1. Normal stomach

3. Fundic mucosa with parietal & chief cells Antral mucosa with mucin secreting glands Stomach - Histology

4. TOPICS GASTRITIS H. PYLORI PEPTIC ULCER DISEASE GASTRIC CANCER

5. GASTRITIS CLASSIFICATION Acute vs Chronic Topographic Etiologic GRADING Mild, Moderate, Severe

6. Sydney system – Classification: Chronic gastritis Fig.: Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996 Oct;20(10):1161-81.

7. H. PYLORI GASTRITIS Epidemiology Morphology Mode of infection Pathogenicity

8. H. pylori Lymphoid follicle Inflammatory infiltrate Atrophic glands

10. 1. H.Pylori

11. H. PYLORI GASTRITIS Types of gastritis Peptic ulcer disease Disease progression Associated tumors

12. GASTRIC & DUODENAL ULCERS Acute vs Chronic

13. ACUTE GASTRIC ULCERS Tend to be multiple No predilective sites Etiologic Associations

14. Hemorrhagic erosions Érosions Erosions Ulcers

15. Intact epithelium Superficial erosion Fibrinoinflammatory exudate Diffuse erosion Inflammatory Infiltrate Intact epithelium Hémorrhage

16. PEPTIC ULCERS Common Sites Usually single but can be multiple Strong association with H.P. Histology: - 4 layers

17. Peptic ulcer (stomach) Esophagu s Ulcer Stomach

18. Peptic ulcer (stomach) Macroscopic appearance : « punched-out » + convergence of gastric folds

19. Peptic ulcer (stomach) Ulcer penetrating just inside the muscularis propria Overhanging margins

20. Peptic ulcer (stomach)

21. Peptic ulcer (duodenum) Ulcer

22. PEPTIC ULCERS Histology: 4 layers Fibrinous exudate Polymorphs Granulation tissue Fibrosis

23. Peptic ulcer (stomach) Mucosal ulceration

24. Ulcer Intact gastric mucosa (with overhanging margin) Peptic ulcer (stomach)

25. Granulation tissue Peptic ulcer (stomach) FibrosisDebris + Acute inflammation

26. Peptic ulcer (stomach)

27. COMPLICATIONS OF PEPTIC ULCERS Hemorrhage Obstruction Penetration Perforation Carcinoma

28. GASTRIC CANCER CLASSIFICATION Early vs Advanced Gross Appearance Histologic

29. Gastric adenocarcinoma : Macroscopic Aspect Early cancer: Advanced cancer: The various morphologies of gastric adenocarcinoma

30. Gastric adenocarcinoma: intestinal type Ulcered tumor Early antral tumor

31. Gastric adenocarcinoma Ulcerated tumor with irregular surface

32. Gastric adenocarcinoma: diffuse type “Linitis plastica” Diffuse wall thickening

33. Gastric adenocarcinoma gastrique Intestinal type adenocarcinoma, moderately differentiated Fibrinopurulent exudate (ulceration) Infiltrative irregular glands

34. Gastric adenocarcinoma Intestinal type adenocarcinoma Desmoplastic reaction Invasive glands

35. Gastric adenocarcinoma Invasive glands Luminal necrosis Intestinal type adenocarcinoma

36. Gastric adenocarcinoma Diffuse type adenocarcinoma (signet ring cell carcinoma) « Signet ring cells » Surface epithelium (normal)

37. T staging

38. N staging

39. Gastric adenocarcinoma Tumor with peritoneal invasion & peritoneal carcinomatosis