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BasicPathologyTutorialYear3
Head&Neck,UpperGastrointestinalDiseases
GrossSpecimensfordescriptionbystudents:
HeadandNeck:
Lab1 CU341(10A2)
Lab2 CU674(10A2)
Lab3 CU857(10A2)
Lab4 CU1200(10A2)
Lab5 CU1545(10A2)
Lab6 CU1783(10A2)
Gastritis,gastriculcersandduodenalulcers
Lab1 CU316
Lab2 CU195
Lab3 CU448
Lab4 CU1471
Lab5 CU1479
Lab6 CU1491
Tumoursofthestomach
Lab1 CU170
Lab2 CU317
Lab3 CU677
Lab4 CU1186
Lab5 CU1191
Lab6 CU2211
Tumoursoftheoesophagus
Lab1 CU900
Lab2 CU1057
Lab3 CU1059
Lab4 CU1060
Lab5 CU1061
Lab6 CU1062
Microscopicslidesfordescriptionbystudents:
TT145Chronicpepticulcer
TT144Carcinomaofthestomach
TT129Carcinomaoftheesophagus
Demonstrationslides:
TT140Normalstomach
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 1/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
TT141Normalpylorus
TT130Carcinomaofthestomach
TT142Carcinomaofthestomach
TT143Carcinomaofthestomach,diffusetype(linitisplasticatype)
Squamouscellcarcinomaisthemostcommonmalignantneoplasminlarynx.Thetumorcanbe
furthersubdividedbytheanatomicallocationsinthelarynxwithreferencetovocalcord:supraglottic
(abovevocalcord),glottic(involvingvocalcord)andsubglottic(belowvocalcord).Thosetumors
involvingalltheregionsaboveandbelowvocalcordarecalled"transglottic".Laryngealtumorsof
differentsublocationshaveslightvariationsinthecriteriaoftumorstaging,whichisoneofthe
importantprognosticindicators.
CU341:Thisspecimenconsistsofanopenedlaryngectomyspecimenwithamalignantirregular
exophytictumorgrowthintheleftsideofthesubglotticregion.Thethyroidcartilageappearsnot
involved.
CU674:Anopenedlaryngectomyspecimenwithanulcerativetumorintheleftsupraglotticregion.
CU857:Anexophytictrasglotticlaryngealtumorinvolvingbothsidesofthelarynx.
CU1200:Anexophytictumorintheleftsupraglotticregionofthelarynx.
CU1545:Atransverselycutlyarynectomyspecimen,containinganexophytictrasglotticlaryngeal
tumorinvolvingbothsidesofthelarynx.
CU1783:Anulcerativetransglotticlyaryngealtumor.(Themultiplecutsarecausedbysamplingfor
diagnosisbypathologist.)
Goalsforthestudentsatthislaboratorysession:
Tobeabletoidentifyanddescribethegrossfeaturesofesophagealandgastrictumours
Tobeabletodescribefeaturesofacuteandchronicgastritis.
Tobeabletodiscussthemicroscopicfeaturesofpepticulcer.
Tobeabletodifferentiatethemicroscopicfeaturesofearlyandlategastriccancers.
Goalsforthestudentsatthistutorialsession:
1.Toknowthecommonnonneoplasticandneoplasticlesionsoftheesophagusandstomach.
2.Toknowthepathogenesisofesophagitis.
3.Toknowthepathogenesisofgastritis,pepticulcerdisease,pyloricstenosisandcancerofthe
stomach.
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 2/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
PGIN33PathologyofUpperGIDisorders
Goalsforthestudentsatthislaboratorysession:
1.Tobeabletoidentifyanddescribethegrossfeaturesofesophagealandgastrictumours
2.Tobeabletodescribefeaturesofacuteandchronicgastritis.
3.Tobeabletodiscussthemicroscopicfeaturesofpepticulcer.
4.Tobeabletodifferentiatethemicroscopicfeaturesofearlyandlategastriccancers.
Goalsforthestudentsatthistutorialsession:
1.Toknowthecommonnonneoplasticandneoplasticlesionsoftheesophagusandstomach.
2.Toknowthepathogenesisofesophagitis.
3.To know the pathogenesis of gastritis, peptic ulcer disease, pyloric stenosis and cancer of the
stomach.
Gastritis,gastriculcersandduodenalulcers
Benign peptic ulcers are mostly located in the pyloric antrum, lesser curve and the first part of
duodenum.Mostulcersaresolitary(80%)andsmall(50%<2cm,75%<3cm,10%>4cm).Size
does not predict a malignant ulcer, although smaller ulcers tend to be benign. Benign ulcers are
roundtooval shaped with sharppunched out edges. The mucosal margin overhangs the base. A
bleeding vessel may be found at the base. Some fibrosis may be due to repeated healing and
ulcerativeprocesses.
