be screwed-up -->=== | | ===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" |
| |'''Intestine'''
| | ! Feature |
| |'''Stomach'''
| | ! Intestine |
| | ! Stomach |
| |- | | |- |
| |Spacing | | |Spacing |
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| |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 |
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| |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)] |
| |} | | |} |
|
| |
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| 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. |
|
| |
|
| Ref.
| | ===Gastric antrum versus gastric body=== |
| *PMID 11984877.
| | {| class="wikitable sortable" |
| | | ! Cell |
| ===Gastric antrum vs. gastric body=== | | ! Body |
| {| class="wikitable" | | ! Antrum |
| |
| | ! Histology |
| | '''Body'''
| | ! Image |
| | '''Antrum'''
| |
| | '''Histology'''
| |
| | '''Image'''
| |
| |- | | |- |
| | '''Parietal cells''' | | | '''Parietal cell''' |
| | abundant | | | abundant |
| | few or none | | | few or none |
| | parietal cells: intensely<br> eosinophilic cytoplasm | | | parietal cells: intensely<br> eosinophilic cytoplasm |
| | [http://commons.wikimedia.org/wiki/File:Parietal_cells.jpg], [http://commons.wikimedia.org/wiki/File:Normal_gastric_mucosa_intermed_mag.jpg] | | | [[Image:Normal_gastric_mucosa_intermed_mag.jpg|thumb|center|60px|Parietal cells. (WC)]] |
| |- | | |- |
| | '''Chief cells''' | | | '''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'' |
| | [http://commons.wikimedia.org/wiki/File:Chief_cells.JPG] | | | [[Image:Chief_cells.JPG|thumb|center|100px|Chief cells. (WC)]] |
| |- | | |- |
| | '''G cells''' | | | '''G cell''' |
| | absent | | | absent |
| | present | | | 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''. | | | 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''. |
| | [http://commons.wikimedia.org/wiki/File:G_cell_hyperplasia_-_very_high_mag.jpg] | | | [[Image:G_cell_hyperplasia_-_very_high_mag.jpg|thumb|center|60px|G cell hyperplasia. (WC)]] |
| |- | | |- |
| | '''Surface''' | | | '''Surface''' |
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| | blunted villi | | | blunted villi |
| | antrum is somewhat <br>duodenum-like | | | antrum is somewhat <br>duodenum-like |
| | [http://commons.wikimedia.org/wiki/File:Normal_gastric_mucosa_intermed_mag.jpg body - flat] | | | [[Image:Normal_gastric_mucosa_intermed_mag.jpg |thumb|center|60px|Body - flat. (WC)]] |
| |- | | |- |
| | '''Gastric glands <br>/ mucosa''' | | | '''Gastric glands <br>/ mucosa''' |
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| *G cells may superficially resemble intraepithelial lymphocytes. | | *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?). | | **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...== |
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| **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= |
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| Note: | | Note: |
| *Heaped edges - suggestive of cancer. | | *Heaped edges - suggestive of [[stomach cancer|cancer]]. |
|
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| Image: | | ====Endoscopic image==== |
| *[http://commons.wikimedia.org/wiki/File:Deep_gastric_ulcer.png Gastric ulcer (WC)].
| | <gallery> |
| | Image:Deep_gastric_ulcer.png | Gastric ulcer. (WC) |
| | </gallery> |
|
| |
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| ===Microscopic=== | | ===Microscopic=== |
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| *Loss of epithelium. | | *Loss of epithelium. |
| *Inflammation. | | *Inflammation. |
| | *+/-Helicobacter organisms - ''see [[Helicobacter gastritis]]''. |
|
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|
| ==Gastritis== | | ==Gastritis== |
| ===Etiology===
| | {{Main|Gastritis}} |
| A specific cause is uncommonly identified histologically.
| | {{Main|Chronic gastritis}} |
| | | {{Main|Acute gastritis}} |
| Gastritis causes:<ref name=Ref_PBoD812-3>{{Ref PBoD|812-3}}</ref>
| |
| *Infectious:
| |
| **H. pylori infection.
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| **[[Tuberculosis]].
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| **Salmonellosis.
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| **[[CMV]].
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| *Endocrine-related:
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| **[[Pernicious anemia]].
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| **[[Diabetes]] - gastric atony.
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| *Trauma, e.g. NG tube.
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| *Vascular, ischemia.
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| *Autoimmune:
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| **[[Crohn's disease]].
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| *Toxins:
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| **[[Alcohol]].
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| **Medications (NSAIDS).
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| **Medications.
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| **Uremia.
