Figure 17.2 Meckel diverticulum.

The blind pouch is located on the

antimesenteric side of the small bowel.
 A B

(A) Preoperative barium enema study

Figure 17.3 Hirschsprung disease.
and dilated sigmoid
showing constricted rectum (bottom of the image)
showing constricted
colon. (B) Corresponding intraoperative photograph Dr. Aliya Husain, I he
rectum and dilation of the sigmoid colon. (Courtesy
University of Chicago, Chicago, 11.)
 B

C
with multiple,
Postmortem specimen
17.4 Viral esophagitis. (A) Multinucleate
gure the distal esophagus. (B)
overlapping herpetic ulcers in nuclear inclusions.
()
cells containing herpesvirus and cytoplasmic
uamous cells with
nuclear
endothelial
omegalovirus-infected

Inclusions.

romal çells (Fig.

 A

B
reflux esophagitis with
Figure 17.5 Esophagitis. (A) Endoscopic view of
a metaplastic zone
muitiple erosions within the squamous-lined esophagus, mucosa. Note the
5arrett esophagus, discussed later), and distal gastric
tanislands of metaplastic epithelium within the white squamous
mucosa.

is
n e feline" or "ringed" endoscopic appearance S. esophagus and
of the

pIcal of eosinophilic esophagitis. (Courtesy Dr. Linda Lee, Brigham

Women's Hospital and Harvard Medical School, Boston, Mass.)
 W
of
in
se

B
A

a
Figure 17.7 Esophageal varices. (A) Although no longer used as a
lgnostic approach, this angiogram demonstrates several tortuous
ophageal varices. (B) Collapsed varices are present in this postmortem
pECimen corresponding to the angiogram in (A).The polypoid areas
present previous sites of variceal hemorrhage that have been ligated
th bands. (C) Dilated varices beneath intact squamous mucosa.
 B

junction.
Normal gastroesophageal
igure I7.8 Barrett esophagus. (A) islands of residual pale squamous
5) Barrett esophagus. Note the small of the
within the Barrett (C) Histologic appearance
mucosa.
mucosa Note the transition
Barrett esophagus.
4uroesophageal junction in with
squamous mucosa (left)
and Barrett metaplasia,
oeLween esophageal
abundant metaplastic goblet cells (right).
 A B
Figure 17.10 Esophageal cancer. (A) Adenocarcinoma usually occurs
distally and, as in this case, often involves the gastric cardia. (B) Squamous
e carcinoma is most frequently found in the mid-esophagus, where it
Commonly causes strictures.
 n g with free

Figure 7.15 Acute gastric perforationin a patient (B) The

prdes.
air under the diaphragm. (A) Mucosal defect with clea
clean edges. (B)
necrotic ulcer base is composed of granulation
tissu
A

folds

Figure 17.16 Ménétrier disease. (A) Marked Ypertrophy of rugalfols

(B) Foveolar hyperplasia with hypertropny lands
elongated and focally dilated glai
(Courtesy Dr. M. Kay Washington, Vanderbilt enn)

Ten
University, Na
A

adenocarcinoma
Figure 17.18 Gastric adenocarcinoma. (A) Intestinal-type
and central
consisting of an elevated mass with heaped-up borders
Infiltrative
ulceration. Compare to the peptic ulcer in Fig. 17.15A. (B) type
(linitis plastica) gastric cancer. The gastric wall is markedly thickened, and
rugal folds are partially lost, but there is no dominant mass.
n

Figure 17.20 Lymphoma. (A) Gastric mucosa-associated lymphoid tissue

lymphoma replacing much of the gastric epithelium. Inset shows
lymphoepithelial lesions with neoplastic lymphocytes surrounding and
infiltratinggastric glands. (B) Disseminated lymphoma within the small
intestinewith numerous small serosal nodules. (C) Large B-cell lymphoma
infiltratingthe small intestinal wall and producing diffuse thickening.
CHAPTER 17

D
Figure 17.21 Neuroendocrine tumor
(carcinoid tumor). (A) Gross cross section of a submucosal tumor nodule. (B) Microscopical
composed of tumor cells embedded in dense
fibrous tissue. (C) In other areas the tumor has
(D) High magnification shows the
characteristically
bland cytology. The chromatin spread
extensively wi
andpepper pattern. LDespite their texture, with fine and coarse clumps, id ntly
innocuous appearance, these
core neurosecretorY granules. tumors can be clinicallv acgressive. (E) Electron microsCOPy
eva
 i n c a r c e r a t e d within

Figure 17.24 Intestinal obstruction. Portion of bowel incar rrhage

hernia. Note of and associated

an inguinal dusky areas serosa

that indicate ischemic damage.

 A

Figure 17.25 lschemic bowel disease. reseccion with dusky serosa of acute ischemia
(A) Jejunal (mesentericthrombosis), (B) Mucosaisdarkcolore
(D) Chronic colonic ischemia WIn
Decause of
hemorrhage. (C) Characteristic attenuated villous epithelium in this case of acute mesenteric thrombosis.
atrophic surface epithelium and fibrotic lamina propria.

encies (e e.acute appendicitis, an

perforated ulcer,atio
 Vo

colitis. (A) The

I7.30 Clostridioides (formerly Clostridium) difficile
Figure composed of neutrophils, dead
tan pseudomembranes
colon is coated by view). (B)
inflammatory debris (endoscopic
epithelial cells, and on gross
examination. (C) Typica
Pseudomembranes are easily appreciated
is reminiscent of
emanating from a damaged crypt
pattern of neutrophils
volcanic eruption.
 B

Figure 17.34 Gross pathology of Crohn disease. (A) Small intestinal

uiCture. (B) Linear mucosal
appearance to the ulcers, which impart a
mucosa, and thickened cobblestone
and associated serositis. intestinal wall. (C) Perforation
(D) Creeping fat.

frequently develan nan

 Small intestine and colon 803

A D

6 Gross pathology of ulcerative colitis. (A) Total colectomy with pancolitis showing active disease,W
and
colitis (rignt)
oon, atrophic distally
mucosa (right). (B) Sharp demarcation between active ulcerative o
dmatory polyps. (D) Mucosal bridges can join inflammatory polypS.
 MAAON

Figure 17.40 Sigmoid diverticular disease. (A) Stool-flled diverticuiaait

regularly arranged. (B) Cross section showing the outpouching of n
through the muscularis propria. (C) Low-power photomicrograp
SIgmoid diverticulum showing protrusion of the mucosa througu
muscularis propria.
 B
11.45 Colonic adenoma Low-gu

(endoscopic view). (B) Adenoma with velvety surtace.()

a
redunculated adenoma
gaph of a
pedunculated tubular adenoma.
 ,

igure 17.48 Familial adenomatous polyposis. (A) Hundreds of small

polyps are present dominant polyp (rignt)
BThree nt throughout this colon with a
Tield.
present in this single microscopic
ddenomas are

Some poln
 A B.
Figure I7.5I Colorectal carcinoma. (A)
Circumferential, ulcerated rectal
cancer. Note the anal mucosa at the bottom of the
the sigmoid colon that has invaded
image. (B) