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07 GI
| Question | Answer | |
|---|---|---|
| Oesophageal squamous papilloma (D) | Oesophagus with papilloma consisting of squamous epithelium with fibrovascular cores. ± Scattered koilocytes. No atypia. | rosai.secondslide.com/view/sem1464/sem1464-case6.svs |
| Oesophageal squamous papilloma (AV) | Usually asymptomatic and incidental. Distal or middle oesophagus. Caused by irritation (alcohol, smoking, reflux), infection (HPV) and genetic syndromes (Goltz-Gorlin syndrome, angioma serpiginosum). | rosai.secondslide.com/view/sem1464/sem1464-case6.svs |
| Barrett oesophagus, no dysplasia (D) | Preserved cell polarity: 1- Apical mucin cap 2- Base of mucin cap 3- Cytoplasm (between mucin and nucleus) 4- Row of nuclei (maintained nuclear polarity) | rosai.secondslide.com/view/sem1464/sem1464-case6.svs |
| Barrett dysplasia, low-grade (D) | Distal oesophagus with columnar metaplasis. Normal architecture, cell elongation, nuclear enlargement, hyperchromasia, stratification, retained polarity, more goblet cells. No invasion. | lmpimg.med.utoronto.ca/LMP48698.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Barrett dysplasia, low-grade (FW) | IHC of limited value. p53, AMACR may help differentiate between non-dysplastic and dysplastic epithelium. Increased Ki-67 index. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F29219.svs |
| Barrett dysplasia, low-grade (AV) | Vienna and Reid classifications. Risk factors inc. GORD, obesity, male, smoking, H.pylori. Role of antireflux therapies is questionable. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FFRCPath%2F2015%2FAutumn%2F329154.svs |
| Barrett dysplasia, high-grade (D) | Distal oesophagus with columnar metaplasia. Abnormal architecture, greater cytological abnormalitis, pleomorphism, irregular outlines, loss of polarity, mitoses, necrosis. No invasion. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30319.svs |
| Barrett dysplasia, high-grade (FW) | IHC of limited value. p53, AMACR may help differentiate between non-dysplastic and dysplastic epithelium. Increased Ki-67 index. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30319.svs |
| Barrett dysplasia, high-grade (AV) | Vienna and Reid classifications. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30319.svs |
| Acute reflux oesophagitis (D) | Scattered eosinophils, oedema, basal cell hyperplasia, elongation of vascular papilla. Worse distally. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FOesophagus%2F4459.svs |
| Acute oesophagitis infections | Candida (fungal hyphae, PASD+), HSV (molding, multinucleation, margination), CMV (inclusions). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FGeneral_Histopathology%2FHisto_EQA_CircAH%2F384876.svs |
| Acute 'pill' oesophagitis | Acute oesophagitis with crystals, resins, and pill frags highlighted with polarisation. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FFRCPath%2F2019%2FAutumn%2F476514.svs |
| Eosinophilic oesophagitis (D) | Oesophagus with eosinophils ( ≥ 15/hpf) concentrated in surface epithelium (vs base), extreme basal zone hyperplasia. ± eosinophilic microabscesses, eosinophil degranulation, surface desquamation, lamina propria fibrosis. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FManchester_FRCPath%2Fseminar_1%2F102553.svs |
| Eosinophilic oesophagitis (AV) | Diffuse or worse proximally. Presents with dysphagia, chest pain, food impaction. A/w “Atopic Triad” (Allergies, Asthma, Eczema). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FOesophagus%2F4202.svs |
| Spindle cell squamous cell carcinoma (aka carcinomasarcoma) (D) | Oesophagus w/ carcinoma and spindle cell components. Long spindle w/ blunt nuclei and atypia. ± Bizarre GCs, bone, cartilage, strap cells. Stroma is edematous w/ scattered collagen. Epithelial: squamous or basaloid, rarely adeno ca. Mitoses. ± NE diff. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FR_Bishop_Collection%2FCard_index_Set%2FGI%2F33624.svs |