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| **[[Smoking]] (heavy).
| |
| *Radiation.
| |
| | |
| ===Endoscopic appearance===
| |
| *Erythematous.
| |
| | |
| ===Microscopic===
| |
| *Inflammatory cells - see below.
| |
| | |
| ====Acute gastritis====
| |
| *[[AKA]] ''active gastritis''.
| |
| | |
| Features:
| |
| *Neutrophils - especially when intraepithelial.
| |
| | |
| =====Focal active gastritis=====
| |
| DDx:
| |
| #Drugs,<ref>{{Cite journal | last1 = Parfitt | first1 = JR. | last2 = Driman | first2 = DK. | title = Pathological effects of drugs on the gastrointestinal tract: a review. | journal = Hum Pathol | volume = 38 | issue = 4 | pages = 527-36 | month = Apr | year = 2007 | doi = 10.1016/j.humpath.2007.01.014 | PMID = 17367604 }}
| |
| </ref> esp. NSAIDs.
| |
| #Infectious.
| |
| #Inflammatory bowel disease.
| |
| | |
| ====Chronic gastritis====
| |
| Features:
| |
| *[[Plasma cells]] (in lamina propria).
| |
| **Various criteria:
| |
| **#Two plasma cells kissing, i.e. two plasma cells touching/overlapping.
| |
| **#Three is a crowd, i.e. three plasma cells in close proximity.
| |
| | |
| =====Lymphocytic gastritis=====
| |
| The DDx is limited:
| |
| #[[Helicobacter gastritis]].
| |
| #[[Celiac disease]].
| |
| #[[NSAID]]s.
| |
| #Idiopathic.
| |
| | |
| ===Sydney criteria for gastritis===
| |
| A bunch of pathologists in Sydney came-up with criteria... and these were revised in Houston.<ref name=pmid8827022>{{cite journal |author=Dixon MF, Genta RM, Yardley JH, Correa P |title=Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994 |journal=Am. J. Surg. Pathol. |volume=20 |issue=10 |pages=1161-81 |year=1996 |month=October |pmid=8827022 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=20&issue=10&spage=1161}}</ref>
| |
| | |
| ===Classification===
| |
| Updated Sydney classification:<ref name=pmid8827022/>
| |
| {| class="wikitable"
| |
| | || '''Non-atrophic Helicobacter''' || '''Atrophic Helicobacter''' || '''Autoimmune'''
| |
| |-
| |
| | Inflammation pattern || antral or diffuse || antrum & corpus, mild inflammation || corpus only
| |
| |-
| |
| | Atrophy & metaplasia || nil || atrophy present, metaplasia at incisura || corpus only
| |
| |-
| |
| |}
| |
| Notes:
| |
| *''Corpus'' = gastric body.
| |
| *''Incisura'' = angular incisure, incisura angularis (Latin) - notched transition point on lesser curvature of the stomach between pylorus and body.<ref>[http://en.wikipedia.org/wiki/Angular_incisure http://en.wikipedia.org/wiki/Angular_incisure]</ref>
| |
| | |
| ===Severity===
| |
| The Sydney group suggests grading severity with the following language:<ref name=pmid8827022/>
| |
| *Mild.
| |
| *Moderate.
| |
| *Marked.
| |
| | |
| These terms are applied to the parameters described in a biopsy. The Sydney criteria lists ''H. pylori'', ''neutrophils'', ''mononuclear cells'', ''antrum (atrophy)'', ''corpus (atrophy)'' and ''intestinal metaplasia''. The paper that discusses this also give a visual analogue scale.
| |
| | |
| Parameters & Severity (adapted from Dixon et al.<ref name=pmid8827022/>):
| |
| {| class="wikitable"
| |
| | || '''Mild''' || '''Moderate''' || '''Marked'''
| |
| |-
| |
| | H. pylori || few touching || many touching || piles
| |
| |-
| |
| | Neutrophils || few || bunches || crowded
| |
| |-
| |
| | Mononuclear cells || not touching || kissing || partying
| |
| |-
| |
| |}
| |
|
| |
|
| ==Helicobacter gastritis== | | ==Helicobacter gastritis== |
| ===General===
| | {{Main|Helicobacter gastritis}} |
| *Several Helicobacter species can cause gastritis:
| |
| **''[[Helicobacter pylori]]'' - most common.
| |
| **''Helicobacter heilmannii''.
| |
| | |
| Epidemiologic associations - ''Helicobacter'' infections are associated with:<ref>{{Ref PBoD|814}}</ref>
| |
| *Gastritis.
| |
| *Peptic ulcers.
| |
| *Cancer.
| |
| **Carcinoma.
| |
| **[[MALT lymphoma]].
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Small - smaller than the nucleus of the gastric foveolar cell.
| |
| **On 400x they are still possible to miss.
| |
| *Look close to the opening of the gastric glands.
| |
| *Are often are found in groups.
| |
| *Location - can be antrum and/or body.<ref>{{cite journal |author=Maaroos HI, Kekki M, Villako K, Sipponen P, Tamm A, Sadeniemi L |title=The occurrence and extent of Helicobacter pylori colonization and antral and body gastritis profiles in an Estonian population sample |journal=Scand. J. Gastroenterol. |volume=25 |issue=10 |pages=1010-7 |year=1990 |month=October |pmid=2263873 |doi= |url=}}</ref>
| |
| *Helicobacter don't like the intestinal mucosa or mucosa that has undergone intestinal metaplasia -- you're unlikely to find 'em there.
