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General
• Definite ca leziuni ale mucoasei si inflamatie
• 10-20% incidenta in USA, incidenta crescuta in
N Iran si China.
• Cea mai frecventa cauza – esofagita de reflux
(reflux continutului gastric in esofagul inferior)
• Alte cauze: intubatie gastrica prelungita
• Uremie
• Ingestia de subst corozive sau iritante
• Chimioterapie si radiatii
• Modificarile histologice pot fi severe sau
(eroziune, ulcer) sau discrete
Esofag normal
Esofagita de reflux
• Scade secretia de
mucus
• Marcat pleomorfism
• Stratificare nucleara
• Frecvente mitoze
• Arhitectura nu se
pastreaza
Carcinoamele esofagiene
• Cele mai frecvente:
• Cc scuamos
• Adenocarcinomul
Micro:
• moderata: edem moderat in lamina propria,
congestie vasculara minima, cateva neutrofile
• severa: eroziune si hemoragie in mucoasa
•
• Not risk factors: alcohol, antacids,
occupational exposure
• Micro: neoplastic intestinal glands
resembling colonic adenocarcinoma;
contain apical mucin vacuoles; variable
calcification, endocrine cells, rare Paneth
cells
• Well differentiated: columnar cells that
secrete mucin, rarely are ciliated
• Poorly differentiated: solid pattern
• Positive stains: acid mucins (Alcian Blue,
colloidal iron), p53 (usually)
Early gastric
adenocarcinoma
The adenocarcinoma is
small and confined to
the gastric mucosa.
Ulcerated adenocarcenoma. A yellow arrow points to malignant glandular structure with intestinal
features.
The tumor are cells arranged in variable sized glands; some of the glands show papillary projections,
others are branching. In their lumen, necrotic debris and nuclear fragments are frequently present.
Note invasion of the muscle layer.
Microscopically, invading adenocarcinoma can be seen here. Normal gastric epithelium at the left merges
with the carcinoma at the right, and irregular neoplastic glands infiltrate downward into the submucosa.
A moderately differentiated gastric adenocarcinoma is infiltrating up and into the submucosa below the
squamous mucosa of the esophagus. The neoplastic glands are variably sized.
At higher magnification, the neoplastic glands of gastric adenocarcinoma demonstrate mitoses, increased
nuclear/cytoplasmic ratios, and hyperchromatism. There is a desmoplastic stromal reaction to the
infiltrating glands.
Diffuse type adenocarcinoma
• Infiltrative growth of poorly differentiated discohesive malignant
cells
• Aka linitis plastica or signet ring adenocarcinoma
• Mean age 48, M=F; more common in gastric cancers in the
young
• No reduction in incidence over past 50 years
• Appears to arise without dysplastic precursor, possibly through
primary involvement of genes affecting cell-cell and cell-matrix
junctional proteins
• No known risk factors
• Linitis plastica: broad region of gastric wall or entire stomach
is extensively infiltrated by malignancy, creating a thickened,
rigid, leather bottle-like stomach; may cause pyloric obstruction
•
Linitis plastica
The wall of the stomach is thickened and rubbery hard due to an extensive infiltration with signet
ring cells.
Stomach carcinoma, linnitus plastica type. A yellow arrow denotes a thickened wall.
The mucosa has areas of hemorrhage, but is without a mass.
Gastric Carcinoma, linnitus plastica type -- A purple arrow points out a white, thickened wall, representing
diffuse infiltrating carcinoma. Grossly the stomach usually has a "leather bottle" appearance. The yellow
arrow points to uninvolved 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. This type of carcinoma has a very poor prognosis. The endoscopic view of this
lesion is shown below, with extensive mucosal erosion.
This cancer presented in a 40-year-old woman complaining of abdominal pain. Endoscopically it was a
"very suspicious" ulcer. Biopsy showed diffusely infiltrating signet ring cell adenocarcinoma. These are
gross photos of the subtotal gastrectomy specimen. The photo above is asen face view of the ulcer. The
pyloric margin is to the left. The ulcer is on the lesser curvature.
• Micro: gastric-type mucus cells, usually do
NOT form glands, infiltrate as individual cells
or small clusters, may be transmural; appear to
arise from middle layer of mucosa; intestinal
metaplasia usually not present; numerous
signet ring cells seen (mucin pushes nucleus
to periphery); submucosal fibrosis present,
variable mucosal ulceration; hypertrophic
muscularis propria; may have marked
desmoplastic and inflammatory reaction.
• Positive stains: mucicarmine, Alcian
blue-PAS, CEA, EMA, keratin, villin.
• Negative stains: TTF-1, p53 (usually).
• DD: metastases from breast, lung;
reactive epithelial atypia associated with
chemotherapy or otherwise; xanthoma;
lymphoma with artifactual signet ring cells
due to cytoplasmic shrinkage.
Gastric carcinoma, signet ring cell type. Yellow arrows points to a classic "signet ring " cells. This is a
large round cell with clear mucinous cytoplasm that causes the nucleus to be pushed to the edge of the
cell. One cell is circled in yellow.
At high power, this gastric adenocarcinoma is so poorly differentiated that glands are not visible. Instead,
rows of infiltrating neoplastic cells with marked pleomorphism are seen. Many of the neoplastic cells have
clear vacuoles of mucin.
This is a signet ring cell pattern of adenocarcinoma in which the cells are filled
with mucin vacuoles that push the nucleus to one side, as shown at the arrow.
Higher magnification shows the fairly uniform tumor cells with abundant intracytoplasmic mucin which pushes the
nuclei to the side, giving the cells their typical "signet-ring" appearance