| Spindle cell squamous cell carcinoma (aka carcinomasarcoma) (FW) | IHC: CKs, vimentin, reticulin, p53. Negative S100. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FR_Bishop_Collection%2FCard_index_Set%2FGI%2F33598.svs |
| Spindle cell squamous cell carcinoma (aka carcinomasarcoma) (AV) | Uncommon, usually middle aged / elderly men. Typically mid oesophagus. Regarded as a variant of SCC. Ca and sarcoma elements are derived from a single clone. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FR_Bishop_Collection%2FCard_index_Set%2FGI%2F33595.svs |
| Gastric inlet pouch (D) | Heterotopic gastric mucosa with fundic / oxyntic type glands admixed with mucous glands surrounded by squamous mucosa. Rarely H.pylori and intestinal metaplasia. No atypia. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30240.svs |
| Lymphocytic gastritis (D) | Gastric mucosa with increased intraepithelial lymphocytes (> 25 per 100), typically greater in surface epithelium. Lymphoplasmacytic expansion of the LP. Neutrophils, esp. in H.pylori. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FStomach%2F6797.svs |
| Lymphocytic gastritis (FW) | IHC: Lymphocytes are predominately CD3 positive T cells with CD8 co-expression. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FStomach%2F4817.svs |
| Lymphocytic gastritis (AV) | Rare, usually in 60s, M=F. A/w coeliac disease (diffuse), H. pylori gastritis (corpus), viral infection, Crohn disease, Ménétrier disease, certain medications and other etiologies. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FStomach%2F4816.svs |
| Gastric bronchogenic cyst (D) | A cyst lined by ciliated respiratory epithelium. The cyst wall may contain seromucinous glands, hyaline cartilage, smooth muscle. ± Fibrosis, inflammation. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FStomach%2F453.svs |
| Gastric bronchogenic cyst (FW) | IHC: CH7. Negative CK20, TTF1, CDX2. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FStomach%2F452.svs |
| Gastric bronchogenic cyst (AV) | Extremely rare embryonic malformation (abnormal budding of primitive foregut). Presents with intermittent epigastric pain or other GI/resp symptoms. Can arise in multiple other sites. Risk of local recurrance if incompletely excised. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FStomach%2F453.svs |
| Mantle cell lymphoma (D) | GI tract containing monomorphic small to medium-sized lymphoid cells with irregular nuclear contours. Clumped chromatin and inconspicuous nucleoli. Diffuse > nodular > mantle zone growth patterns. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FDr_H_A_Haematopathology_Atlas%2FCD5_POs_BCL%2FCase_018%2F501256.svs |
| Mantle cell lymphoma (FW) | IHC: Cyclin D1, SOX11, CD20, CD79a, CD5, CD43. Negative CD10, BCL6 and CD23. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FDr_H_A_Haematopathology_Atlas%2FCD5_POs_BCL%2FCase_022%2F501359.svs |
| Mantle cell lymphoma (AV) | t(11;14)(q13;q32) translocation between IGH and CCND1 causing cyclin D1 overexpression. May present in GI tract as ulcer, mass, lymphoid polyps or thickening of mucosa. Clinically aggressive. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2Fhmds%2FSet_1%2F46389.svs |
| Gastrointestinal stromal tumour (GIST) (D) | A GI intramural, submucosal, or subserosal mass. Spindle cell, epithelioid, or mixed morphology. Minimal nuclear pleiomorphism. | lmpimg.med.utoronto.ca/LMP23516.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Gastrointestinal stromal tumour (GIST) (FW) | IHC: CD117 (KIT), DOG1. SDHB loss in SDH-deficient tumours. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FIleum%2F9141.svs |