| |
| *''Helicobacter pylori'':
| |
| **Typically have a "v" shape ''or'' a comma-like shape.
| |
| *''Helicobacter heilmannii'':
| |
| **Corkscrew appearance.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Immunohistochemical_detection_of_Helicobacter_%281%29_histopatholgy.jpg H. pylori - IHC (WC)].
| |
| *Helicobacter gastritis:
| |
| **[http://commons.wikimedia.org/wiki/File:Gastritis_helicobacter_-_high_mag.jpg Gastritis due to HP (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Gastritis_helicobacter_-_very_high_mag_cropped.jpg HP visible (WC)].
| |
| *[http://commons.wikimedia.org/wiki/Category:Helicobacter_gastritis Set of images - HP gastritis (WC)].
| |
| *[http://gut.bmj.com/content/58/12/1669/F2.large.jpg Helicobacter heilmannii (bmj.com)].<ref>URL: [http://gut.bmj.com/content/58/12/1669.extract http://gut.bmj.com/content/58/12/1669.extract]. Accessed on: 2 March 2012.</ref>
| |
| | |
| ===Stains===
| |
| *[[Cresyl violet stain]] - background and organisms blue.
| |
| *[[Warthin-Starry stain]] - background yellow, organisms black.
| |
| | |
| ===IHC===
| |
| *Helicobacter pylori IHC stain +ve.
| |
|
| |
|
| ==Intestinal metaplasia of the stomach== | | ==Intestinal metaplasia of the stomach== |
| *[[AKA]] ''gastric [[intestinal metaplasia]]''.
| | {{Main|Intestinal metaplasia of the stomach}} |
| *Abbreviated ''IM''.
| |
| ===General===
| |
| *Often part of surgical pathology report, e.g. "negative for intestinal metaplasia" or "intestinal metaplasia present".
| |
| *May be associated with Helicobacter spp. infection -- though Helicobacter don't like intestinal type mucosa, i.e. H. pylori are not typically found in regions with intestinal metaplasia.
| |
| *May be reversible - some epidemiological evidence.<ref name=pmid12477745>{{Cite journal | last1 = Walker | first1 = MM. | title = Is intestinal metaplasia of the stomach reversible? | journal = Gut | volume = 52 | issue = 1 | pages = 1-4 | month = Jan | year = 2003 | doi = | PMID = 12477745 | PMC = 1773527
| |
| }}</ref>
| |
| | |
| Significance:
| |
| *Moderate risk increase for carcinoma; risk less than for Barrett's esophagus.<ref name=pmid20203636>{{cite journal |author=Correa P, Piazuelo MB, Wilson KT |title=Pathology of gastric intestinal metaplasia: clinical implications |journal=Am. J. Gastroenterol. |volume=105 |issue=3 |pages=493–8 |year=2010 |month=March |pmid=20203636 |pmc=2895407 |doi=10.1038/ajg.2009.728 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895407/?tool=pubmed}}</ref>
| |
| **Odds ratio for corpus (~5.8x) higher than antrum (2.3x) when compared to individuals without IM.<ref name=pmid21575058>{{Cite journal | last1 = Sakitani | first1 = K. | last2 = Hirata | first2 = Y. | last3 = Watabe | first3 = H. | last4 = Yamada | first4 = A. | last5 = Sugimoto | first5 = T. | last6 = Yamaji | first6 = Y. | last7 = Yoshida | first7 = H. | last8 = Maeda | first8 = S. | last9 = Omata | first9 = M. | title = Gastric cancer risk according to the distribution of intestinal metaplasia and neutrophil infiltration. | journal = J Gastroenterol Hepatol | volume = 26 | issue = 10 | pages = 1570-5 | month = Oct | year = 2011 | doi = 10.1111/j.1440-1746.2011.06767.x | PMID = 21575058 }}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Goblet cells are present in the stomach.<ref>URL: [http://esynopsis.uchc.edu/eAtlas/GI/1280.htm http://esynopsis.uchc.edu/eAtlas/GI/1280.htm]. Accessed on: 16 August 2010.</ref>
| |
| **In [[H&E stain|H&E]] the vacuole often stains light grey.
| |
| | |
| Image:
| |
| *[http://en.wikipedia.org/wiki/File:Gastric_adenocarcinoma.jpg Intestinal metaplasia in the stomach - crappy quality (WC)].
| |
|
| |
|
| ==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= |
| 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== |
| ===General===
| | {{Main|Gastric antral vascular ectasia}} |
| *Abbreviated ''GAVE''.
| |
| *Antrum lesion - due dilated capillaries.
| |
| *AKA ''watermelon stomach'' - due to characteristic endoscopic appearance.<ref name=pmid18625989>{{cite journal |author=Chatterjee S |title=Watermelon stomach |journal=CMAJ |volume=179 |issue=2 |pages=162 |year=2008 |month=July |pmid=18625989 |pmc=2443230 |doi=10.1503/cmaj.080461 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18625989}}</ref>
| |
| | |
| ===Gross/endoscopic appearance===
| |
| * Linear red streaks in antrum - oriented toward the pyloric valve... vaguely resembles a watermelon.
