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

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Presentation transcript:

Normal stomach

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

TOPICS GASTRITIS H. PYLORI PEPTIC ULCER DISEASE GASTRIC CANCER

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

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 Am J Surg Pathol Oct;20(10):

H. PYLORI GASTRITIS Epidemiology Morphology Mode of infection Pathogenicity

H. pylori Lymphoid follicle Inflammatory infiltrate Atrophic glands

1. H.Pylori

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

GASTRIC & DUODENAL ULCERS Acute vs Chronic

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

Hemorrhagic erosions Érosions Erosions Ulcers

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

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

Peptic ulcer (stomach) Esophagu s Ulcer Stomach

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

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

Peptic ulcer (stomach)

Peptic ulcer (duodenum) Ulcer

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

Peptic ulcer (stomach) Mucosal ulceration

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

Granulation tissue Peptic ulcer (stomach) FibrosisDebris + Acute inflammation

Peptic ulcer (stomach)

COMPLICATIONS OF PEPTIC ULCERS Hemorrhage Obstruction Penetration Perforation Carcinoma

GASTRIC CANCER CLASSIFICATION Early vs Advanced Gross Appearance Histologic

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

Gastric adenocarcinoma: intestinal type Ulcered tumor Early antral tumor

Gastric adenocarcinoma Ulcerated tumor with irregular surface

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

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

Gastric adenocarcinoma Intestinal type adenocarcinoma Desmoplastic reaction Invasive glands

Gastric adenocarcinoma Invasive glands Luminal necrosis Intestinal type adenocarcinoma

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

T staging

N staging

Gastric adenocarcinoma Tumor with peritoneal invasion & peritoneal carcinomatosis