Final Interpretation of Endoscopic Gastrointestinal Biopsy
Final Interpretation of Endoscopic Gastrointestinal Biopsy
Final Interpretation of Endoscopic Gastrointestinal Biopsy
UPPER GASTROINTESTINAL
& SMALL INTESTINAL BIOPSIES
1) Fiberoptic, 2) Electronic.
ENDOSCOPIC BIOPSY FORCEPS
1. Magnifying lens,
2. Orienting mucosal surface upward by
mounting biopsy on Filter paper / wire
mesh / plastic mesh/ frosted glass,
Fixation 10% buffered formalin for 2-3 hr
Alternative - Bouins fluid.
BIOPSY PROCESSING
Automatic tissue processor or by hand processing in
short cycles
Ascending grades of Alcohol - 30 mins each
Xylene - 30 mins each
Paraffin bath - 60 min each
Orientation is imp while making the paraffin block
Step sections at 3-4 level
STAINS : H & E,
SPECIAL STAINS :- PAS, Alcian blue, Z N, Congo
red, Masson trichrome, etc.
INTERPRETATION OF BIOPSIES
2. Recognize the
squamocolumnar junction
3.Describe extent of
metaplasia 1. Locate gastro-esophageal
consistently junction
BARRETT ESOPHAGUS
Incomplete intestinal
metaplasia - goblet +
foveolar type cells.
Complete goblet +
neuroendocrine + paneth
cells.
a/w foci of fundic &
cardiac type epithelium
BARRETT ESOPHAGUS
Alcian blue stain at
pH 2.5
Fibrovacular core
Acanthotic, parakeratotic
stratified squamous epi
SQUAMOUS CELL CARCINOMA
Chronic gastritis
Ulcers
Polyps
CHRONIC GASTRITIS
CHRONIC GASTRITIS
Causes :-
H. pylori gastritis
Multifocal atrophic gastritis
Gastritis secondary to drug therapy
Autoimmune gastritis
Granulomatous gastritis
Gastritis in immunosuppressed patients.
HELICOBACTER PYLORI
GASTRITIS
Endoscopy :- Normal /
mucosal nodules with erosion,
prominent mucosal folds
Increased (>25 lymphocytes/
100 epithelial cells) in
superfical, foveolar + lamina
propria
Antral prominent a/w celiac
disease ,corpus prominent a/w
H. pylori infection
EOSINOPHILIC GASTRITIS
MAG, allergic
granulomatosis, crohns
disease, food allergy,
Eustoma rotundatum,
connective tissue disorders
scleroderma,
polymyositis,,
Patchy intense infiltration
by sheets of eosinophlis
displacing mucosal glands
producing crypt abcesses
GASTRITIS IN
IMMUNOCOMPROMISED PATIENTS
CMV infection
HSV infection
MAI
Cryptosporidium
infection
REACTIVE GASTROPATHY
Reflux or Chemical gastritis,
Aspirin, NSAIDS, bile reflux, mucosal prolapse,
Mucosal edema with Foveolar hyperplasia with loss of mucin
& hyperchromatic nuclei in uninflammed biopsy
Glandular compartment normal,
Prepyloric region bile reflux
ACUTE EROSIVE GASTRITIS
Necrotic debris
Inflammatory infiltrate
Granulation tissue
REGENERATIVE ATYPIA
OR DYSPLASIA ?
GASTRIC POLYPS
GASTRIC POLYPS
Hamartomatous Hyperplastic &
Peutz - jeghers inflammatory polyps
syndrome Hyperplastic polyp
Juvenile polyp Fundic gland polyp
Cowden disease Inflammatory fibroid
polyp
Lymphoid hyperplasia
GASTRIC POLYPS
Neoplastic polyps Mucosal folds
Adenoma Giant folds (normal variant)
Carcinoma Zollinger ellison syndrome
Carcinoid Menetrier disease
Lymphomatous polyposis Malignant infiltration
Mesenchymal tumors
Peutz-Jeghars polyps
Childhood, adolescent
1-3 cm, coarsely
lobulated surface, short
& broad stalk
Smooth muscles
Juvenile polyps
Rounded smooth
surface, 1-2 cm, short
narrow stalk
Similar to inflammatory
colonic polyps
Exaggerated response to
mucosal damage chronic
gastritis
at junction of pyloric &
corpus mucosa, GE junction
Multiple, sessile, broad base
small, 0.5 2.5 cm
>2 cm , a/w malignancy
FUNDIC GLAND POLYP
Multiple (> 10), a/w
drugs for acid
suppression, FAP
Small, 1-15 mm,
Multiple - dysplasia
MC in antrum, sessile
Mucosal trauma
Overgrowth of loose
connective tissue
stroma, ulcerates
mucosa
Thin walled blood
vessels
Inflamm. cells
ENLARGED MUCOSAL FOLDS
Sessile,
Tubulovillous & villous
type
Gastric & intestinal
differentiation
Two layers dysplastic
epithelium on top,
nondysplastic cystically
dilated glands below.
Malignancy intestinal
type, >2cm
CARCINOMA OF STOMACH
Nodular. Polypoid,
ulcerated, plaque
like- diffuse
Intestinal
adenocarcinoma &
diffuse type, signet
ring cell ca.