| Gastrointestinal stromal tumour (GIST) (AV) | Chr4 (4q12) KIT or PDGFRA mut. Cells of Cajal differentiation. Stomach (54%), small bowel (30%). AFIP/Lasota-Miettinen: Mitoses (≤5/>5), Size (≤2, 2-5, 5-10, >10 cm), Site (^distal) Core: Type, mitoses, mucosal invasion, margins, treatment response. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FJejunum%2F9855.svs |
| Autoimmune (metaplastic) atrophic gastritis (AMAG) (D) | Atrophy of oxyntic gastric mucosa, LP fibrosis, ± metaplastic change. Early chronic inflammation, prominent intestinal metaplasia, G cell hyperplasia, ECL cell hyperplasia. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30358.svs |
| Autoimmune (metaplastic) atrophic gastritis (AMAG) (FW) | IHC: Intestinal metaplasia: MUC2. Enterochromaffin-like cell (ECL) hyperplasia: synaptophysin, chromogranin A. Pseudopyloric metaplasia: MUC6. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30358.svs |
| Autoimmune (metaplastic) atrophic gastritis (AMAG) (AV) | Autoantibodies destroy parietal cells/oxyntic mucosa → No intrinsic factor → B12 deficiency → Pernicious anemia. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30358.svs |
| Radiation enterocolitis (D) | Acute: eosinophilia of LP / crypts, reduced goblet cell mucin. Chronic: Architectural changes & atrophy, mild inflammation, fibrosis Paneth cell metaplasia, ulceration, mild atypia, vessel dilation/hyaline/fibrosis/thickening/thrombi. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FColon%2F6330.svs |
| Radiation enterocolitis (AV) | Acute (<6m) or chronic. 5-15% get chronic radiation proctitis. Ionizing radiation damages proteins, lipid bilayer & DNA > vascular damage & ischaemia > fibrosis, ulcers, stenosis, strictures, fistulas, infection, bleeding. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FR_Bishop_Collection%2FCard_index_Set%2FGI%2F33617.svs |
| Gastric neuroendocrine tumour (NET) (D) | Gastric mucosa showing a uniform population of cells with round nuclei and finely stippled chromatin; architectural patterns such as trabeculae, acini, nests, and ribbons. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FNW%2FCirc_AE%2F50801.svs |
| Gastric neuroendocrine tumour (NET) (FW) | IHC: Synaptophysin and chromogranin A. Ki67 % for grading. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FNW%2FCirc_AA%2F51002.svs |
| Gastric neuroendocrine tumour (NET) (AV) | Grades 1, 2, 3 (mitoses <2, 2-20, >2; Ki67 <3, 3-20, >20%). NET-specific UICC TNM. Prognosis ranges from excellent (Type 1 ECL-cell) to poor (Type 3 ECL-cell). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FNW%2FCirc_AE%2F50801.svs |
| Gastric neuroendocrine carcinoma (NEC) (D) | Gastric mucosa with small cell or large cell carcinoma pattern. Sheets or trabeculae of poorly differentiated cells; high mitotic count | rosai.secondslide.com/view/sem1173/sem1173-case8.svs |
| Gastric neuroendocrine carcinoma (NEC) (FW) | IHC: Synaptophysin and chromogranin A. High Ki-67 proliferation index. | rosai.secondslide.com/view/sem1173/sem1173-case8.svs |
| Gastric neuroendocrine carcinoma (NEC) (AV) | Gastric NEC and MANEC have a poor prognosis. | rosai.secondslide.com/view/sem1173/sem1173-case8.svs |
| Gastric hyperplastic polyp (D) | Gastric polyp consisting of elongated and tortuous foveolar epithelium; cystically dilated glands mixed with inflammatory changes. Commonly erosions, ulcerations, and inflammation. Dysplasia in up to 20%, carcinoma in 2%. | rosai.secondslide.com/view/sem1141/sem1141-case2.svs |
| Gastric hyperplastic polyp (FW) | IHC: H.pylori (or Giemsa). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FR_Bishop_Collection%2FCard_index_Set%2FGI%2F33586.svs |
| Gastric hyperplastic polyp (AV) | Usually in the antrum. A/w H.pylori gastritis. High risk of dysplasia and adenocarcinoma if >10cm. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30294.svs |
| Reactive (chemical) gastropathy (D) | Foveolar hyperplasia (corkscrew appearance with x2 elongation of gastric cardiac foveolae and pits). Mucin depletion, enlarged hyperchromatic nuclei. Ectatic vessels. No significant inflammation or oedema. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30061.svs |
