Difference between revisions of "Stomach"

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Revision as of 03:12, 23 October 2010

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'''Stomach''' is an important organ for pathologists.  It is often inflammed and may be a site that cancer arises from.  Gastroenterologists often biopsy the organ.  Surgeon take-out the organ.
'''Stomach''' is an important organ for pathologists.  It is often inflammed and may be a site that cancer arises from.  Gastroenterologists often biopsy the organ.  Surgeon take-out the organ.


=Normal=
==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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=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>
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*Inflammation + small bacteria = suspect H. pylori gastritis.
*Inflammation + small bacteria = suspect H. pylori gastritis.


=Non-neoplastic disease=
==Gastritis==
==Gastritis==
===Etiology===
===Etiology===
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**With H&E vacuole may stain greyish.
**With H&E vacuole may stain greyish.


==Gastric dysplasia==
=Miscellaneous=
==Gastric antral vascular ectasia==
===General===
*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] - wikipedia.org.
 
===Microscopic===
Features:<ref>{{Ref GLP|118}}</ref>
*Fibrin thrombi - '''characteristic feature'''.
*Dilated capillaries in lamina propria.
 
==Reactive gastropathy==
===General===
===General===
*Criteria similar to those in adenomatous colonic polyps - see ''Microscopic''.
*May be seen in the context of a previous resection/surgical reconstruction, e.g. Billroth II.
*Divided into:
 
**Low grade.  
====Epidemiology====
**High grade.
*Associated with...<ref>ALS. 5 February 2009.</ref>
***Nuclei no longer stratified.  
**Excess acid.
**EtOH.
**Bile.
**H. pylori.
**Drug:
***Iron (brown pigment on histology).
***NSAIDs.


===Microscopic===
===Microscopic===
*Nuclear changes.
Features -triad:<ref>El-Zimaity. 18 October 2010.</ref>
**Nuclear crowding/pseudostratification.
#Foveolar hyperplasia.
**Elongation of nuclei (cigar-shaped nuclei).
#*Tortuosity of glands in the "neck" region of the gastric glands.
*Cytoplasm - hyperchromatic.
#*Associated with "mucin depletion" - cytoplasm not clear -- as is usual.
*Mitosis - particularily above the basement membrane.
#Smooth muscle fibre hyperplasia.
#*Abundant eosinophilic lamina propria.
#Scant acute & chronic inflammatory cells.
 
Notes:
*Triad rarely present.


Image: [http://upload.wikimedia.org/wikipedia/commons/7/7a/Gastric_adenoma_(2).jpg Gastric adenoma (wikipedia.org)].
DDx:
*Amyloidosis.
*Collagenous gastritis.


==Gastric polyps==
=Gastric polyps=
Similar to colonic polyps - see [[intestinal polyps]].
Similar to colonic polyps - see [[intestinal polyps]].


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*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm Fundic gland polyp (ouhsc.edu)].
*[http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm Fundic gland polyp (ouhsc.edu)].


==Gastric antral vascular ectasia==
=Neoplastic=
==Gastric dysplasia==
===General===
===General===
*Abbreviated ''GAVE''.
*Criteria similar to those in adenomatous colonic polyps - see ''Microscopic''.
*Antrum lesion - due dilated capillaries.
*Divided into:
*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>
**Low grade.  
 
**High grade.
===Gross/endoscopic appearance===
***Nuclei no longer stratified.  
* 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] - wikipedia.org.


===Microscopic===
===Microscopic===
Features:<ref>{{Ref GLP|118}}</ref>
*Nuclear changes.
*Fibrin thrombi - '''characteristic feature'''.
**Nuclear crowding/pseudostratification.
*Dilated capillaries in lamina propria.
**Elongation of nuclei (cigar-shaped nuclei).
 
*Cytoplasm - hyperchromatic.
==Reactive gastropathy==
*Mitosis - particularily above the basement membrane.
===General===
*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.
**Drug:
***Iron (brown pigment on histology).
***NSAIDs.


===Microscopic===
Image: [http://commons.wikimedia.org/wiki/File:Gastric_adenoma_(2).jpg Gastric adenoma (WC)].
Features -triad:<ref>El-Zimaity. 18 October 2010.</ref>
#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.
 
Notes:
*Triad rarely present.
 
DDx:
*Amyloidosis.
*Collagenous gastritis.


==Gastric cancer==
=Gastric cancer=
*GIST (see [[gastrointestinal stromal tumour]]).
*GIST (see ''[[gastrointestinal stromal tumour]]'').
*Adenocarcinoma.
*Adenocarcinoma.
*MALT lymphoma.
*MALT lymphoma.
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**Proximal tumours may require a complete gastrectomy as the stomach is innervated from its proximal part.
**Proximal tumours may require a complete gastrectomy as the stomach is innervated from its proximal part.


==See also==
=See also=
*[[Esophagus]].
*[[Esophagus]].
*[[Intestinal polyps]].
*[[Intestinal polyps]].
*[[Duodenum]].
*[[Duodenum]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gastrointestinal pathology]]
[[Category:Gastrointestinal pathology]]
Michael
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