| |
| | |
| Endoscopic images:
| |
| *[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2443230&rendertype=figure&id=f1-19 Watermelon stomach (pubmedcentral.nih.gov)].
| |
| *[http://en.wikipedia.org/wiki/File:Gave.png GAVE (WP)].
| |
| | |
| ===Microscopic===
| |
| Features:<ref>{{Ref GLP|118}}</ref>
| |
| *Fibrin thrombi - '''characteristic feature'''.
| |
| *Dilated capillaries in lamina propria.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Gastric_antral_vascular_ectasia_-_2_-_intermed_mag.jpg GAVE - intermed. mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Gastric_antral_vascular_ectasia_-_2_-_very_high_mag.jpg GAVE - very high mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Gastric_antral_vascular_ectasia_-_very_high_mag.jpg GAVE - two thrombi - very high mag. (WC)].
| |
|
| |
|
| ==Reactive gastropathy== | | ==Reactive gastropathy== |
| ===General===
| | {{Main|Reactive gastropathy}} |
| *[[AKA]] ''chemical gastropathy'',<ref name=pmid16939055>{{Cite journal | last1 = Genta | first1 = RM. | title = Differential diagnosis of reactive gastropathy. | journal = Semin Diagn Pathol | volume = 22 | issue = 4 | pages = 273-83 | month = Nov | year = 2005 | doi = | PMID = 16939055 }}</ref> incorrectly referred to as ''chemical gastritis'' (see below).
| |
| *May be seen in the context of a previous resection/surgical reconstruction, e.g. Billroth II.
| |
| | |
| ====Epidemiology====
| |
| Associated with:<ref>ALS. 5 February 2009.</ref>
| |
| *Excess acid.
| |
| *EtOH.
| |
| *Bile.
| |
| *H. pylori.
| |
| *Drugs:<ref name=pmid16939055>{{Cite journal | last1 = Genta | first1 = RM. | title = Differential diagnosis of reactive gastropathy. | journal = Semin Diagn Pathol | volume = 22 | issue = 4 | pages = 273-83 | month = Nov | year = 2005 | doi = | PMID = 16939055 }}</ref>
| |
| **Iron (brown pigment on histology).
| |
| **NSAIDs - synergistic effect with corticosteroids.
| |
| | |
| Drugs that cause erosions and/or ulcers -- adapted from ''Genta'':<ref name=pmid16939055>{{Cite journal | last1 = Genta | first1 = RM. | title = Differential diagnosis of reactive gastropathy. | journal = Semin Diagn Pathol | volume = 22 | issue = 4 | pages = 273-83 | month = Nov | year = 2005 | doi = | PMID = 16939055 }}</ref>
| |
| | |
| {| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
| |
| ! Drug
| |
| ! Comment
| |
| ! Indication for Rx
| |
| |-
| |
| | NSAIDs
| |
| | common cause
| |
| | pain, reduce cardiovascular risk
| |
| |-
| |
| | Corticosteroids
| |
| | synergistic effect with NSAIDs
| |
| | rheumatologic diseases + others
| |
| |-
| |
| | Potassium (KCl)
| |
| | common cause
| |
| | renal failure
| |
| |-
| |
| | Bisphophonates
| |
| | uncommon cause
| |
| | [[osteoporosis]]
| |
| |-
| |
| | Ferrous sulfate
| |
| | very common if symptomatic
| |
| | iron deficiency anemia
| |
| |-
| |
| | Chloroquine
| |
| | uncommon
| |
| | only in the context of [[malaria]]
| |
| |-
| |
| | Sodium polystyrene sulfonate (Kayexalate)
| |
| | rare
| |
| | renal failure patients
| |
| |} | |
| | |
| ====Relation to gastritis====
| |
| *May mimic a (true) gastritis symptomatically and visually in an endoscopic examination.
| |
| *"Chemical gastritis" is misnomer. Etymologically, the ''-itis'' in ''gastritis'', implies an inflammatory process. Chemical gastropathy is not (predominantly) an inflammatory process.
| |
| **This type of confusion is not uncommon. [[Steatohepatitis]] is another example of this; it is not a process with significant inflammation yet, confusingly, carries the ''-itis'' ending.
| |
| | |
| ===Microscopic===
| |
| Features - triad:<ref>El-Zimaity. 18 October 2010.</ref><ref name=pmid16939055/>
| |
| #Foveolar hyperplasia.
| |
| #*Tortuosity of glands in the "neck" region of the gastric glands.
| |
| #*Associated with "mucin depletion" - cytoplasm not clear -- as is usual.
| |
| #Smooth muscle fibre hyperplasia.
| |
| #*Abundant eosinophilic lamina propria.
| |
| #Scant acute & chronic inflammatory cells.
| |
| Additional features.
| |
| *+/-Edema.
| |
| *+/-Erosions.
| |
| | |
| Notes:
| |
| *Triad rarely present; mild inflammation common.
| |
| | |
| DDx:
| |
| *[[Amyloidosis]].
| |
| *[[Collagenous gastritis]].
