Pathology Practicals 3 Part1

8/3/2019 Pathology Practicals 3 Part1

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PATHOLOGY PRACTICALS 3Part 1 (GIT)

By: Jeffrey James Co :D



DISEASES OF THE

GASTROINTESTINAL TRACT



CHRONIC BENIGN PEPTIC ULCER, STOMACH

Hx: A 36 yo female w/ recurrent epigastric pain relieved by food

and antacids, accompanied by massive hematemesisLAYERS OF Peptic Ulcer




Punched out lesions, sharplydefined margins«




1. Common sites of ulceration:

y Lesser curvature of stomach, proximal duodenum.

2. Three conditions associated with H. pylori infection:

y Chronic Gastritis

y Gastric Cancer

y Peptic Ulcer

3. Complications of Peptic Ulcer:

y Anemia

y Hemorrhage

y Perforationy Obstruction from edema/scar



BENIGN G ASTROINTESTINAL STROMAL TUMOR

Smooth muscle tumor in the GIT

Most common site: stomach

Cell of origin: Interstial cells of Cajal



Cell of origin

y Cells of Cajal from muscularis propria

Differentiate Benign from Malignant GIST

BENIGN G ASTROINTESTINAL STROMAL TUMOR

Benign Malignant

Firm, Spherical Projectionto the Lumen

Irregular and ulcerated

Intercalating bundles of

fusiform light blue

staining cells

Hemorrhage and Necrosis

Mitotic Figures with

pleomorphism



A DENOCARCINOMA , P YLORIC, STOMACH

Hx: 75 yo male, vomiting,

epigastric fullness, poor appetite,weight loss, w/ black tarry stools



Etiologic Factors

y Long term ingestion of nitrates, smoked salted foods

Compare 2 types of gastric carcinoma

DIFFUSE INTESTINAL

A DENOCARCINOMA , P YLORIC, STOMACH

Diffused infiltrations,

ulcerated, w/ signet

ring

Proliferation of glands, polypoid

and fungating

Signet ring

cells



MECKEL·S DIVERTICULITIS

Hx: 22 yo male; severe abdominal pain w/ fever and vomiting



Difference between true and false diverticulum

Possible Complications

y Obstruction

y Diverticulitis

y Bleeding and Ulcers

MECKEL·S DIVERTICULITIS

True False

Involves all the layers,

mucosa, submucosa, and

muscularis layer

Meckel·s Diverticulum

Involves only two layers:

Mucosa, submucosa

Diverticulosis



SEGMENTAL HEMORRHAGIC INFARCTION, ILEUM

Hx: 68 yo male with severe abdominalpain, nausea, vomiting, and diarrhea



Usual causes of infarction of the Bowel

y Hernia

y Adhesions

y Embolus

y Arterial, venous thrombosis

y Hypotension Most common causes of mesenteric vascular

occlusion

y Arteriolosclerosis

y

Smokingy Hypercholesterolemia

y Embolus

Segment of the colon frequently involved

y Watershed areas

SEGMENTAL HEMORRHAGIC INFARCTION, ILEUM



ILEOCECAL TUBERCULOSIS

Hx: 33 yo male Abdominal

enlargement

GRANULOMAS

REMEMBER:

Epithelioid cells (Hallmark)

Chronic Granulomatous

Inflam

Langhan·s Giant cell



L YMPHOMA , NON-HODGKIN·S DISEASE,

DIFFUSE L ARGE CELL TYPE, ILEUM

Hx: 64 yo male; Abdominal

enlargement w/ small, scanty, hard

stools and occasional fever

Lymph nodule-looking

Lymphocyte looking



Category of this tumor in the REAL Classification:y Peripheral B cell Neoplasm

Compare the behavior of Non-hodgkin and Hodgkin·s

lymphoma:

y

Non-hodgkin·s = poor prognosis, metastasizes in organsy Hodgkin·s = better prognosis, metastasizes mostly in

lymph nodes

L YMPHOMA , NON-HODGKIN·S DISEASE,

DIFFUSE L ARGE CELL TYPE, ILEUM



EXTERNAL AND INTERNAL HEMORRHOIDS

Hx: 45 yo male, alcoholic, gradual abdominal

enlargement, edema

Dx:

Mixed type of

Hemorrhoids

Note: both squamous

and columnar

epithelium are present

columnar

squamous



Enumerate 5 complications of this lesion

y Bleeding, Infection

y Thrombosis, Ulceration

y Anemia (severe bleeding)