| Reactive (chemical) gastropathy (FW) | IHC: Complete or patchy loss of apical MUC1 expression. Negative H. pylori staining. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F29921.svs |
| Reactive (chemical) gastropathy (AV) | Indiced by NSAIDs, bile reflux or alcohol. Insult to gastric epithelium -> excessive cellular exfoliation -> foveolar hyperplasia. Antral mucosa > oxyntic mucosa. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F29915.svs |
| Gastric adenocarcinoma - poorly cohesive carcinoma (inc. signet-ring cell carcinoma) (D) | Stomach with neoplastic cells that are isolated or arranged in small aggregates with no well-formed glands. Desmoplasia. Can be of either signet-ring cell type or non–signet-ring cell type (NOS). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FStomach%2F11206.svs |
| Gastric adenocarcinoma - poorly cohesive carcinoma (inc. signet-ring cell carcinoma) (FW) | IHC: ERBB2 (HER2) (for anti-HER2 therapy). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F29965.svs |
| Gastric adenocarcinoma - poorly cohesive carcinoma (inc. signet-ring cell carcinoma) (AV) | Lower sensitivity to chemo(radio)therapy. Gastric ca causes: H.pylori, tobacco, rubber manufacture, radiation. Gastric ca molecular types: EBV+ve, Microsatellite-unstable, Genomically stable, Chromosomally unstable | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F29961.svs |
| Coeliac disease (D) | Duodenum with lymphocytosis (> 30 IEL/100 enterocytes), crypt hyperplasia, villous atrophy. Enterocyte flattening. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FJejunum%2F7897.svs |
| Coeliac disease (AV) | Long-term autoimmune reaction to gluten. Anti-endomyseal (IgA) antibody or anti-transglutaminase antibody (tTGA) serology in association with bx. Marsh-Oberhuber histological classification. Risks of T cell lymphoma and adenocarcinoma. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FJejunum%2F7896.svs |
| Ampullary adenoma (D) | Polyp on the duodenal surface of ampulla showing dysplastic glandular epithelium. Intestinal or pancreatobiliary differentiation. Low-grade or high-grade dysplasia. | tumourclassification.iarc.who.int/Viewer/DisplayImage2?f=474 |
| Ampullary adenoma (FW) | IHC: usually positive CK7 and CK20. Intestinal: MUC2 and CDX2. Pancreatobiliary: EMA (MUC1), MUC5AC, and MUC6. | tumourclassification.iarc.who.int/Viewer/DisplayImage2?f=475 |
| Ampullary adenoma (AV) | Rare. Incidental or symptoms of obstruction. | tumourclassification.iarc.who.int/Viewer/DisplayImage2?f=2377 |
| Peutz-Jeghers polyp (D) | Polyp with arborizing strands of smooth muscle and overlying non-neoplastic epithelium. Dysplasia is exceedingly rare. Pseudoinvasion (epithelial misplacement) may be seen. Gastric polyps are less distinctive. | lmpimg.med.utoronto.ca/LMP21610.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Peutz-Jeghers polyp (FW) | IHC: Caldesmon highlights smooth muscle. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FWednesday_Teaching%2F20-Oct-10%2F126362.svs |
| Peutz-Jeghers polyp (AV) | STK11 germline mutation. PJS is an autosomal dominant polyp and cancer predisposition syndrome. 95% with PJS have polyps in the small intestine. May cause small bowel intussusception. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FGeneral_Histopathology%2FHisto_EQA_CircL_Set4%2F44517.svs |
| Giardiasis (D) | Wide range of features. Villi may be normal or blunted. Increased IELs, ± lymphoid aggregates. Free-floating 'kite and pear' shaped organisms along surface. | lmpimg.med.utoronto.ca/LMP35166.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Giardiasis (FW) | SS: Methylene blue positively stains the trophozoites. IHC: CD117 positive. | lmpimg.med.utoronto.ca/LMP38537.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Giardiasis (AV) | May be in conjunction with CVID and a paucity of LP plasma cells. Protozoan disease with asymptomatic colonization or diarrhoea. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FDuodenum%2F5105.svs |