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Reactive_gastropathy_-_low_mag.jpg RG - low mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Reactive_gastropathy_-_high_mag.jpg RG - high mag. (WC)].
| |
| | |
| ==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.
| |
| | |
| ==Lymphocytic gastritis==
| |
| ===General===
| |
| DDx:
| |
| *Celiac disease.
| |
| **Check [[duodenum]].
| |
| *H. pylori.
| |
| *HIV/AIDS.
| |
| | |
| ===Microscopic===
| |
| Features:<ref>El-Zimaity. 18 October 2010.</ref>
| |
| *25 lymphocytes / 100 epithelial cells.
| |
| | |
| ==Pernicious anemia==
| |
| ===General===
| |
| *Pathology: loss of parietal cells, gastric atrophy, [[macrocytic anemia]].
| |
| *Etiology: autoimmune.
| |
| | |
| Diagnosis based serology for antibodies to:<ref name=pmid12643357>{{Cite journal | last1 = Oh | first1 = R. | last2 = Brown | first2 = DL. | title = Vitamin B12 deficiency. | journal = Am Fam Physician | volume = 67 | issue = 5 | pages = 979-86 | month = Mar | year = 2003 | doi = | PMID = 12643357 }}</ref>
| |
| *Parietal cells.
| |
| *Intrinsic factor.
| |
| | |
| Others:
| |
| *Gastrin level (increased).<ref name=pmid21947876>{{Cite journal | last1 = Annibale | first1 = B. | last2 = Lahner | first2 = E. | last3 = Fave | first3 = GD. | title = Diagnosis and management of pernicious anemia. | journal = Curr Gastroenterol Rep | volume = 13 | issue = 6 | pages = 518-24 | month = Dec | year = 2011 | doi = 10.1007/s11894-011-0225-5 | PMID = 21947876 }}</ref>
| |
| **Normal < 100 pg/mL.<ref>URL: [http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512 http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512]. Accessed on: 14 August 2012.</ref>
| |
| | |
| Note:
| |
| *Parietal cells produce ''intrinsic factor'' (important for vitamin B12 absorption) and ''hydrogen chloride'', i.e. stomach acid.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Corpus predominant inflammation.
| |
| *Increased G cells in the antrum.
| |
| **Increased gastrin level to try and stimulate (missing) parietal cells.
| |
| | |
| DDx:
| |
| *[[Gastric neuroendocrine tumour]].
| |
| | |
| Notes:
| |
| *Compare with other types of ''[[gastric atrophy]]''.
| |
|
| |
|
| ===IHC=== | | ==Autoimmune metaplastic atrophic gastritis== |
| Features:<ref name=pmid20975338>{{Cite journal | last1 = Park | first1 = JY. | last2 = Cornish | first2 = TC. | last3 = Lam-Himlin | first3 = D. | last4 = Shi | first4 = C. | last5 = Montgomery | first5 = E. | title = Gastric lesions in patients with autoimmune metaplastic atrophic gastritis (AMAG) in a tertiary care setting. | journal = Am J Surg Pathol | volume = 34 | issue = 11 | pages = 1591-8 | month = Nov | year = 2010 | doi = 10.1097/PAS.0b013e3181f623af | PMID = 20975338 }}</ref>
| | *[[AKA]] ''autoimmune gastritis''. |
| *Chromogranin A +ve (demonstrates ''nodular enterochromaffin-like cell hyperplasia''). | | {{Main|Autoimmune metaplastic atrophic gastritis}} |
| *Gastrin -ve (body of stomach).
| |
|
| |
|
| ==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.
| |
| | |
| ==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.
| |
| | |
| ==Plasma cells in the stomach==
| |
| DDx of plasmacytosis:
| |
| *[[Plasma cell neoplasm]].
| |
| *[[Syphilis]].
| |
| *Chronic [[gastritis]].
| |
|
| |
|
| ==Gastritis cystitis profunda== | | ==Gastritis cystitis profunda== |
Line 510: |
Line 291: |
|
| |
|
| ==Ménétrier's disease== | | ==Ménétrier's disease== |
| *[[AKA]] ''diffuse foveolar cell hyperplasia''.<ref name=Ref_PCPBoD8_410>{{Ref PCPBoD8|410}}</ref>
| | {{Main|Ménétrier's disease}} |
| ===General===
| |
| *Super rare.
