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Practical Lecture GIT Module Pathology

1. The document discusses several pathologies involving the oral cavity, esophagus, stomach, small intestine, liver, gallbladder, and pancreas. 2. Key pathologies described include leukoplakia, erythroplakia, pleomorphic adenoma, esophageal varices, Barrett's esophagus, esophageal adenocarcinoma, celiac disease, Crohn's disease, ulcerative colitis, alcoholic cirrhosis, hepatocellular carcinoma, gallstones, acute and chronic pancreatitis, and pancreatic adenocarcinoma. 3. Gross and microscopic features are provided for each condition to aid in diagnosis.

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jwan ahmed
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144 views

Practical Lecture GIT Module Pathology

1. The document discusses several pathologies involving the oral cavity, esophagus, stomach, small intestine, liver, gallbladder, and pancreas. 2. Key pathologies described include leukoplakia, erythroplakia, pleomorphic adenoma, esophageal varices, Barrett's esophagus, esophageal adenocarcinoma, celiac disease, Crohn's disease, ulcerative colitis, alcoholic cirrhosis, hepatocellular carcinoma, gallstones, acute and chronic pancreatitis, and pancreatic adenocarcinoma. 3. Gross and microscopic features are provided for each condition to aid in diagnosis.

Uploaded by

jwan ahmed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Practical Lecture

GIT module
pathology
Leukoplakia: irregular white patch on the
• gum.
white patch or plaque , smooth surface , located on the gingiva
• (lichen planus & candidiasis or Leukoplakia ), differentiate by cannot be
scraped off if it was leukoplakia.
• Microscopy may show spectrum form increased surface keratinization
without dysplasia to invasive keratinizing SCC
Oral
•
Erythroplakia
red, velvety , appear to be flat or slightly depressed relative to the
surrounding mucosa
• greater risk of malignant transformation
Microscopy may show  Severe dysplasia , Carcinoma in situ, or
Invasive carcinoma.
• pleomorphic adenoma(benign mixed tumor of SG) of salivary gland,
• Small circumscribed multilobulated variegated cut surface.
• Yellowish-white in color.
• Smooth surface
myxochondroid stroma

acinar

Pleomorphic adenoma featuring


1. myxochondroid stroma  mesenchymal elements
2. acinar arrangement of the epithelial elements
Esophageal
varices

• the esophagus in x-ray  Multiple filling defects


• Endoscopy  markedly dilated BV. With blood engorment
• Microscopy : Dilated varices beneath intact squamous mucosa
pale squamous mucosa remain goblet cells

esophageal squamous

• Gross  Note how the texture of distal esoph. resemble that of stomach. Note, the
presence the small islands of residual pale squamous mucosa within 
the Barrett mucosa (Only a few areas of pale squamous mucosa remain within the
predominantly metaplastic columnar reddish mucosa of the distal esophagus.)
• Histologic appearance  Note the transition between esophageal
squamous mucosa (left) and Barrett metaplasia, with abundant 
metaplastic goblet cells (right).
Esophageal
adenocarcinoma

• Adenocarcinoma usually occurs distally and, as in this 
case, often involves the gastric cardia.
• Gross exophytic mass , focal area of necrosis , multiple focals of
hemorrhage .
• Micro Mucin-producing glands ,  organized into back-to-back 
glands
Esophageal squamous
cell carcinoma.

nests of malignant cells

keratin
pearls

• Squamous cell carcinoma is most frequently found in the 
mid-esophagus, where it commonly causes strictures. 
• Gross gray-white , polypoid, or exophytic, protrude into the lumen ,
may cause obstruction.
• Micro  moderately to well-Differentiated ,nests of malignant 
cells that partially recapitulate the organization of 
squamous epithelium , with keratin pearls within the nests.
Chronic peptic ulcer (gastric
ulcer)

1. punched-out lesion.
2. Sharply-demarcated.
3. Non-elevated margins
4. Radiating out ( from the lesion) mucosal rugae
5. Clear base ( bcz of peptic enzyme digestion of exudates) and somewhate
grayish in color ( bcz of fibrin deposition)
Gastric adenocarcinoma, Intestinal-type
adenocarcinoma

• Gross  bulky mass , an elevated mass with heaped-up 


borders and central ulceration. Focals of haemorrhage
• Micro  columnar, gland-forming cells infiltrating through 
desmoplastic stroma , well-medorately differentiated.
Gastric adenocarcinoma, diffuse Signet-ring cells
type

• Gross  The gastric wall is markedly thickened and 
rugal folds are partially lost. ( resemble leather bottle)
• Micro  Signet-ring cells can be recognized by their 
large cytoplasmic mucin vacuoles and peripherally 
displaced, crescent-shaped nuclei. poorly differentiated.
Flattening of villi , mosaic- pattern

Normal mucosa Celiac disease

1. Loss of villi
2. Crypt-hyperplasia
3. Incr. CD8+ in epith.
4. Incr. CD4+ in lamina propria.
Crohn’s
disease

• Linear mucosal ulcers, which impart a cobblestone 
appearance to the mucosa, and thickened intestinal wall.
• Fat wrapping = creeping fat
• skip lesions 
Crohn’s
disease

Low-power histology of Crohn’s disease. Fissures (small arrow) disrupt the


mucosa, and lymphoid chronic inflammation extends through the wall to the
subserosal fat (large arrows).
ulcerative colitis
• Pseudopolyp
s
• mucosal
Bridges
• mural
thickening is
not present,
• the serosal
surface is
normal
(A) The liver is bile-stained, soft, and congested. (B) Hepatocellular necrosis
caused by acetaminophen overdose. Confluent necrosis is seen in the
perivenular region (zone 3, arrow). There is little inflammation.
Liver cirrhosis /
Alcoholic cirrhosis
Liver cirrhosis

Alcoholic cirrhosis in an active drinker


Hepatocellular carcinoma. A, cross-section of a cirrhotic liver, with a
hepatocellular carcinoma that occupies the majority of the left side of the
section. B, Cirrhotic liver contain several small nodules and few larger and
either white or bile stained HCC. Hepatocellular carcinoma is a highly
aggressive malignant neoplasm, but histologically may resemble its cell of
Secondary liver
metastasis
Gallstones
Mixed gallstones. Pigment gallstones
Acute pancreatitis: The microscopic field shows a region of fat necrosis (bottom) and focal
pancreatic parenchymal necrosis (center).
The gross pancreas reveals dark areas of hemorrhage in the pancreatic substance and a focal
area of pale fat necrosis in the peripancreatic fat (upper left).
Chronic
Pancreatiti
s  Extensive fibrosis and atrophy 
1.
has left only residual islets of
langerhan (left)  which are
embedded in the sclerotic tissue
2. and ducts (right) The ductal 
epithelium may be atrophied or 
hyperplastic or may show 
squamous metaplasia.
3.  a sprinkling of chronic 
inflammatory cells and a few 
islands of acinar tissue (Acinar 
loss is a constant feature.)
• Grossly,  pancreas is hard, with
dilated ducts and visible calcified
concretions..
Infiltrating ductal adenocarcinoma of
the pancreas shows a large tumor in
the tail of the pancreas (arrow) and
extensive metastases in the liver.

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