| Pancreatic heterotopia (D) | Pancreatic tissue within GI tract with no anatomical/vascular connection to pancreas. Usually within submucosa. Most common in stomach. | lmpimg.med.utoronto.ca/LMP75201.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Pancreatic heterotopia (FW) | IHC: Acinar cells: trypsin, chymotrypsin, PAS, BCL10. Ductal cells: CK7, CK8 / CK18. Islet cells: synaptophysin, chromogranin A and INSM1. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FBlack_Box%2F20-Nov-08%2F70875.svs |
| Pancreatic heterotopia (AV) | Four types: 1. all pancreatic tissue; 2. Ducts only; 3. Acini only; 4. Islet cells only. Adenocarcinoma may arise from heterotopic tissue. Developmental anomaly a/w Meckel diverticulum. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FManchester_FRCPath%2Fseminar_1%2F102595.svs |
| Gastric heterotopia (D) | Mature gastric tissue found outside the stomach. foveolar epithelium with specialized antral glands ± oxyntic mucosa. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30240.svs |
| Gastric heterotopia (AV) | Asymptomatic or epigastric pain, obstruction, intussusception, perforation. Developmental anomaly a/w Meckel diverticulum. Rare malignant transformation. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FJejunum%2F11106.svs |
| Appendiceal goblet cell adenocarcinoma (D) | Appendix with an amphicrine tumour of goblet-like mucinous cells + endocrine and Paneth-like cells. Typically tubules resembling intestinal crypts. LG or HG (complex, cribriforming, HG cytology, mitoses, necrosis). Signet-ring cell variant. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FWednesday_Teaching%2F21-May-09%2F88229.svs |
| Appendiceal goblet cell adenocarcinoma (FW) | IHC: (not required) CK7/CK20, CDX2, chromogranin and synaptophysin. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FEndocrine%2FCirculation_19%2F89513.svs |
| Appendiceal goblet cell adenocarcinoma (AV) | Graded by loss of tubular or clustered growth: G1 = <25%; G2 = 25-50%; G3 = >50%. Staging as per appendiceal adenocarcinomas. Metastases to peritoneum, omentum, abdominal wall, and ovaries. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FGeneral_Histopathology%2FHisto_EQA_CircE_Set4%2F8462.svs |
| Low-grade appendiceal mucinous neoplasm (LAMN) (D) | Appendix with pseudostratified mucinous epithelium. "Pushing border". Long filiform villi without serration. Mural fibrosis with loss of the lamina propria and muscularis mucosae. Abundant apical mucin with elongated nuclei and low grade nuclear atypia. | lmpimg.med.utoronto.ca/LMP86952.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Low-grade appendiceal mucinous neoplasm (LAMN) (AV) | Frequent KRAS, GNAS alterations and loss of chr 5q. Rupture can cause pseudomyxoma peritonei (mucinous peritoneal deposition). High-grade variant (HAMN). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FNW%2FCirc_AT%2F278720.svs |
| High-grade appendiceal mucinous neoplasm (HAMN) (D) | Histological features similar to those of LAMN, with the addition of micropapillary features, cribriforming, piling up of epithelial cells with high-grade features. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FMaleki_FRCPath_collection%2FSet_010%2F334681.svs |
| High-grade appendiceal mucinous neoplasm (HAMN) (FW) | IHC (not needed): CK20, CDX2, SATB2, Negative PAX8. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FMaleki_FRCPath_collection%2FSet_010%2F334681.svs |
| High-grade appendiceal mucinous neoplasm (HAMN) (AV) | Frequent KRAS, GNAS alterations and loss of chr 5q. Rupture can cause pseudomyxoma peritonei (mucinous peritoneal deposition). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FPostgraduate%2FMaleki_FRCPath_collection%2FSet_010%2F334681.svs |
