Pathology Review Carousel 17

Gastrointestinal Lab I, Part I

Image

Slide #

Tissue

Mag

Feature

1

Stomach (slide 9)

LP

Chronic gastric ulcer: gastric wall with ulcer base showing all four layers of chronic ulcer.

2

Stomach (slide 9)

MP

Same.

3

Stomach

Gross

Benign chronic gastric ulcer: note sharp margins, flat relatively clean ulcer base and folds that radiate from the ulcer margin, location on the lesser curvature in the antrum at the fundopyloric junctional mucosa (precepitous proximal and sloping distal border not clearly seen).

4

Stomach

Gross

Penetrating gastric carcinoma: note nodularity of the base and the thickened nodular or rolled margins and that the rugae or folds do not radiate to the edge of the ulcer in most areas.

5

Stomach

Gross

Multiple acute peptic ulcers: multiple, small black ulcers located in the body and fundus.

7

Stomach (slide 116)

LP

Linitis Plastica: mucosa showing the normal glands spread apart and not reaching the muscularis mucosa.

8

Stomach (slide 116)

HP

Many signet ring cells (individual malignant glandular cells) in mucosa replacing the normal mucosa. Note the few benign glands present and how benign appearing the individual malignant cells appear.

9

Stomach (slide 116)

LP

Focus where carcinoma infiltrates as cords of cells (remember epithelial cells usually show cohesion, such as these foci. But in linitis plastica, the poorly differentiated carcinoma tends to infiltrate as individual cells).

10

Stomach (slide 116)

HP

Same as 9.

11

Stomach

Gross

Linitis plastica or diffusely infiltrating carcinoma, note leather bottle appearance.

13

Appendix (slide 117)

LP

Carcinoid tumor: Mucosa replaced by rosettes and nests of tumor.

14

Appendix (slide 117)

HP

Carcinoid tumor: note rosettes, solid cords, uniformity of cells and lack of mitoses.

15

Appendix (slide 117)

Gross

Carcinoid: yellowish-white tumor replacing mucosa and filling lumen. Note rim of gray-white muscularis propria.

16

Ileum

Gross

Multiple carcinoids beneath the mucosa.

17

Patient

Gross

Flushing of the skin in patient with carcinoid syndrome (Remember carcinoid syndrome develops in patients who almost always have metastases in the liver).

19

Patient

Gross

Squamous carcinoma of the lower lip.

20

Patient

Gross

Squamous carcinoma of the ventral lateral surface of the tongue.

22

Parotid (slide 75)

LP

Benign mixed tumor or pleomorphic adenoma, note variability, stroma and glands.

23

Parotid (slide 75)

MP

Glands and cords of epithelial cells, spindle shaped myoepithelial cells, and stroma.

24

Parotid

Gross

Benign mixed tumor or pleomorphic adenoma. Note well circumscribed appearance, and remember pseudopodia of tumor extend into surrounding parenchyma.

26

Colon (slide 45)

LP

Colon, adenomatous polyp. Note how blue the slide appears because of the closely spaced pseudostratified, large nuclei. Some of the polyp is formed of glands and some of finger like projections or villi.

27

Same

HP

Shows pseudostratification of large nuclei.

28

Colon

HP

Stalk of polyp showing relatively normal epithelium for comparison.

29

Colon

Gross

Pedunculated adenomatous polyps with their narrow stalks (most likely tubular adenomas).

30

Colon

Gross

Large sessile villous adenoma (45% of large villous adenomas, > 2 cm in diameter, contain malignant change, ie, adenocarcinoma)

31

Colon (slide 44)

LP

Adenocarcinoma invading into muscularis propria

32

Colon

LP

Adenocarcinoma at junction with uninvolved mucosa. Note invasion beneath the mucosa and compare the nuclei of the carcinoma to the nuclei of the normal mucosa.

33

Colon

HP

Adenocarcinoma. Note cribriform pattern (glands that are back to back without intervening stroma). Also note other features of malignancy.

34

Colon

Gross

Adenocarcinoma with the gross napkin ring pattern or apple core pattern. Note how narrow the lumen becomes in the area of the carcinoma. The mucosa is nodular and erythematous in this region. It may be ulcerated.

