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Category Archives: Stomach
Gastric Juvenile Polyp
Juvenile Polyp
Clinical presentation:
- increased risk of colorectal and gastric carcinoma
Gross appearance:
- smooth-surfaced, 1-2 cm, short narrow stalk
Histology:
- irregular cysts in lamina propria with normal foveolar epithelium
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Tagged , Juvenile polyp, Polyp, polyps, Stomach juvenile polyp, Stomach polyp
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Fundic Gland Polyp
Fundic Gland Polyp
Gross appearance and location:
- multiple sessile polyps
- fundus or body of stomach
Histology:
- mixture of mucous and specialized glands
- associated with familial adenomatous polyposis syndrome (FAP) if numerous
Genetics:
sporadic: β-catenin mutations
FAP: APC mutations
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Tagged apc gene, APC mutation, Familial Adenomatous Polyposis, familial adenomatous polyposis syndrome, Fundic Gland Polyp, Fundic Gland Polyps, Fundic polyp, Gastric polyp, Stomach polyp, Stomach polyps, β-catenin, β-catenin mutation
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Stomach Hyperplastic Polyp
Stomach Hyperplastic Polyp
Histology:
- dilated, tortuous foveolar lined glands
- inflammatory cells and increased regenerative atypia in epithelium
- surface maturation is usually present
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Tagged Gastric hyperplastic polyp, Hyperplastic Polyp, Polyp, polyps, Stomach, Stomach Hyperplastic Polyp, Stomach polyp, Stomach polyps
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Zollinger Ellison Syndrome
Zollinger Ellison Syndrome
Gastrinoma
Pathophysiology:
- gastrin-secreting endocrine tumor in pancreas (gastrinoma) or in ectopic gastric tissue (duodenum or Meckel’s diverticulum)
- causes hypergastrinemia and an increase in serum gastrin
- 20% associated with MEN-1, 80% sporadic
Gross Appearance and Location:
- fundus and body (where parietal cells are)
- massive rugal folds
Histology:
- increase in parietal cells and hypertrophy of the fundus and body of the stomach
- enterochromaffin-like cell linear hyperplasia in body of stomach
Immunohistochemistry:
- gastrinoma is chromogranin, synaptophysin and gastrin positive
Posted in Stomach
Tagged Endocrine tumor, Gastrin, Gastrinoma, men-1, men1, Syndrome, Zollinger Ellison, Zollinger Ellison Syndrome
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Autoimmune Gastritis
Autoimmune Gastritis
Clinical:
- older, white women, Helicobacter pylori negative, associated with pernicious anemia
Pathophysiology:
- autoimmune disease with an antibody directed at parietal cells, intrinsic factor
- results in decreased acid production
- causes G cell hyperplasia in the antrum of the stomach
- leads to ECL cell linear hyperplasia in the fundus of the stomach
Gross appearance and location:
- fundus and body of the stomach
- thinning and loss of rugal folds
Histology:
- decreased parietal, chief cells in fundus, body of stomach
- linear and nodular hyperplasia of G endocrine cells (antrum)
- ECL cell linear hyperplasia (body)
Laboratory findings:
- increased serum gastrin, intrinsic factor antibody, decrease in parietal cells, decrease in vitamin B12 n
Autoimmune gastritis is a risk factor for:
- increased risk of stomach adenocarinoma, carcinoid tumours, peptic ulcer disease
Posted in Stomach
Tagged , autoimmune disease, autoimmune gastritis, G cell hyperplasia, gastritis, Intrinsic factor, Parietal cells, pernicious anemia, Stomach inflammation
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Hemorrhagic Gastritis
Hemorrhagic Gastritis
Also known as Acute Erosive Gastritis
Causes:
Aspirin, non steroidal anti-inflammatory drugs (NSAIDs), ASA, steroids, iron pills, crack cocaine, radiation, chemotherapy, hypoperfusion, Cushing ulcer (from head injury, severe burns)
Gross appearance:
- pinpoint hemorrhages
Histology:
- sloughing epithelium, necrotic debris, hemorrhage, reactive epithelium
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Tagged Acute erosive gastritis, ASA, Cocaine, Cushing ulcer, Erosive gastritis, gastritis, Hemorrhagic gastritis, Iron pills, NSAID, Steroids
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Stomach Histology
Stomach
Histology and Physiology
Fundus, body
- specialized glands containing chief and parietal cells
- pit:gland ratio = 3:1
Antrum, cardia
- mucous glands
- pit:gand = 1:1
Stomach Cells
- parietal cells appear pale eosinophilic, located more proximal in the neck
- chief cells located more in the base of the pits
- mucus neck cells
- endocrine cells
- foveolar cells
- APUD cells
- endocrine {G cells secrete gastrin, EnterChromaffin cells secrete serotonin, D cells secrete somatostatin} antrum and EnterChromaffin-like cells (fundus secrete histamine),
Immunohistochemistry:
- stomach: MUC1, MUC5AC, MUC6, PAS
- intestine: MUC2, Alcian blue pH=2.5
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Tagged , Antrum, Cardia, Chief cells, D cell, Fundus, G cell, Gastric histology, MUC1, MUC5AC, MUC6, Parietal cells, pas, Stomach, Stomach body, Stomach cells, Stomach endocrine cells, Stomach histology, Stomach physiology
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Helicobacter Pylori Gastritis
Helicobacter Pylori Gastritis
- gram negative curvilinear organism
Factors that increase virulence:
Invasive factors:
- vacA – vacuolating cytotoxin and cagA genes
- lipopolysaccharide (endotoxin)
- adhesion
- urease → converts urea into NH3 (buffers the gastric acid)
Protective factors:
- mucous production
- HCO3- bicarbonate secretion into mucous
- mucosal blood flow
- prostaglandin production
- regenerative capacity of epithelium
Gross appearance and location of Helicobacter Pylori
- stomach antrum and body
- Helicobacter pylori infection causes the stomach to appear red (erythema), granular, erosions OR normal!
Helicobacter Pylori Infection Histology
Chronic active gastritis with:
- lymphocytes, plasma cells and neutrophils in pits, abscesses
- lymphoid aggregates
- organisms present in lumen, often in mucous
Chronic atrophic gastritis with:
- gland atrophy
- intestinal metaplasia
- lymphoplasmacytic infiltrate
Ulcer:
- fibrinous exudate
- neutrophils
- granulation tissue
- fibrosis
Gross appearance:
- flat edge (not rolled, not friable = malignant), punched out appearance
- usually lesser curvature at antral-body region
- occur anywhere bathed in gastric acid
duodenal more common than gastric regions
Special stains
- Giemsa
Immunohistochemistry
- antibody for Helicobacter pylori
Helicobacter pylori infection increases the risk for:
- adenocarcinoma, MALToma, peptic ulcer disease
Posted in Stomach
Tagged , Bacteria, gastritis, Heartburn, helicobacter pylori, Helicobacter pylori atrophic gastritis, Helicobacter pylori cancer, Helicobacter pylori chronic gastritis, Helicobacter pylori gastritis, Helicobacter pylori infection, Helicobacter pylori MALToma, Helicobacter pylori peptic ulcer disease, Helicobacter pylori risk factors, Helicobacter pylori stomach changes, Helicobacter pylori stomach infection, Indigestion, MALToma, Peptic ulcer disease, Stomach infeciton, Stomach inflammation, Stomach pain
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