| Enterobius vermicularis appendicitis (D) | Appendix with normal appearance or various inflammatory patterns: ulceration, suppuration, lymphoid hyperplasia, eosinophils, neutrophils, plasma cells. Worms ± eggs seen mostly in lumen. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FR_Bishop_Collection%2FCard_index_Set%2FGI%2F33577.svs |
| Enterobius vermicularis appendicitis (AV) | Common worm disease, mostly in children. Aka 'threadworm', live and reproduce in the ileum, cecum, colon and appendix. | lmpimg.med.utoronto.ca/LMP19163.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| IBD-associated dysplasia (D) | LG: enlarged elongated nuclei, ^N:C, hyperchromasia with retained polarity. Serrated type with hypereosinophilic, mucin-depleted cytoplasm. HG: distorted architecture, pleimorphism, mitoses. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30614.svs |
| IBD-associated dysplasia (FW) | IHC: p53 for equivocal cases, mutant in dysplasia. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30429.svs |
| IBD-associated dysplasia (AV) | High-grade dysplasia is pTis. Vienna and Riddell classification systems. LGD -> HGD 5 yr risk is 54%. HGD -> Ca 5 yr risk is 40–90%. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30427.svs |
| Pseudomembranous colitis (D) | Colon with inflammatory and ischemic features. 'Volcano' of fibrin, mucin and inflammatory cells, mainly NPs, forming a pseudomembrane. Inflammation of LP and capillary fibrin thrombi. | lmpimg.med.utoronto.ca/LMP48749.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Pseudomembranous colitis (AV) | Most common cause is broad spectrum antibiotic use -> C. difficile. Decreased oxygenation, disrupted blood flow and endothelial injury. | lmpimg.med.utoronto.ca/LMP93678.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Diversion colitis (D) | Colon with lymphoid follicular hyperplasia (+ germinal centers), patchy muscularis mucosa hypertrophy, architectural changes, mucosal degeneration, mucin depletion, inflammation, paneth cell metaplasia. | lmpimg.med.utoronto.ca/LMP30680.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Diversion colitis (AV) | A/w surgical interruption of normal bowel flow, and changes in the microbiota. Surgical management is preferred. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FRectum%2F6478.svs |
| Colonic vasculitis (D) | Colonic mucosa with focal submucosal inflammation surrounding blood vessels. Varying histological features. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FSlide_Library%2FMFD_Collection%2FFull_Collection%2F30622.svs |
| Colonic vasculitis (AV) | A/w systemic vasculitis involving small or medium vessels. Can be clinically silent or cause intestinal ischemia. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FFRCPath%2F2020%2FAutumn%2F476394.svs |
| Ischaemic colitis (D) | Superficial epithelial damage, crypt withering, LP hyalinization and haemorrhage. Chronic changes: Architectural distortion, basal lymphoplasmacytosis, Paneth cell metaplasia. Occasional pseudomembranes and acute inflammation. | lmpimg.med.utoronto.ca/LMP77329.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Ischaemic colitis (AV) | Due to ischaemia, infection (e.g. E.coli 0157:H7, C.diff), medication (e.g. NSAIDs). Watershed areas most commonly affected (splenic flexure and rectosigmoid colon). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FColon%2F6369.svs |
| Sclerosing peritonitis (D) | Inflammatory and fibrosing process affecting visceral peritoneum that can encase small bowel. Infiltrates mesentery at attachment site with peritoneum. Usually spares retroperitoneum. | |
| Sclerosing peritonitis (AV) | A/w beta blockers, chronic peritoneal dialysis, abdominal surgery. | |