Distinguish External from Internal Hemorrhoids

External- stratified squamous Internal- columnar

EXTERNAL AND INTERNAL HEMORRHOIDS

Not a hemorrhoid pero

ganito itsura ng epithelium



A MOEBIC COLITIS

Hx: 67 yo female; abdominalpain and loose bowel

movement, mucoid stool

Flask-shaped ulcer

Amoeba containing rbc



A NAL FISTULA

Inflammatory

cells on ducts

and glands

Hx: 25 yo male; pain andtenderness at the anal region

during defecation



JUVENILE (RETENTION) POLYP, COLON

NON-NEOPLASTIC POLYP

Hx: 10 yo male, fresh blood in stools

Denuded superficial

epith

Well differentiated

columnar cells with

goblet cells

Smooth solid,polypoid, brown



VILLOUS A DENOMA , RECTUM

NEOPLASTIC POLYP

Hx: 67 yo female, blood-

streaked stools

Finger-like processes

Dysplastic,pseudostratified columnar

cells, slightly

hyperchromatic,

pleomorphic nuclei



3 histologic classifications

of colorectal adenomas

y Tubular

y

Villous - chances of becoming adenocarcinoma

y Tubulovillous

VILLOUS A DENOMA , RECTUM

Cauliflower-like arborescent

mass



MUCINOUS A DENOCARCINOMA , COLON

Hx: 42 yo male w/

frequent bowelmovement, abdominal

enlargement, weight loss,

anemia, hematochezia

Mucus staining columnar

cells



Differentiate clinically andmorphologically bet. Carcinomas of

the left and right side of the colon.

y Right CA- fungating and polypoid

causes diarrhea (bloody stools)

y Left CA- annular, encircling napkinlike lesions, causes constipation

Biologic behavior of mucinous

carcinoma and signet ring

carcinoma

y Mucinous- presence of mucus cellsspread faster

y Signet ring CA- more aggressive and

poorer prognosis

MUCINOUS A DENOCARCINOMA , COLON



M ALIGNANT MELANOMA , A NORECTAL

Hx: 62 yo male fresh blood-streaked stools

Vertical growth- highchance of metastasis

Radial growth-

horizontal growth

pattern, rare

metastasis, (-)angiogenesis

Characteristic:

1. prominent MACROnucleoli

2. presence of melanin pigments



G ASTROINTESTINAL STROMA S ARCOMA

(M ALIGNANT GIST), COLON

Hx: 53 yo male abdominal enlargement

associated w/ constipation



A CUTE SUPPURATIVE A PPENDICITIS

4 outcomes of acute

inflammation

y Complete resolution

y Healing by CT replacement

y Abscess

y Progression to Chronic

Complications

y Rupture > peritonitisy Bacteremia

y Liver infection and abscess

y Sepsis

Hx: 25 yo female sudden onset of

epigastric pain w/ fever, nauseaand vomiting



G ANGRENOUS A PPENDICITIS

Hx: 21 yo female, sudden severe pain in RLQ

Note: all layers are

necrotic



A DENOCARCINOMA . A PPENDIX RARE

Hx: 28 yo female severe right abdominal pain

with vomiting

Most common primary

malignant tumor of the appendix

Ans: Carcinoid Tumor

CARCINOID TUMOR

Most common site:

TIP of the appendix



DISEASES OF THE LIVER,

BILIARY S YSTEM AND P ANCREAS



POLYCYSTIC LIVER

Hx: 32 yo female, sudden onset of

headache, loss of consciousnessBP: 220/100

Kidney: cobblestone appearance

Histogenetic origin:

biliary epithelium, biliarymicrohamartomas

Clinical significance:

1. Berry aneurysm

2. Intracranial hemorrhage

3. Polycystic aneurysm



POLYCYSTIC LIVER

Lined by flattened cuboidal

epith



F ATTY LIVER (MUST KNOW)

Hx: 45 yo alcoholic male, obese

and diabetic

1. Give two morphologic patterns

of fatty change

Answer: Macrovesicular steatosis

and microvesivular steatosis



C ARDIAC SCLEROSIS (CIRRHOSIS) MUST KNOW

Hx: 22 Yo female w/ RHD w/ Mitral Stenosis, difficulty breathingPE: edema of the lower extremities, enlarged and firm liver

NUTMEG

appearance of the liver

Type of

hemodynamic

dysfunction:

CHRONIC

PASSIVE

CONGESTION



Radiating centrilobular scars, markedly dilated

and congested sinusoids with hemosiderin laden

Von Kupffer cells.