CARCINOMA OF STOMACH
ENDOCRINE TUMORS
Type I pernicious anemia hypergastrinemia
ECL cell proliferation
Multiple mucosal nodules , (> 5 mm, invading submucosa -
neoplastic)
F>M; Body of stomach
Whipples disease
Abetalipoproteinemia
Agammaglobinemia
Collagenous colitis
WHIPPLES DISEASE
Diarrhea, malabsorption
Tropheryma whippeli
Lamina propria,
muscularis mucosae,
submucosa foamy
macrophages PAS
positive diastase
resistant bacilli
DD- 1.histoplasmasis
2. MAIC
ABETALIPOPROTEINEMIA
Lack of apoprotein B
Accumulation of
triglycerides in
enterocytes
tips of villi show
intracytoplasmic lipid
droplets
DD megaloblastic
anemia, CS, TS
AGAMMAGLOBULINEMIA
Absence of plasma cells
& lymphocytes,
COLLAGEN COLITIS
End stage of celiac sprue
Unresponsive to gluten free diet.
Total villous atrophy, subepithelial collagen
deposition
Uneven collagen distribution, multiple
biopsies
Biopsy: may have diagnostic value
(Patchy lesions)
Giardia lamblia
MC duodenum
Patchy villous atrophy
Trophozoites along
surface epithelium
Giemsa / trichrome
red organism
Stool examination,
ELISA, direct IF,
PARASITIC INFESTATIONS
Strongyloides
stercoralis
In duodenum, jejunum
In Mucosa eggs
rhabditiform larvae
Stool examination for
larvae
LYMPHANGIECTASIA
Dilatation of mucosal
submucosal subserosal
lymphatics
Protein losing enteropathy,
hypoalbuminemia, edema
Primary congenital
obstructive defects
Secondary retroperitoneal
fibrosis,pancreatitis,
malignancies
EOSINOPHILIC ENTERITIS
MC in children & young adults
Patchy Mucosal involvement malabsorption ,
diarrhoea; submucosa, muscularis propria
obstruction
1. Absence of associated other inflammatory cells
2. Focal mucosal architectural distortion crypt
abcesses,
3. Infiltration of muscularis mucosae
EOSINOPHILIC ENTERITIS
Causes
Parasites
IBD
NHL
a/w peripheral
eosinophilia
Never associated with
chronicity or
metaplastic changes
CROHN S DISEASE
caseation without
granulomas
LYMPHOMAS
IPSID (-chain dis.) :-
Special type of MALToma,
MC Ileum,
Solitory, polypoid,
ulcerative or infiltrative,
Thickened folds with small
nodules,
MC low grade,
Immune response to cont.
Ag stimulation
LYMPHOMAS
MALT Lymphoma :-
MC Ileum,
Same as gastric MALToma,
Lympho-epithelial lesions less common
Burkitts lymphoma :-
Sporadic,
Ileo-caecal inv.,
Medium, non-cleaved, monomorphic sized cells,
Round nuclei, multiple nucleioli & abundant
basophilic cytoplasm,
Starry-sky app.
Biopsy : Abnormal but
Not diagnostic
Celiac sprue
Tropical sprue
Protein energy malnutrition
(Kwashiorkor)
Folate deficiency
Vitamin B12 deficiency
Bacterial over growth syndrome
CELIAC SPRUE
Immunogenic injury d/t Gluten (wheat, rye, barley),
Type II adenovirus,
Severe in Proximal intestinal mucosa,
II I
Marsh Scoring
Hamartomatous polyp :-
Stomach, SI, Colon,
Solitory, 1-3 cm,
Sessile / pedunculated,
Normal glandular
epithelium resting on
branching smooth msl
(christmas tree app.),
POLYPS
Juvenile polyps :-
Children, adolescents,
MC Rectum,
Solitory,
Pedunculated, < 3 cm,
Glistening white, smooth,
With polyposis 15-30 %
dysplasia,
Cystic, tortuous, dilated
glands l/b mucin secreting
epi.
POLYPS
Inflammatory polyps :-
Amoebiasis, Adj to ulcers,
Anostomatic sites, UC, CD
raised mucosa,
Nodules of granulation
tissue,
Sec to mucosal prolapse in
ileum,
POLYPS
Angiogenic polyp :-
d/t angiogenic growth
factors by carcinoid
tumours,
Exuberant mucosal
polyposis = Cobble
stoning
Expanded villi +
intramucosal capillary
& fibromuscular
proliferation,
POLYPS
Inflammatory fibroid
polyp :-
Small intestine, stomach,
1.5 13 cm, broad based,
Polypoid,
Arises in submucosa,
extending to mucosa & MP,
Mesenchymal lesion =
inflam + vascular prolif.
POLYPS
Lymphoid polyp :-
Ileum with FAP coli &
Gardeners synd.
Multiple,
Lymphoid follicles in
mucosa & submucosa,
ADENOMATOUS POLYPS
Tubular adenoma :-
Less common,
Periampullary region,
Small pedunculated,
Single or multiple,
ADENOMATOUS POLYPS
Villous adenoma :-
Rectum & recto-sigmoid
colon,
Sessile, up to 10 cm,
Velvety cauliflower-like,
Tubulo-villous :-
Intermediate,
Intermixed pattern,
Risk of malignancy
villous component
NEOPLASTIC POLYPS
Adenocarcinoma :-
MC Duodenum (periampullary region),
a/w HNPCC, Crohns, Peutz-Jeghers synd.,
Polypoid, Napkin ring in distal tumours,
NEOPLASTIC POLYPS
CARCINOID :-
MC Ileum,
a/w Celiac dis, Crohns
dis, Inflammatory
polyps,
Multiple with intact
mucosa,
Bright yellow colored,
Clinicopathological Correlation
Endoscopist Pathologist