| |
| *Increased risk of gastric adenocarcinoma.<ref name=Ref_PCPBoD8_410>{{Ref PCPBoD8|410}}</ref>
| |
|
| |
|
| Clinical:<ref>{{Cite journal | last1 = Rich | first1 = A. | last2 = Toro | first2 = TZ. | last3 = Tanksley | first3 = J. | last4 = Fiske | first4 = WH. | last5 = Lind | first5 = CD. | last6 = Ayers | first6 = GD. | last7 = Piessevaux | first7 = H. | last8 = Washington | first8 = MK. | last9 = Coffey | first9 = RJ. | title = Distinguishing Ménétrier's disease from its mimics. | journal = Gut | volume = 59 | issue = 12 | pages = 1617-24 | month = Dec | year = 2010 | doi = 10.1136/gut.2010.220061 | PMID = 20926644 }}</ref>
| | ==Gastric xanthoma== |
| *Classic: nausea, emesis, abdominal pain and peripheral edema.
| | *Abbreviated ''GX''. |
| | *[[AKA]] ''xanthelasma''. |
| | *[[AKA]] ''stomach lipidosis''. |
| | {{Main|Gastric xanthoma}} |
|
| |
|
| Other:
| | ==Gastric ischemia== |
| *Gastric mass (may mimic cancer). | | :''Gastric necrosis'' redirects here. |
| *Hypochlorhydria. | | ===General=== |
| *Protein loss - leads to peripheral edema. | | *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:<ref name=Ref_PCPBoD8_410>{{Ref PCPBoD8|410}}</ref> | | Features: |
| *Foveolar cell hyperplasia - '''key feature'''. | | *+/-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. |
|
| |
|
| DDx:
| | Image: |
| *[[Cronkhite-Canada syndrome]].<ref name="pmid11428328">{{cite journal |author=Junnarkar SP, Sloan JM, Johnston BT, Laird JD, Irwin ST |title=Cronkhite-Canada syndrome |journal=The Ulster medical journal |volume=70 |issue=1 |pages=56–8 |year=2001 |month=May |pmid=11428328 |pmc=2449205 |doi= |url=}}</ref> | | *[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> |
|
| |
|
| Images:
| | ==Portal hypertensive gastropathy== |
| *[http://path.upmc.edu/cases/case36.html Ménétrier's disease - crappy images (upmc.edu)]. | | *Abbreviated ''PHG''. |
| | {{Main|Portal hypertensive gastropathy}} |
|
| |
|
| ==Gastric xanthoma== | | ==Amyloidosis of the stomach== |
| *Abbreviated ''GX''.
| | *[[AKA]] ''gastric amyloidosis''. |
| *[[AKA]] ''xanthelasma''. | | {{Main|Amyloidosis}} |
| *[[AKA]] ''stomach lipidosis''.
| |
| ===General=== | | ===General=== |
| *Uncommon. | | *Very rare. |
| *Benign. | | *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> |
|
| |
|
| ===Gross/endoscopic===
| | Endoscopic DDx: |
| *Yellowish nodule or plaque.<ref name=Ref_GLP111>{{Ref GLP|111}}</ref> | | *[[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> |
| **Classically lesser curvature and antrum.<ref name=pmid6284833/>
| |
|
| |
|
| ===Microscopic=== | | ===Microscopic=== |
| Features:<ref name=Ref_GLP111>{{Ref GLP|111}}</ref> | | Features: |
| *Collections of gastric lamina propria with lipid-laden macrophages.
| | *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/> |
|
| |
|
| DDx:
| | ===Stains=== |
| *[[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>
| | *[[Congo red stain]] +ve. |
| *[[Whipple disease]]. | |
| *MAC infection.
| |
|
| |
|
| Images:
| | ==Eosinophilic gastritis== |
| *[http://www.flickr.com/photos/hemeguy/2911032670/in/photostream/ GX - low mag. (flickr.com)].
| | {{Main|Eosinophilic gastritis}} |
| *[http://www.flickr.com/photos/hemeguy/2911031464/in/photostream GX - high mag. (flickr.com)].
| |
|
| |
|
| ===IHC=== | | ==Proton pump inhibitor effect== |
| *CD68 +ve. | | *Abbreviated ''PPI effect''. |
| *Panker (AE1/AE3) -ve.
| | {{Main|Proton pump inhibitor effect}} |
|
| |
|
| =Gastric polyps= | | =Gastric polyps= |
Line 570: |
Line 357: |
| *[[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. |
| *Adenomatous polyp. | | *[[Gastric adenoma]] - polypoid [[gastric dysplasia]]. |
|
| |
|
| ==Inflammatory fibroid polyp== | | ==Inflammatory fibroid polyp== |
| ===General===
| | {{Main|Inflammatory fibroid polyp}} |
| *Benign.
| |
| *Through-out GI tract.
| |
| *Can be thought of as granulation tissue-like.<ref name=Ref_DCHH138/>
| |
| ===Microscopic===
| |
| Features:<ref name=pmid20393746>{{Cite journal | last1 = Daum | first1 = O. | last2 = Hatlova | first2 = J. | last3 = Mandys | first3 = V. | last4 = Grossmann | first4 = P. | last5 = Mukensnabl | first5 = P. | last6 = Benes | first6 = Z. | last7 = Michal | first7 = M. | title = Comparison of morphological, immunohistochemical, and molecular genetic features of inflammatory fibroid polyps (Vanek's tumors). | journal = Virchows Arch | volume = 456 | issue = 5 | pages = 491-7 | month = May | year = 2010 | doi = 10.1007/s00428-010-0914-8 | PMID = 20393746 }}</ref>
| |
| *Proliferating spindle cells (fibroid) - '''key feature'''.