GI continued (Part II)

Image	Slide #	Tissue	Mag	Feature
	1	Stomach (slide 9)	LP	Chronic gastric ulcer: gastric wall with ulcer base showing all four layers of chronic ulcer.
	2	Stomach (slide 9)	MP	Same.
	3	Stomach	Gross	Benign chronic gastric ulcer: note sharp margins, flat relatively clean ulcer base and folds that radiate from the ulcer margin, location on the lesser curvature in the antrum at the fundopyloric junctional mucosa (precepitous proximal and sloping distal border not clearly seen).
	4	Stomach	Gross	Penetrating gastric carcinoma: note nodularity of the base and the thickened nodular or rolled margins and that the rugae or folds do not radiate to the edge of the ulcer in most areas.
	5	Stomach	Gross	Multiple acute peptic ulcers: multiple, small black ulcers located in the body and fundus.
	7	Stomach (slide 116)	LP	Linitis Plastica: mucosa showing the normal glands spread apart and not reaching the muscularis mucosa.
	8	Stomach (slide 116)	HP	Many signet ring cells (individual malignant glandular cells) in mucosa replacing the normal mucosa. Note the few benign glands present and how benign appearing the individual malignant cells appear.
	9	Stomach (slide 116)	LP	Focus where carcinoma infiltrates as cords of cells (remember epithelial cells usually show cohesion, such as these foci. But in linitis plastica, the poorly differentiated carcinoma tends to infiltrate as individual cells).
	10	Stomach (slide 116)	HP	Same as 9.
	11	Stomach	Gross	Linitis plastica or diffusely infiltrating carcinoma, note leather bottle appearance.
	13	Appendix (slide 117)	LP	Carcinoid tumor: Mucosa replaced by rosettes and nests of tumor.
	14	Appendix (slide 117)	HP	Carcinoid tumor: note rosettes, solid cords, uniformity of cells and lack of mitoses.
	15	Appendix (slide 117)	Gross	Carcinoid: yellowish-white tumor replacing mucosa and filling lumen. Note rim of gray-white muscularis propria.
	16	Ileum	Gross	Multiple carcinoids beneath the mucosa.
	17	Patient	Gross	Flushing of the skin in patient with carcinoid syndrome (Remember carcinoid syndrome develops in patients who almost always have metastases in the liver).
	19	Patient	Gross	Squamous carcinoma of the lower lip.
	20	Patient	Gross	Squamous carcinoma of the ventral lateral surface of the tongue.
	22	Parotid (slide 75)	LP	Benign mixed tumor or pleomorphic adenoma, note variability, stroma and glands.
	23	Parotid (slide 75)	MP	Glands and cords of epithelial cells, spindle shaped myoepithelial cells, and stroma.
	24	Parotid	Gross	Benign mixed tumor or pleomorphic adenoma. Note well circumscribed appearance, and remember pseudopodia of tumor extend into surrounding parenchyma.
	26	Colon (slide 45)	LP	Colon, adenomatous polyp. Note how blue the slide appears because of the closely spaced pseudostratified, large nuclei. Some of the polyp is formed of glands and some of finger like projections or villi.
	27	Same	HP	Shows pseudostratification of large nuclei.
	28	Colon	HP	Stalk of polyp showing relatively normal epithelium for comparison.
	29	Colon	Gross	Pedunculated adenomatous polyps with their narrow stalks (most likely tubular adenomas).
	30	Colon	Gross	Large sessile villous adenoma (45% of large villous adenomas, > 2 cm in diameter, contain malignant change, ie, adenocarcinoma)
	31	Colon (slide 44)	LP	Adenocarcinoma invading into muscularis propria
	32	Colon	LP	Adenocarcinoma at junction with uninvolved mucosa. Note invasion beneath the mucosa and compare the nuclei of the carcinoma to the nuclei of the normal mucosa.
	33	Colon	HP	Adenocarcinoma. Note cribriform pattern (glands that are back to back without intervening stroma). Also note other features of malignancy.
	34	Colon	Gross	Adenocarcinoma with the gross napkin ring pattern or apple core pattern. Note how narrow the lumen becomes in the area of the carcinoma. The mucosa is nodular and erythematous in this region. It may be ulcerated.