CU316
lesser curve
tumour
edge is sharply demarcated
greater curve
Ulcerattheantrum.Thespecimenconsistsofpartofthebodyandtheantrum.Alargeulcerisnoted
atthebodyantralregion.Thebaseoftheulcerisfairlysmooth.
CU195
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 3/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
blood clot
Ulcerattheantrum.Thisspecimenconsistsoftheantrumandthebodyofthestomach.Anulceris
seen at the antrum. The base of the ulcer is smooth. Blood clot at the base indicates previous
bleeding.
Ulceratthelessercurveneartheangularincisure.Thisspecimenconsistsalargepartofthebodyof
the stomach. A large ulcer is noted at the lesser curve near the angular incisure. The base of the
ulcerissmooth.Ableedingvesselisfoundatthebase.Fibrosisisseenfromtheserosalsurface.
hence the black hole in the tumour
CU1471
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 4/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
Ulcerattheduodenum.Thespecimenconsistsofthestomachandtheduodenum.Theulcerissmall.
Perforationmightoccurandisanimportantdifferentialdiagnosisofacuteabdomen.
CU1479
Ulceratthestomach.Thespecimenshowsthebodyofthestomachwithsmallulcer.Thebaseofthe
ulcer is smooth. The rugae are drawn towards the ulcer. Regeneration of the mucosa results in a
slightlyoverhangingappearances.
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 5/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
CU1491
Ulcer at the lesser curve near the angular incisure. This specimen consists of the oesophagus ,
stomachandduodenumwithanulceratthelessercurveneartheangularincisure.Bloodclotatthe
baseindicatespreviousbleeding.
Tumoursofthestomach
Malignantprimarygastrictumorsaremostlyadenocarcinoma.Grossly,gastriccarcinomaspresentas
:a)afungatingorpolypoidmassb)malignantulcerwithraisedevertededgesc)anexcavatedulcer
resembling chronic peptic ulcer or d) as a diffusely infiltrating lesion that causes thickening and
contraction of the stomach wall with relatively little mucosal involvement. Gastric carcinomas are
frequentlyatpylorusandantrum(50to60%),cardiac(2025%),lessercurvature(40%)andgreater
curvature(1215%).Therefore,thefavouredlocationofgastriccarcinomaisonthelessercurvature
ofantropyloricregion.
CU170
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 6/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
Tumour at the lesser curve. The specimen shows a stomach opened on the greater curve with a
malignant ulcer on the lesser curve. This tumour disrupts the normal rugal pattern of the gastric
mucosaandinfiltratesthestomachwall,involvingtheserosa. note the white lines
CU317
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 7/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
Tumour at the antrum. The specimen shows the lower part of the body with the antrum. The
specimen is opened on the greater curve. A malignant ulcer is seen in the antrum. This tumour
infiltratesthestomachwall,involvingtheserosa.
CU677
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 8/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
Tumouratthelessercurve.Thespecimenconsistsofpartofastomachopenedonthelessercurve.
Alargepolypisnotednearthegreatercurveonthebody.Thislargepolypoidmassprotrudesoutinto
thecavityofthestomach.Themucosalsurfaceisulcerative.Itinfiltratesthestomachwall.
(its not smooth)
CU1186
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 9/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
Tumouratthepyloricantrum.Thespecimenconsistsofpartofthebodyandtheantrum.Thistumour
islarge,occupyingnearlythewholeantrum.Itinfiltratesthestomachwallinvolvingtheserosa.Blood
ontheulcerativesurfaceindicatesprobablychronicbleedingfromthetumour.
CU1191
Tumour in the stomach. The specimen consists of the body and the antrum of the stomach. This
tumourexpandsthesubmucosaandinvolvescircumferentiallyatthebodytotheantrum.Thetumour
infiltratesthestomachwall.
CU2211
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 10/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
Tumour in the stomach. This specimen consists of the body of the stomach opened on the greater
curve.Thistumourislocatedmainlyatthelessercurve.Itappearsinfiltratingthestomachwalland
involving the serosa. Cystic spaces represent collections of mucin. The normal rugal pattern of the
gastricmucosaislost,indicatingdiffuseinfiltrationofthetumour.
Tumoursoftheoesophagus
Carcinomas, especially squamous cell carcinomas of the oesophagus represent vast majority of
malignant oesophagus tumours. The tumours could be classified according to their cell types.
Squamouscellcarcinomasconstitute8085%ofallOesophagealcarcinomasandadenocarcinomas
makeupabout5to15%andtheremaindercomposeofundifferentiatedorrarecancers.Over50%of
carcinomasoftheoesophagusariseinthemiddlethird,39%inthelowerthirdand20%intheupper
third. Generally, three gross morphologic patterns can be recognised in carcinomas of the
oesophagus.Themostcommononeisthatofthepolypoidfungatinglesion(60%)thatprotrudesinto
thelumen.Thesecondgrosspatternisnecroticcancerousulceration(25%)thattendstoexcavate
deep into the surrounding structure. The third type is the diffuse infiltrating pattern that tends to
spread within the wall of the oesophagus. In the fungating tumour, the lesions are raised and
protruded into the lumen. In most of the times, the lesions have infiltrated deep into the muscular
layers.
