|
|
(3 intermediate revisions by 2 users not shown) |
Line 54: |
Line 54: |
| Notes: | | Notes: |
| *Intraepithelial lymphocytes in the gastric mucosa have a clear halo around 'em.<ref>Sternberg H4P 2nd Ed., P.484</ref> | | *Intraepithelial lymphocytes in the gastric mucosa have a clear halo around 'em.<ref>Sternberg H4P 2nd Ed., P.484</ref> |
| *Memory device: '''F'''olveolar cells have '''f'''riends, i.e. they are close to other foveolar cells. | | *Memory device: '''F'''oveolar cells have '''f'''riends, i.e. they are close to other foveolar cells. |
|
| |
|
| ===Gastric antrum versus gastric body=== | | ===Gastric antrum versus gastric body=== |
Line 146: |
Line 146: |
|
| |
|
| ====Sleeve gastrectomy==== | | ====Sleeve gastrectomy==== |
| *Indication: morbid [[obesity]].
| | {{Main|Sleeve gastrectomy}} |
| *The prevalence of [[Helicobacter gastritis]] is 33-44%.<ref name=pmid23386918>{{cite journal |author=Albawardi A, Almarzooqi S, Torab FC |title=Helicobacter pylori in sleeve gastrectomies: prevalence and rate of complications |journal=Int J Clin Exp Med |volume=6 |issue=2 |pages=140–3 |year=2013 |pmid=23386918 |pmc=3560499 |doi= |url=}}</ref><ref name=pmid24158738>{{cite journal |author=Onzi TR, d'Acampora AJ, de Araújo FM, ''et al.'' |title=Gastric histopathology in laparoscopic sleeve gastrectomy: pre- and post-operative comparison |journal=Obes Surg |volume=24 |issue=3 |pages=371–6 |year=2014 |month=March |pmid=24158738 |doi=10.1007/s11695-013-1107-8 |url=}}</ref>
| |
| *[[GIST]]s are seen in 0.6% of cases (based on a series of 827 patients<ref>{{Cite journal | last1 = Yuval | first1 = JB. | last2 = Khalaileh | first2 = A. | last3 = Abu-Gazala | first3 = M. | last4 = Shachar | first4 = Y. | last5 = Keidar | first5 = A. | last6 = Mintz | first6 = Y. | last7 = Nissan | first7 = A. | last8 = Elazary | first8 = R. | title = The True Incidence of Gastric GIST-a Study Based on Morbidly Obese Patients Undergoing Sleeve Gastrectomy. | journal = Obes Surg | volume = | issue = | pages = | month = Jun | year = 2014 | doi = 10.1007/s11695-014-1336-5 | PMID = 24965544 }}</ref>).
| |
| | |
| =====Sign out=====
| |
| <pre>
| |
| Partial Stomach, Sleeve Gastrectomy:
| |
| - Stomach wall within normal limits.
| |
| </pre>
| |
| | |
| <pre>
| |
| Partial Stomach, Sleeve Gastrectomy:
| |
| - Stomach wall with a small quantity of INTESTINAL METAPLASIA and
| |
| moderate (mucosa confined) chronic inactive inflammation.
| |
| - Fundic gland polyp.
| |
| - NEGATIVE for Helicobacter-like organisms.
| |
| - NEGATIVE for dysplasia and NEGATIVE for malignancy.
| |
| </pre>
| |
| | |
| <pre>
| |
| Partial Stomach, Sleeve Gastrectomy:
| |
| - Stomach wall with abundant HELICOBACTER-LIKE ORGANISMS and moderate chronic active
| |
| inflammation of the mucosa.
| |
| - NEGATIVE for intestinal metaplasia.
| |
| - NEGATIVE for dysplasia and NEGATIVE for malignancy.
| |
| </pre>
| |
| | |
| =====Block letters=====
| |
| <pre>
| |
| STOMACH, GREATER CURVE, SLEEVE GASTRECTOMY:
| |
| - STOMACH WALL WITHIN NORMAL LIMITS.
| |
| </pre>
| |
|
| |
|
| =Introduction= | | =Introduction= |
Line 408: |
Line 377: |
|
| |
|
| ==Gastric dysplasia== | | ==Gastric dysplasia== |
| :''Gastric adenoma'' directs here.
| | {{Main|Stomach adenoma}} |
| *[[AKA]] ''gastric columnar dysplasia''.
