GI Tract

Pathology

Acute Gastritis Gross: diffusely hyperemic gastric mucosa with some area hemorrhage Patho: Neutrophils infiltration in gastric mucosa Normal glandular structure

Chronic gastritis Patho: Intestinal metaplasia of gastric mucosa Inflammatory cell infiltration (Lymphocyte, plasma cell)

No.2

Peptic ulcer (No.1:GU, No.2:DU)

Gross: Large, round, sharply punched-out mucosal ulcer Mucosal fold radiate to ulcer margin Clean base ulcer Patho: (Chronic PU) Ulcer surrounded by overhanging gastric mucosal margins Necrotic debris Inflammatory cell (PMN) Granulation with capillary Fibrosis in ulcer base

Adeno CA of stomach (Well diff.)

Gross: Irregular base gastric ulcer with surrounding nodularity
fungating, polypoid, ulcer, ect.

Elevate ulcer margin Loss of gastric fold radiate to ulcer margin Patho: Neoplastic cell form glandular structure with lined by columnar mucin-secreting cell Pleomorphic nuclei, mitoses, hyperchromatism Increased nuclear/cytoplasm ratio Stromal invasion Lymphocytic infiltration

Linitis Plastica (CA Stomach)

Gross: Diffuse thickening and induration gastric wall Loss of gastric fold (rugae) shrunken "leather bottle stomach appearance Perigastric adenopathy Patho: Signet ring cell infiltration (mucin vacuoles cytoplasm displaces nuclei to peiphery)

Gastric Lymphoma
Gross: Enlarged and thickened gastric folds Mural thickening and focal ulceration Cut surface show fish-fleshy appearance () Patho: Dense lymphocytic infiltration Lymphoepithelial lesions No germinal center

GIST
Gross: Large well define submucosal mass Cut surface is tan, lack whirling smooth muscle pattern of leiomyoma/sarcoma Patho: Uniform of spindle cell/epitheloid cell/mixed Eosinophilic cytoplasm Hypercellular Mitosis

Non-Hodgkin's Lymphoma
Gross: Multifocal irregular mass on mucosal surface Tan color Patho: Atypical lymphocytic infiltration Hyperchromatin and prominent nucleoli Mitotic figures Not seen germinal center
Hodgins lymphoma Reed sternberg cell (Giant neoplastic reticulum cell with double mirror-image nuclei and prominent nucleoli)

Reed sternberg cell

Reed sternberg cell

-as with sarcomas in general

GIST
Gross:
Normal mucosa and intact Large well define submucosal tumor Cut surface show fleshy white tumor with focal hemorrhage

Typhoid Fever
Gross: Multiple longitudinal mucosal ulcer Irrigular and necrosis at ulcer base Patho: Degeneration of intestinal brush border Mucosal ulceration and necrosis Hypertrophic Payers patch Inflammatory cell (mainly macrophage) infiltration

TB Enteritis
Gross: Multiple transverse mucosal ulcer with oval shape Irregular ulcer base and white caseous foci Luminal stricture and narrowing Patho: Multinucleated giant cell (Langhan s cells) Caseous necrosis granuloma Lymphocytic infiltration

Acute Appendicitis
Gross: Yellowish-tan exudate and hyperemia appendix Cut surface of tip appendix show yellowish-tan mucosal exudation with hyperemic border Patho: Mucosal ulceration and necrosis Extensive neutrophilic exudate PMN infiltration extend through muscular layer

Pseudomembranous Colitis
Gross: Erythematous colonic mucosa covered with yellow-green exudate (pseudomembranes) No mucosal erosion Patho: Pseudomembrane composed of inflammatory cells (PMN predominated), necrotic epithelium, mucus Mucosa shows congested vessels but still intact

Amebic Colitis
Flake-shaped ulcer spread in submucosa Intact of muscularis propria Ameba (E. histolytica) seen within cellular debris Ameba have smaller nuclei and ingesting RBC Inflammatory cell infiltration

-crypt abscesses are histologic finding more typical with ulcerative colitis

Ulcerative Colitis
Gross: Diffuse mucosal ulceration and hemorrhage extended from rectum to cecum Pseudopolyps appearance Patho: Crypt hyperplasia (Pseudopolyp) Loss of goblet cells in epithelium Ulcer base with fibrin, capillaries and IF cells Acute & chronic inflammatory cell infiltration in lamina propria and submucosa Crypt abscess (Neutrophilic exudate)

CMV Colitis
Gross: Patchy mucosal ulcer, necrosis and hyperemia Thickening mucosal fold Patho: Pseudomembrane overlying necrotic mucosa Inflammatory cell infiltration Viral intracytoplasmic inclusion in macrophage at colon wall

Tubular Adenomatous polyp

Gross: Pedunculated polyps with slender stalks Irregular surface Patho: Round gland-like pattern Crowded, disorganized glands Less goblet cells Epithelial dysplasia and hyperchromatic nuclei Loss of polarity with palisading Basement membrane intact without invasive tumor

Tubulovillous Adenoma 25-50% of epithelium is papillary features and remainder is tubular features

Normal colonic epithelium with goblet cell

Villous Adenoma
Gross: Sessile polyp with broad base, irregularity Patho: Frond (Finger) like projection with fibrovascular core Epithelial dysplasia and hyperchromatic nuclei No goblet cells Mucosal border intact without invasive tumor

-shows

mucin

-irregular in size and shape

AdenoCA
Gross Circumferential mucosal mass Irregularity, firm, rolled (Over hanging) edge and central ulceration Patho: Malignant glands are Tall columnar epithelium Pleomorphic and hyperchromatic nuclei Loss of polarity No goblet cells Infiltrating muscularis propria Irregular gland architecture

-normal mucosa on Rt. -

-tumor cell exhibit monotonous morphology -delicate intervening fibrovascular stroma

Carcinoid of Colon
Gross: Submucosal mass, well define, round Cut surface show, solid, firm, yellow-tan () Intact mucosa Patho: Uniform round cell (monomorphism) Small round nuclei and eosinophilic cytoplasm No mitosis Form discrete islands, glands islands or sheet Fibrovascular stroma