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 11/22
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CU900
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 12/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
Thisspecimenconsistsofanopenedoesophaguswithamalignantulcer.Thetumourinfiltratesthe
walloftheoesophagus.Mucosalspreadisalsoseen.
CU1057
Thisspecimenconsistsofanopenedoesophaguswithamalignantulcer.Thetumourinfiltratesthe
walloftheoesophagusthroughthemuscularispropria.Mucosalspreadisalsoseen.
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 13/22
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CU1059
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 14/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
Thisspecimenconsistsofanopenedoesophagusandthecardiaofthestomach.Amalignantulceris
seen.Thetumourinfiltratesthewalloftheoesophagus,disruptingthemuscularispropria.
CU1060
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 15/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
ulcerative tumour
stenosis / stricture >
difficulty swallowing (dysphagia)
Thisspecimenconsistsofanopenedoesophaguswithacircumferentialmalignantulcer.Thetumour
infiltratesthewalloftheoesophagus.Thetumourresultsinnarrowingoftheoesophagusresultingin
difficultiesinswallowing.
CU1061
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 16/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 17/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
Thisspecimenconsistsofanopenedoesophaguswithamalignantulcer.Thetumourinfiltratesthe
walloftheoesophagus.Mucosalspreadisalsoseen.
CU1062
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 18/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
Thisspecimenconsistsofanopenedoesophaguswithamalignanttumour.Thetumourispolypoid
andprotrudesintothelumenresultinginobstruction.Itinvolvesthesubmucosaandappearsconfined
withinthewalloftheoesophagus.
Microscopicslides
SlidesTT140&TT141
Identifytheorgan.
Identitythelayerspresentinthisorgan.
Trytoappreciatethedifferencesintheglandsbetweentwoslides.
SlideTT129
Identifytheorganonlowpower.
Describethechangesintheepithelium.
Canyouidentifytheinterruptionofthenormalepitheliumbyanewgrowth?
Describethemorphologyofthenewgrowth.
Canyouseeinvasionbythenewgrowthinyoursection?
Howwouldyougradethistumor?
SlideTT130
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 19/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
gastric pits
fat cells and tumour glandular cells
advanced stage of adenocarcinoma
Identifytheorgan.
Istheepitheliumnormal?
Canyoudescribethechangesintheepithelium?
Ifyouthinkthisisamalignanttumor,isthereinvasionofthistumorintothemuscularislayer?How
deepistheinvasion?
Whatisyourdiagnosis?
SlideTT144
Identifytheorgan.
ComparethisslidewithslidesTT130andTT142.Canyoudescribethedifferenceinthemorphology
oftheneoplasticcells?
Whatkindofsubstancearethesecellssecreting? mucin
Whatisyourdiagnosis?
SlideTT143
Identifytheorgan. stomach
Describethemorphologyofthegrowth.
Describewhatisdesmoplasticreaction?Isthisfeaturepresentonthisslide?
Whatistheprognosisofthistumor?
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 20/22
5/14/2017 PGIN3-3 Pathology of Upper GI Disorders
SlideTT145
Identifytheorgan.
Locatetheulceratedareaandidentifythefourdistinctlayersseeninanulcer(refertoyourlecture
notes).
goblet cells
Identifythefociofmetaplasicchange(intestinalmetaplasia)inthissection.
Observe the degree (mild, moderate or severe) and types of inflammatory cell infiltration on the
mucosa. plasma cells (basophilic), histology characteristics: dotted nuclei around the periphery with perinuclear halo
Namethemaincausesofpepticulcer.
Problemsforstudents:
1.Discusstheriskfactorsforsquamouscellcarcinomaoftheesophagus.
2.Discussthepathogenesisofpepticulcer.
3.Discussthetypesofchronicgastritis.
4.Discusstheriskfactorsandlocationofgastriccancers.
5.Comparethegrossfeaturesofbenignandmalignantgastriculcer.
ListofVocabulary
Dysphagia
Odynophagia
Pyrosis(Heartburn)
Achalasia
Barrett'sesophagus
MalloryWeisssyndrome
Boerhaave'ssyndorme
Varices
Cushing'sulcer
Curling'sulcer
PeutzJegherspolyps
Linitisplastica
Intestinalmetaplasia
Helicobacterpyloriandhelicobactergastritis
Krukenbergtumor
Refluxesophagitis
http://webapps.acp.cuhk.edu.hk/med3/upper_gi.html 21/22