C ARDIAC SCLEROSIS (CIRRHOSIS)

5 conditions that give rise

to chronic passive

congestion of the liver:

1. CHF right side

2. Obstruction of Inf.

Vena cava

3. Portal Hypertension

4. Shock

5. Chronic alcohol abuse



C ARDIAC SCLEROSIS (CIRRHOSIS)

Dilated Sinusoids



TUBERCULOSIS LIVER

Granulomatous

inflammation

Destroyed liver architecture

Hx: 18 yo female difficulty of

breathing, high grade fever,

productive cough with bloody

sputum



SCHISTOSOMIASIS LIVER

NO HISTORY SA MANUAL! LOL

Schistosoma ova deposits with

lymphocytes, macrophages andplasma cells«

TAND AAN NYO ITSURA NG SCHISTOSOMA OVA

Type of calcification? D YSTROPHIC calcification



Spider angiomas

Jaundice and

icteric sclerae

Ascites

Edema of

both lower ex



A LCOHOLIC CIRRHOSIS

45 yo alcoholic male, gradual abdominal

enlargment, edema of both lower extremities and

jaundice,



Rounded nodules

(pseudolobules)

NODULE

FORMATION



3 criteria for the histologic diagnosis of cirrhosis

y Nodule Formation, Fibrosis, Diffuse liver

architecture destruction

Fibrous Septae

NORMAL HEPATOCYTES

B C S



BILIARY CIRRHOSIS SECOND ARY TO

EXTRAHEPATIC BILIARY A TRESIA

Hx: 10month old baby boy, fever,

poor suck, jaundice

B C S



A disease in which there is inflammation with stricture

of hepatic or common bile ducts. This leads to markedcholestasis with intrahepatic bile duct proliferation,

fibrosis and cirrhosis.

The common bile duct is reduced to a thin band of fibrous

tissue extending from the hilum of the liver, to theduodenal area.

BILIARY CIRRHOSIS SECOND ARY TO

EXTRAHEPATIC BILIARY A TRESIA



Large fat

vacuolated

hepatocytes

Proliferation

of bile ducts

Fibrous bands



HEPATOCELLULAR C ARCINOMA SOLITARY LESION

Hx: 45 yo alcoholic male, jaundice abdominal

enlargement, severe body

weakness, anorexia, and weight

loss

2-8 cells thick trabeculae



HEPATOCELLULAR C ARCINOMA

Hyperchromatic

Pleomorphic

Degenerative and

dysplastic changes

Lymphocytic

infiltrates

ETASTATIC DENOCARCINOMA, IVER



ETASTATIC DENOCARCINOMA , IVER

MULTIPLE LESIONS

Normal liver

Metastasis

Varying size, yellowish

brown nodules



CHOLESTEROLOSIS, G ALLBLA DDER MUST KNOW

Fat vacuolated cells

TAND AAN NYO ITSURA NITO



G ANGRENOUS CHOLECYSTITIS

Hx: 46 yo female, severe colicky righthypochondriac pain radiating to the right

shoulder

Gross: Dark-red, swollen

and covered with thread-

liked fibrinous material



G ANGRENOUS CHOLECYSTITIS

Microscopy: Necrosis and infiltratesof neutrophils



CHRONIC C ALCULOUS CHOLECYSTITIS

Hx: 40 yo female, obese, RUQ pain,

colicky

Can be composed of:

Cholesterol

Bilirubin

Calcium salts

MOST COMMON TYPE OF STONE: CHOLESTEROL



CHRONIC CHOLECYSTITIS

1. Histologic findings:

Ans: Muscle hypertrophy, inflammatory infiltrates, plasma cells in

submucosa, lymphocytes

2. Complications:

Ans: Bacterial superinfection, perforation/ulceration, peritonitis, rupture,

jaundice, biliary stones

ROKITANSKY-ASCHOFF SINUSES



A CUTE HEMORRHAGIC P ANCREATITIS MUST KNOW

Hx: 57 yo female, sudden severe abdominal pain, radiating to the back

(after a heavy dinner), vomiting, increased serum amylase



QUIZ FOR GIT

No Answers« Baka sisihin nyo pako pagmali!



QUIZ!

2. Diagnosis?



END

You have now finished GIT« LOL

Pathology Practicals 3 Part1

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