Systemic Pathology Series

for MBChB III, Gastritis,

Ulcers, Tumours and other
Gastric Lesions
Dr Edwin Walong MBChB
Mmed (Pathology)
11th February 2014

Anatomy

Anatomy

Clinical Manifestations
Epigastric pain, tenderness
Nausea, vomiting
Bloating, feeling of fullness
distension
Upper GI Bleeding Melena Stool,
haematemesis
Nutritional deficiencies, B12

Overview
Gastritis
Acute
Chronic
Atrophic (Pernicious
Anaemia)
Eosinophilic
Lymphocytic
Sydney Classification

Peptic Ulcer Disease

(including
perforation)

Gastric Neoplasms
Polyps (hyperplastic,
adenomatous)
Gastric
Adenocarcinoma
Gastrointestinal
Stromal Tumours
Gastric Lymphomas,
Carcinoids
Metastatic Neoplasms

Other Gastric Lesions

pyloric stenosis

Gastritis - acute
Chemical: alkali,
acid ingestion
Dietary - spices
Drugs: Alcohol,
NSAIDS (cox 1),
Corticosteroids,
Tobacco

Iatrogenic
instrumentation
Infections (viral,
bacterial)
Stress burns,
severe illness

Acute haemorrhagic
gastritis

Acute haemorrhagic
gastritis

Acute Haemorrhagic
Gastritis

Infectous Gastritis, EBV

Gastritis - Chronic
Characterised by chronic
inflammation
Aetiology: infections eg Helicobacter
pylori.
Exposures as in acute gastritis
reflux, chemicals, alcohol, etc
Chronic Granulomatous inflammatory
lesions
Autoimmune gastritis
Exposure to exessive gastric

Chronic gastritis

Helicobacter pylori associated

gastritis

Helicobacter pylori, Warthin

Starry

Helicobacter heilmanii

Helicobacter spp
Helicobacter heilmanii
Helicobacter felis
Acquired, contamination of
contaminated water, usually in
childhood
Strains that produce Cag A are
associated with severe pathology
and malignant neoplasms (MALT
lymphoma, Gastric Adenocarcinoma

Granulomatous gastritis

Atrophic Gastritis

Gross pathology, atrophic

gastritis

Intestinal Metaplasia

Eosinophilic Gastritis

Lymphocytic Gastritis

Systems Grading

Biopsy Sites

Histology Sydney
Classification

Overview
Gastritis
Acute
Chronic
Atrophic (Pernicious
Anaemia)
Eosinophilic
Lymphocytic
Sydney Classification

Peptic Ulcer Disease

(including
perforation)

Gastric Neoplasms
Polyps (hyperplastic,
adenomatous)
Gastric
Adenocarcinoma
Gastrointestinal
Stromal Tumours (GIST)
Gastic Lymphomas,
Carcinoids
Metastatic Neoplasms

Other Gastric Lesions

pyloric stenosis

Peptic Ulcer Disease

Gastric Neoplasms, Benign

Gastric Adenocarcinoma,
ulcerated

Gastric Adenocarcinoma,
Exophytic

Gastric Carcinoma

Gastric Dysplasia

Gastric Adenocarcinoma

Gastric Adenocarcinoma, Nodal

Staging

Histology
Gastric Adenocarcinoma
Signet Ring Gastric Adenocarcinoma

Gastrointestinal Stromal
Tumours

GIST

GIST
Interstitial cell of Cajal
C kit mutations (CD 117), Amenable
to targeted therapy (imatinib
mesylate)
DOG 1 IHC

Others
Lymphomas MALT
Carcinoids, Neuroendocrine
Neoplasms
Metastatic Gastric Neoplasms

Overview
Gastritis
Acute
Chronic
Atrophic (Pernicious
Anaemia)
Eosinophilic
Lymphocytic
Sydney Classification

Peptic Ulcer Disease

(including
perforation)

Gastric Neoplasms
Polyps (hyperplastic,
adenomatous)
Gastric
Adenocarcinoma
Gastrointestinal
Stromal Tumours (GIST)
Gastic Lymphomas,
Carcinoids
Metastatic Neoplasms

Other Gastric Lesions

pyloric stenosis

Congenital Pyloric Stenosis

Congenital lesions
Associated with trisomy 21, 9q, etc
Pyloric Atresia, Antral Web, Gastric
Duplication

Hyperplastic lesions- Menetriers

disease

Museum Specimens, Slide

demonstrations