Surgical pathology of the stomach

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Surgical pathology of the stomach

• Ackerman.

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Cogenital.

• Heterotrophic pancreas
• Hypertrophic pyloric stenosis

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CLASSIFICATION AND GRADING OF GASTRITIS BASED ON
TOPOGRAPHY, MORPHOLOGY AND ETIOLOGY

• Non Atrophic
• Atrophic
• Autoimmune
• Multifocal
• Special Forms
• Chemical
• Radiation
• Non infectious Granulomatous
• Eosinophilic
• Infectious Gastritides

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CLASSIFICATION AND GRADING OF GASTRITIS BASED ON
TOPOGRAPHY, MORPHOLOGY AND ETIOLOGY

• Non Atrophic
• Atrophic
• Autoimmune
• Multifocal
• Special Forms
• Chemical
• Radiation
• Non infectious Granulomatous
• Eosinophilic
• Infectious Gastritides

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H-pylori gastritis
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Atrophic Gastritis
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others

• Duplication
• Diverticula
• Bezoars
• Aneurysms(dieulafoysdisease
• xanthoma

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Polyps.
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dysplasia
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• Peptic ulcer

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ulcer
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carcinoma
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Macroscopic Pathology

• Gross types
• Polypoid
• Ulcerative
• Infiltrative (extreme is linitis plastica
  leather bottle stomach)

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Signet ring
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Microscopy

• Intestinal type (forms glands like cancers of
  colon and oesophagus)
• Diffuse type dissociated tumour cells often
  containing a mucinous blob signet ring cells

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Spread of gastric carcinoma

• Local infiltration (through wall of stomach to
  peritoneum, pancreas etc)
• Lymphatic local and regional lymph nodes
• Blood liver, lungs
• Transcoelomic (across peritoneal cavity). Often
  involves ovaries (esp. signet ring cancer)
  Krukenberg tumour.

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GIST

• Larger tumours with high mitotic rate tend to
  behave malignantly
• Stomach is commonest site

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GIST-spindle cell neoplasm of GI tract
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Less common gastric neoplasms

• Lymphoma
• Gastrointestinal stromal tumour (GIST)
• Neuroendocrine (carcinoid) tumours

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Gastric lymphoma

• Malignant neoplasm of mucosa associated lymphoid
  tissue (MALT)
• A (usually) low grade B-cell (marginal cell)
  lymphoma

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IHC

• Keratin
• EMA
• MUC1
• CK7/CK20
• SPECIFIC-pepsinogen i.ii

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Other microscopic types

• Carcinoid-well differentiated,atypical,small
  cell,adeno ca
• Adenosquamous and squamous ca
• Mucinous
• Hepatoid
• Oncocytic
• Lymphoepithelial
• Sarcomatoid
• rhabdoid

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diagnosis

• Biopsy.

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Spread.

• 1.invasion.spread to serosa and regional lymph
  nodes and others.supraclavicular lymphnode having
  metastasis is called Virchow node.(left)
• 2.local spread to duodenum pancreas and
  retroperitoneum
• 3.peritoneum liver and lung
• Krukenberg tumour

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