Pathology Lab.

Gastrointestinal tract
MD IV
 Esophagus
• Carcinoma of esophagus:The most common
types of esophageal cancer are squamous cell
carcinoma and adenocarcinoma.
• Squamous cell carcinoma constitute 90% of
esophagus cancers.
• In USA the incidence of adenocarcinoma
associated with Barrett esophagus has been
increase.
 Carcinoma of esophagus:
Approximately 60% of squamous cell carcinomas develop in
the middle third of the organ, 30% occur in the lower third,
and 10% occur in the upper third
Adenocarcinoma develops in associated with a condition
called Barrett's esophagus. This type usually occurs in the
lower third of the esophagus
This is normal
esophageal squamous
mucosa at the left, with
underlying submucosa
containing mucus glands
and a duct surrounded
by lymphoid tissue. The
muscularis is at the right
Carcinoma of esophagus:
  Squamous cell carcinoma( esophagus)
Infiltrating squamous
cell carcinoma of the
mid-esophagus. Solid
nests of neoplastic cells
are infiltrating down
through the submucosa.
Esophageal cancers
often spread to
surrounding structures,
making surgical removal
difficult
 Stomach ( Gastric ulcer)

Gastric ulcer - "a breach

in the mucosa that
extends through the
muscularis mucosae
into the submucosa or
deeper" 
Chronic peptic ulcer
 Chronic peptic ulcer
Chronic peptic
ulcer (stomach) is a mucosal
defect which penetrates the
muscularis mucosae and
muscularis propria, produced
by acid-pepsin aggression.
Ulcer margins are
perpendicular and present
chronic gastritis
 Carcinoma Stomach
Gastric cancer can develop in any part of
the stomach and may spread throughout the
stomach and to other organs; particularly
the esophagus, lungs, lymph nodes, and
the liver. Stomach cancer causes about 800,000
deaths worldwide per year
 Carcinoma Stomach
 Histologically, there are two major types of gastric adenocarcinoma
(Lauren classification): intestinal type or diffuse type

 Intestinal type adenocarcinoma tumor cells describe irregular tubular

structures, harboring pluristratification, multiple lumens, reduced
stroma ("back to back" aspect). Often, it associates intestinal
metaplasia in neighboring mucosa

The diffuse variant is composed of malignant cells that do not from

glands.
They permeates the mucosa & wall as scattered individual signet-ring
cells or small clusters.
 Adenocarcinoma- stomach

Gastric
adenocarcinoma
with ulcerated
surface and
rolled border.
 Adenocarcinoma- stomach

Histopathological
image of well
differentiated
gastric
adenocarcinoma.
H & E stain
 Adenocarcinoma- stomach
This is an example of
linitis plastica, a diffuse
infiltrative gastric
adenocarcinoma which
gives the stomach a
shrunken "leather
bottle" appearance
with extensive
mucosal erosion and a
markedly thickened
gastric wall.
 signet ring cell

This is a signet ring cell pattern of adenocarcinoma in which the

neoplastic cells are filled with cytoplasmic mucin vacuoles that
compress the nucleus to one side, as shown at the arrow. Signet ring
cell adenocarcinomas are poorly differentiated and tend to be highly
invasive in nature
 Acute appendicitis
Gross.
• Edema,Hypermia & tan yellow exudate.
 Acute appendicitis.
• Subserosal exudate
• Edema & exudate in mocosa.
 Acute appendicitis (Micro)
• Mucosal inflammation & necrosis.
 Acute Appendicitis(Micro)
• Neutrophils extend in to the muscle layers.
 Intestine
The American Cancer Society estimated that 150000
individuals would be diagnosed with colorectal cancer
and 49,960 would die from this disease in the United
States in 2008

Virtually all adenocarcinomas develop from adenomas.

In general, the bigger the adenoma, the more likely it is
to become cancerous.
 Adenocarcinoma of colon
Here is example of an
adenocarcinoma of
colon. This cancer is
more exophytic in its
growth pattern. Thus,
one of the
complications of a
carcinoma is
obstruction (usually
partial).
 Adenocarcinoma of colon

Law power High power

 Adenocarcinoma of colon
The edge of the carcinoma arising in the villous
adenoma is seen here. The neoplastic glands are
long and frond-like, similar to those seen in a
villous adenoma.
 Ulcerative colitis
Ulcerative colitis is a form of inflammatory bowel
disease\ (IBD). Ulcerative colitis is a form of colitis,
a disease of the intestine, specifically the large intestine
or colon, that includes characteristic ulcers, or open sores,
in the colon

In patients with ulcerative colitis, ulcers and inflammation

of the inner lining of the colon lead to symptoms
ofabdominal pain, diarrhea, and rectal bleeding.
Gross:  This colectomy was performed for idiopathic ulcerative colitis. 
The mucosa is hyperemic, friable, and granular due to capillary
dilatation and congestion in the lamina propria
Ulcerative colitis
Microscopically, the
inflammation of
ulcerative colitis is
confined primarily to the
mucosa. Here, the
mucosa is eroded by an
inflammatory process
with ulceration that
undermines surrounding
mucosa.