| |
| ===General===
| |
| *Lesions that protrude into the lumen ''and'' are macroscopically apparent are known as: ''adenomas''.<ref name=pmid10680883>{{Cite journal | last1 = Rugge | first1 = M. | last2 = Correa | first2 = P. | last3 = Dixon | first3 = MF. | last4 = Hattori | first4 = T. | last5 = Leandro | first5 = G. | last6 = Lewin | first6 = K. | last7 = Riddell | first7 = RH. | last8 = Sipponen | first8 = P. | last9 = Watanabe | first9 = H. | title = Gastric dysplasia: the Padova international classification. | journal = Am J Surg Pathol | volume = 24 | issue = 2 | pages = 167-76 | month = Feb | year = 2000 | doi = | PMID = 10680883 }}</ref>
| |
| *Polypoid forms are grouped various ways.<ref name=pmid18384215>{{Cite journal | last1 = Park | first1 = do Y. | last2 = Lauwers | first2 = GY. | title = Gastric polyps: classification and management. | journal = Arch Pathol Lab Med | volume = 132 | issue = 4 | pages = 633-40 | month = Apr | year = 2008 | doi = 10.1043/1543-2165(2008)132[633:GPCAM]2.0.CO;2 | PMID = 18384215 | url=http://www.archivesofpathology.org/doi/full/10.1043/1543-2165(2008)132%5B633:GPCAM%5D2.0.CO;2 }}</ref>
| |
| | |
| ====Grading====
| |
| Like in the colon - they are divided into:
| |
| *Low grade.
| |
| *High grade.
| |
| | |
| ====Subclassification====
| |
| One subclassification:<ref>URL: [http://surgpathcriteria.stanford.edu/gitumors/gastric-adenoma/printable.html http://surgpathcriteria.stanford.edu/gitumors/gastric-adenoma/printable.html]. Accessed on: 18 December 2012.</ref>
| |
| *Intestinal: goblet cells or [[Paneth cell]]s.
| |
| **Not associated with FAP.
| |
| *Gastric: foveolar epithelium.
| |
| **Associated with [[familial adenomatous polyposis]] (FAP).
| |
| | |
| ===Microscopic===
| |
| *Histologic criteria similar to columnar dysplasia in the [[esophagus]].
| |
| **The threshold is much lower than in the colon and rectum.
| |
| | |
| ====Foveolar type====
| |
| Features:
| |
| *Hyperchromasia at the surface - '''key feature'''.
| |
| *Cytoplasm with (shortened) champagne flute-like luminal aspect (apical mucin caps).
| |
| *Nuclear changes:
| |
| **Hyperchromasia.
| |
| **Enlargement.
| |
| *No intestinal metaplasia.
| |
| | |
| DDx:
| |
| *[[Gastric carcinoma]].
| |
| *[[Reactive changes]].
| |
| | |
| ====Intestinal type====
| |
| Features - intestinal:
| |
| *[[Intestinal metaplasia of the stomach|Intestinal metaplasia]].
| |
| *Hyperchromasia of cytoplasm.
| |
| *Nuclear changes:
| |
| **Loss of nuclear polarity.
| |
| **Increased [[NC ratio]].
| |
| **Elongation of nucleus and pseudostratification.
| |
| | |
| DDx:
| |
| *[[Gastric carcinoma]].
| |
| *[[Reactive changes]].
| |
| *[[Intestinal metaplasia of the stomach|Intestinal metaplasia]].
| |
| | |
| =====Images=====
| |
| <gallery>
| |
| Image:Gastric_adenoma_(1).jpg | Gastric adenoma. (WC/KGH)
| |
| Image:Gastric_adenoma_(2).jpg | Gastric adenoma. (WC/KGH)
| |
| </gallery>
| |
| www:
| |
| *[http://www.sciencedirect.com/science/article/pii/S1756231710001878 Gastric polyps - several images (sciencedirect.com)].
| |
| *[http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282008%29132%5B633%3AGPCAM%5D2.0.CO%3B2 Gastric polyps - several images (achivesofpathology.org)].
| |
| | |
| ====Grading====
| |
| =====Low-grade gastric dysplasia=====
| |
| Features:
| |
| *Nuclear changes:
| |
| **Nuclear crowding/pseudostratification with hyperchromasia.
| |
| **Elongation of nuclei (cigar-shaped nuclei).
| |
| **Nuclear stratification intact; nuclei close to the basement membrane.
| |
| *Architecture:
| |
| **Focal irregularities in the glandular contours.
| |
| | |
| Negatives:
| |
| *No desmoplasia.
| |
| *No necrosis.
| |
| *No surface maturation.
| |
| | |
| DDx:
| |
| *Indefinite for dysplasia.
| |
| *High-grade gastric columnar dysplasia - see below.