| |
| **Loosely arranged, concentrically, around blood vessels.<ref name=Ref_GLP115>{{Ref GLP|115}}</ref>
| |
| **Perivascular hypocellular zones.<ref name=Ref_DCHH138>{{Ref DCHH|138}}</ref>
| |
| *Inflammation:
| |
| **Eosinophils - often prominent.
| |
| *+/-Leiomyoma/schwannoma-like areas - with nuclear palisading.<ref name=Ref_DCHH138>{{Ref DCHH|138}}</ref>
| |
| *+/-Vascular for fibrous tissue.
| |
| *Poorly circumscribed/infiltrates into the lamina propria.
| |
| | |
| DDx:
| |
| *[[Inflammatory myofibroblastic tumour]].
| |
| *[[GIST]] - usually sharply demarcated border.
| |
| | |
| Notes:
| |
| *Concentric = share the same centre.<ref>URL: [http://dictionary.reference.com/browse/concentric http://dictionary.reference.com/browse/concentric]. Accessed on: 29 November 2011.</ref>
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Inflammatory_fibroid_polyp_-_low_mag.jpg IFP - low mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Inflammatory_fibroid_polyp_-_high_mag.jpg IFP - high mag. (WC)].
| |
| | |
| ===IHC===
| |
| Features:<ref name=pmid20393746/>
| |
| *CD34 +ve.
| |
| **There is a CD34 -ve variant.
| |
| *Vimentin +ve -- diffuse.<ref>{{Cite journal | last1 = Kolodziejczyk | first1 = P. | last2 = Yao | first2 = T. | last3 = Tsuneyoshi | first3 = M. | title = Inflammatory fibroid polyp of the stomach. A special reference to an immunohistochemical profile of 42 cases. | journal = Am J Surg Pathol | volume = 17 | issue = 11 | pages = 1159-68 | month = Nov | year = 1993 | doi = | PMID = 8214261 }}</ref>
| |
| | |
| Others:
| |
| *CD117 -ve.<ref name=pmid15163021>{{Cite journal | last1 = Ozolek | first1 = JA. | last2 = Sasatomi | first2 = E. | last3 = Swalsky | first3 = PA. | last4 = Rao | first4 = U. | last5 = Krasinskas | first5 = A. | last6 = Finkelstein | first6 = SD. | title = Inflammatory fibroid polyps of the gastrointestinal tract: clinical, pathologic, and molecular characteristics. | journal = Appl Immunohistochem Mol Morphol | volume = 12 | issue = 1 | pages = 59-66 | month = Mar | year = 2004 | doi = | PMID = 15163021 }}
| |
| </ref>
| |
| *S100 -ve.
| |
| | |
| ===Molecular===
| |
| *A subset have mutations in PDGFRA.<ref name=pmid20393746>{{Cite journal | last1 = Daum | first1 = O. | last2 = Hatlova | first2 = J. | last3 = Mandys | first3 = V. | last4 = Grossmann | first4 = P. | last5 = Mukensnabl | first5 = P. | last6 = Benes | first6 = Z. | last7 = Michal | first7 = M. | title = Comparison of morphological, immunohistochemical, and molecular genetic features of inflammatory fibroid polyps (Vanek's tumors). | journal = Virchows Arch | volume = 456 | issue = 5 | pages = 491-7 | month = May | year = 2010 | doi = 10.1007/s00428-010-0914-8 | PMID = 20393746 }}</ref>
| |
|
| |
|
| ==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'''.
| |
| | |
| 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>
| |
| *[[Peutz-Jeghers polyp]].
| |
| | |
| Images:
| |
| *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)].
| |
| *[[WC]]:
| |
| **[http://en.wikipedia.org/wiki/File:Gastric_hyperplastic_polyp_%281%29_foveolar_type.jpg Gastric hyperplasia - low mag. (WC)].
| |
| **[http://en.wikipedia.org/wiki/File:Gastric_hyperplastic_polyp_%283%29_foveolar_type.jpg Gastric hyperplasia - high mag. (WC)].
| |
| | |
| ==Adenomatous polyps==
| |
| ===General===
| |
| *Divided into "gastric" and "intestinal type". (???)
| |
| | |
| *Can be 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> (???)
| |
| | |
| ===Microscopic===
| |
| *Type.
| |
| **Intestinal: goblet cells or Paneth cells.
| |
| **Gastric: foveolar epithelium. (???)
| |
| *Architectural crowding of glands.
| |
| *Hyperchromasia of cytoplasm.
| |
| *Nuclear changes:
| |
| **Loss of nuclear polarity.
| |
| **Increased [[NC ratio]].
| |
| **Elongation of nucleus.