| Digestive system metastases (D) | Most metastses are to liver (colorectal, breast, stomach), small bowel (melanoma, lung, breast), colorectum (stomach, breast, cervix). | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FRectum%2F6491.svs |
| Digestive system metastases (AV) | TNM follows the criteria established for the respective tumour entities. No specific staging for CUP. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FGI%2FCirculation_X_2013%2F8.svs |
| Endometriosis of the colon (D) | Endometrial glands (with cilia) and stroma plus haemosiderin in deeper layers of colon. Usually surrounded by smooth muscle. Epithelium may have inflammation and ulcers. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FColon%2F6327.svs |
| Endometriosis of the colon (FW) | IHC: ER, PR, CD10. Negative CDX2, CEA. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FNW%2FCirc_X%2F51336.svs |
| Endometriosis of the colon (AV) | Can cause clinical symptoms (pain, obstruction or diarrhoea). Malignant transformation is rare. | www.virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FGeneral_Histopathology%2FHisto_EQA_CircO_Set8%2F53053.svs |
| Amoebic colitis (D) | Colon with inflammatory cells, fibrin and necrosis ± overlying organisms resembling detached macrophages. Superficial mucosal necrosis progressing to erosions and ulcers. | virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FNW%2FCirc_BG%2F514617.svs |
| Amoebic colitis (FW) | SS: PAS highlights amebic trophozoites in deep pink. IHC: Amoebae are CD68 negative. | s3.us-east-2.amazonaws.com/mayo-vm/slides/whe59W9LcUyommMZeGjgXQ.html |
| Amoebic colitis (AV) | Infection by protozoan parasite Entamoeba histolytica. Treatment is with metronidazole + antiparasitic. Rick of perforation / necrosis. | virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEQA%2FNW%2FCirc_BG%2F514617.svs |
| Solitary rectal ulcer syndrome (D) | Ulcerated or polypoid lesion(s) 4-10 cm from anal margin. Mucosal prolapse and superficial ulceration. Crypt hyperplasia/elongation w/ dilation and diamond-shaped glands. Fibromuscular hyperplasia of LP. Thickened muscularis mucosae, splayed fibres. | virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FRectum%2F6760.svs |
| Solitary rectal ulcer syndrome (AV) | Presents with rectal bleeding and constipation. On colonoscopy may present as a polyp. Due to pelvic muscle dysfunction. Most frequent in middle aged women. | virtualpathology.leeds.ac.uk/slides/library/view.php?path=%2FResearch_4%2FTeaching%2FEducation%2FTeaching%2FMFD_GI%2FRectum%2F6760.svs |
| Anal condyloma (D) | Anus with hyperplastic papillary squamous epithelium with parakeratosis and a fibrovascular core. Koilocytes in upper third. No dysplasia. | rosai.secondslide.com/view/sem1123/sem1123-case1.svs |
| Anal condyloma (FW) | IHC: p16 strong, block-like p16 in dysplasia and carcinoma with high-risk HPV subtypes. | rosai.secondslide.com/view/sem1123/sem1123-case1.svs |
| Anal condyloma (AV) | Caused by HPV (6 and 11) Mostly in 30s. Sexually transmitted, higher risk in imunodeficiency. Buschke–Lowenstein tumour (BLT) is a giant condyloma with features of deep growth and local destruction. | rosai.secondslide.com/view/sem1123/sem1123-case1.svs |
| Inflammatory fibroid polyp (D) | Stomach or small intestine with a poorly marginated hypocellular lesion. Short spindled/stellate cells in oedematous or myxoid stroma. Inflammation: Eosinophils + lymphocytes. Thin-walled vessels with surrounding 'onion skin' spindled cells. Few mitoses. | lmpimg.med.utoronto.ca/LMP78978.htm?utm_campaign=Full&utm_medium=referral&utm_source=dlml |
| Inflammatory fibroid polyp (FW) | IHC: CD34. (Negative CD117, S100, DOG1.) | rosai.secondslide.com/view/sem350/sem350-case9.svs |
| Inflammatory fibroid polyp (AV) | Benign mesenchymal GI polyp A/w PDGFRA mutation. Anywhere in GI, but most common in stomach and small intestine. | rosai.secondslide.com/view/sem581/sem581-case21.svs |
Created by:
kuc