| |
| **The threshold is much lower than in the colon and rectum!
| |
| | |
| Images:
| |
| *[http://path.upmc.edu/cases/case431.html Low-grade gastric columnar dysplasia - several images (upmc.edu)].
| |
| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204467/figure/F4/ Gastric low-grade dysplasia (nih.gov)].<ref name=pmid22076218>{{Cite journal | last1 = Kushima | first1 = R. | last2 = Kim | first2 = KM. | title = Interobserver Variation in the Diagnosis of Gastric Epithelial Dysplasia and Carcinoma between Two Pathologists in Japan and Korea. | journal = J Gastric Cancer | volume = 11 | issue = 3 | pages = 141-5 | month = Sep | year = 2011 | doi = 10.5230/jgc.2011.11.3.141 | PMID = 22076218 }}</ref>
| |
| =====High-grade gastric dysplasia=====
| |
| Features:
| |
| *Nuclear changes:
| |
| **Round hyperchromatic nuclei.
| |
| **Loss of normal nuclear stratification.
| |
| *Architecture:
| |
| **Irregularities in the glandular contours.
| |
| **Back-to-back glands.
| |
| **+/-Cribriforming of the glands.
| |
| **+/-Necrosis.
| |
| | |
| Negatives:
| |
| *No [[desmoplasia]].
| |
| | |
| DDx:
| |
| *Low-grade gastric columnar dysplasia.
| |
| *[[Gastric adenocarcinoma]].
| |
| | |
| =====Images=====
| |
| <gallery>
| |
| Image:High_grade_gastric_dysplasia_-_low_mag.jpg | High grade gastric dysplasia - low mag. (WC/Nephron)
| |
| Image:High_grade_gastric_dysplasia_-_very_high_mag.jpg | High grade gastric dysplasia - very high mag. (WC/Nephron)
| |
| </gallery>
| |
| www:
| |
| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404600/figure/F8/ Gastric high-grade dysplasia - probably (nih.gov)].<ref name=pmid22188910>{{Cite journal | last1 = Correa | first1 = P. | last2 = Piazuelo | first2 = MB. | title = The gastric precancerous cascade. | journal = J Dig Dis | volume = 13 | issue = 1 | pages = 2-9 | month = Jan | year = 2012 | doi = 10.1111/j.1751-2980.2011.00550.x | PMID = 22188910 }}</ref>
| |
| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204467/figure/F7/ Gastric high-grade dysplasia - probably (nih.gov)].
| |
| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204467/figure/F6/ Gastric high-grade dysplasia (nih.gov)].<ref name=pmid22076218/>
| |
| | |
| ===Sign out===
| |
| ====Indefinite for dypslasia====
| |
| <pre>
| |
| STOMACH, ANTRUM, BIOPSIES:
| |
| - ANTRAL-TYPE MUCOSA INDEFINITE FOR DYSPLASIA WITH MODERATE CHRONIC INFLAMMATION.
| |
| - EXTENSIVE INTESTINAL METAPLASIA.
| |
| - NEGATIVE FOR HELICOBACTER-LIKE ORGANSIMS.
| |
| - NEGATIVE FOR MALIGNANCY.
| |
| </pre>
| |
| | |
| ====Intestinal type====
| |
| <pre>
| |
| STOMACH, ANTRUM, BIOPSIES:
| |
| - ANTRAL-TYPE MUCOSA WITH FOCUS OF LOW-GRADE DYSPLASIA (INTESTINAL TYPE).
| |
| - EXTENSIVE INTESTINAL METAPLASIA.
| |
| - MODERATE CHRONIC INFLAMMATION.
| |
| - NEGATIVE FOR HELICOBACTER-LIKE ORGANSIMS.
| |
| - NEGATIVE FOR MALIGNANCY.
| |
| </pre>
| |
| | |
| ====Foveolar type====
| |
| <pre>
| |
| STOMACH POLYP, EXCISION:
| |
| - ADENOMATOUS POLYP, FOVEOLAR TYPE.
| |
| - NEGATIVE FOR HIGH-GRADE DYSPLASIA.
| |
| - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
| |
| </pre>
| |
| | |
| ====Foveolar type with high-grade dysplasia====
| |
| <pre>
| |
| STOMACH POLYP, EXCISION:
| |
| - LARGE ADENOMATOUS POLYP (FOVEOLAR TYPE) WITH HIGH-GRADE DYSPLASIA.
| |
| - NEGATIVE FOR MALIGNANCY.
| |
| </pre>
| |
|
| |
|
| ==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. |