| |
|
| |
|
| ==Fundic gland polyp== | | ==Fundic gland polyp== |
| ===General===
| | {{Main|Fundic gland polyp}} |
| *Most common stomach polyp.<ref name=pmid20567540/>
| |
| *''Fundic'' location - duh!
| |
| **May be in the body.<ref name=pmid20567540>{{Cite journal | last1 = Spiegel | first1 = A. | last2 = Stein | first2 = P. | last3 = Patel | first3 = M. | last4 = Patel | first4 = R. | last5 = Lebovics | first5 = E. | title = A report of gastric fundic gland polyps. | journal = Gastroenterol Hepatol (N Y) | volume = 6 | issue = 1 | pages = 45-8 | month = Jan | year = 2010 | doi = | PMID = 20567540 }}</ref>
| |
| | |
| ====Clinical significance====
| |
| *Weak association with FAP ([[familial adenomatous polyposis]]).<ref name=pmid20567540/><ref name=pmid18322941>{{cite journal |author=Freeman HJ |title=Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis |journal=World J. Gastroenterol. |volume=14 |issue=9 |pages=1318-20 |year=2008 |month=March |pmid=18322941 |doi= |url=http://www.wjgnet.com/1007-9327/14/1318.asp}}</ref>
| |
| *Associated with chronic proton pump inhibitors (PPI) use -- approximately 4x risk.<ref>{{cite journal |author=Jalving M, Koornstra JJ, Wesseling J, Boezen HM, DE Jong S, Kleibeuker JH |title=Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy |journal=Aliment. Pharmacol. Ther. |volume=24 |issue=9 |pages=1341-8 |year=2006 |month=November |pmid=17059515 |doi=10.1111/j.1365-2036.2006.03127.x |url=}}</ref>
| |
| | |
| Notes:
| |
| *Animal studies suggested PPIs cause [[neuroendocrine tumour]]s -- but this has not been found in humans.<ref>{{cite journal |author=Masaoka T, Suzuki H, Hibi T |title=Gastric epithelial cell modality and proton pump inhibitor |journal=J Clin Biochem Nutr |volume=42 |issue=3 |pages=191-6 |year=2008 |month=May |pmid=18545640 |pmc=2386521 |doi=10.3164/jcbn.2008028 |url=}}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm]. Accessed on: 19 October 2010.</ref>
| |
| *Polypoid shape (may not be appreciated on microscopy).
| |
| *Dilated gastric glands.
| |
| **Flatted epithelial lining (consisting of normal foveolar epithelium) - '''key feature'''.
| |
| | |
| Image:
| |
| *[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm Fundic gland polyp (ouhsc.edu)].
| |
| | |
| Notes:
| |
| *The presence of dysplastic changes should prompt consideration of ''FAP''.
| |
|
| |
|
| =Neoplastic= | | =Neoplastic= |
Line 695: |
Line 376: |
| #Gastric carcinoma. | | #Gastric carcinoma. |
|
| |
|
| ==Gastric columnar dysplasia== | | ==Gastric dysplasia== |
| *[[AKA]] ''gastric dysplasia''.
| | {{Main|Stomach adenoma}} |
| ===General===
| |
| *Criteria similar to columnar dysplasia in the [[esophagus]].
| |
| | |
| Divided into:
| |
| *Low grade.
| |
| *High grade.
| |
| | |
| ===Microscopic===
| |
| | |
| ====Low-grade gastric columnar 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.
| |
| | |
| Images:
| |
| *[http://path.upmc.edu/cases/case431.html Low-grade gastric columnar dysplasia - several images (upmc.edu)].
| |
| | |
| ====High-grade gastric columnar 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.
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/w/index.php?title=File:High_grade_gastric_dysplasia_-_low_mag.jpg High grade gastric dysplasia - low mag. (WC)].
| |
| *[http://commons.wikimedia.org/w/index.php?title=File:High_grade_gastric_dysplasia_-_very_high_mag.jpg High grade gastric dysplasia - very high mag. (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Gastric_adenoma_(2).jpg Gastric adenoma (WC)].
| |
|
| |
|
| ==Gastric neuroendocrine tumour== | | ==Gastric neuroendocrine tumour== |
| *[[AKA]] ''neuroendocrine tumour of the stomach''. | | *[[AKA]] ''neuroendocrine tumour of the stomach'' and ''gastric NET''. |
| ===General=== | | ===General=== |
| *Behaviour dependent on the subtype. | | *Behaviour dependent on the subtype. |
Line 824: |
Line 461: |
| Features: | | Features: |
| *Sheets of lymphoid cells. | | *Sheets of lymphoid cells. |
| *"Lymphoepithelial lesion" - gastric crypts invaded by a monomorphous population of lymphocytes.<ref>DB. 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'''. |
Line 840: |
Line 477: |
| 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 859: |
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 885: |
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)].
| |
| | |
| ===IHC===
| |
| *CK7 +ve.
| |
| *CK20 -ve, occasionally +ve.
| |
| | |
| ===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.
| |
|
| |
|
| =See also= | | =See also= |