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Systemic Pathology Series for MBChB III, Gastritis, Ulcers, Tumours and other Gastric
Lesions Dr Edwin Walong MBChB Mmed
(Pathology)11th February 2014
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Anatomy
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Anatomy
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Clinical Manifestations
• Epigastric pain, tenderness• Nausea, vomiting• Bloating, feeling of ‘fullness’ distension• Upper GI Bleeding – Melena Stool,
haematemesis• Nutritional deficiencies, B12
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Overview
• Gastritis– Acute– Chronic– Atrophic (Pernicious
Anaemia)– Eosinophilic– Lymphocytic– Sydney Classification
• Peptic Ulcer Disease (including perforation)
• Gastric Neoplasms– Polyps (hyperplastic,
adenomatous)– Gastric Adenocarcinoma– Gastrointestinal Stromal
Tumours– Gastric Lymphomas,
Carcinoids– Metastatic Neoplasms
• Other Gastric Lesions– pyloric stenosis
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Gastritis - acute
• Chemical: alkali, acid ingestion
• Dietary - spices• Drugs: Alcohol, NSAIDS
(cox 1), Corticosteroids, Tobacco
• Iatrogenic – instrumentation
• Infections (viral, bacterial)
• Stress – burns, severe illness
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Acute haemorrhagic gastritis
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Acute haemorrhagic gastritis
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Acute Haemorrhagic Gastritis
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Infectous Gastritis, EBV
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Gastritis - Chronic
• Characterised by chronic inflammation• Aetiology: infections eg Helicobacter pylori.• Exposures as in acute gastritis – reflux,
chemicals, alcohol, etc• Chronic Granulomatous inflammatory lesions• Autoimmune gastritis• Exposure to exessive gastric enzymes,
Zollinger Ellison syndrome, gastric carcinoids
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Chronic gastritis
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Helicobacter pylori associated gastritis
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Helicobacter pylori, Warthin Starry
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Helicobacter heilmanii
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Helicobacter spp
• Helicobacter heilmanii• Helicobacter felis• Acquired, contamination of contaminated
water, usually in childhood• Strains that produce Cag A are associated with
severe pathology and malignant neoplasms (MALT lymphoma, Gastric Adenocarcinoma
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Granulomatous gastritis
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Atrophic Gastritis
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Gross pathology, atrophic gastritis
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Intestinal Metaplasia
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Eosinophilic Gastritis
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Lymphocytic Gastritis
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Systems Grading
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Biopsy Sites
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Histology Sydney Classification
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Overview
• Gastritis– Acute– Chronic– Atrophic (Pernicious
Anaemia)– Eosinophilic– Lymphocytic– Sydney Classification
• Peptic Ulcer Disease (including perforation)
• Gastric Neoplasms– Polyps (hyperplastic,
adenomatous)– Gastric Adenocarcinoma– Gastrointestinal Stromal
Tumours (GIST)– Gastic Lymphomas,
Carcinoids– Metastatic Neoplasms
• Other Gastric Lesions– pyloric stenosis
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Peptic Ulcer Disease
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Gastric Neoplasms, Benign
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Gastric Adenocarcinoma, ulcerated
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Gastric Adenocarcinoma, Exophytic
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Gastric Carcinoma
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Gastric Dysplasia
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Gastric Adenocarcinoma
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Gastric Adenocarcinoma, Nodal Staging
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Histology
• Gastric Adenocarcinoma• Signet Ring Gastric Adenocarcinoma
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Gastrointestinal Stromal Tumours
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GIST
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GIST
• Interstitial cell of Cajal• C – kit mutations (CD 117), Amenable to
targeted therapy (imatinib mesylate)• DOG 1 IHC
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Others
• Lymphomas – MALT• Carcinoids, Neuroendocrine Neoplasms• Metastatic Gastric Neoplasms
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Overview
• Gastritis– Acute– Chronic– Atrophic (Pernicious
Anaemia)– Eosinophilic– Lymphocytic– Sydney Classification
• Peptic Ulcer Disease (including perforation)
• Gastric Neoplasms– Polyps (hyperplastic,
adenomatous)– Gastric Adenocarcinoma– Gastrointestinal Stromal
Tumours (GIST)– Gastic Lymphomas,
Carcinoids– Metastatic Neoplasms
• Other Gastric Lesions– pyloric stenosis
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Congenital – Pyloric Stenosis
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Congenital lesions
• Associated with trisomy 21, 9q, etc• Pyloric Atresia, Antral Web, Gastric
Duplication
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Hyperplastic lesions- Menetrier’s disease
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Museum Specimens, Slide demonstrations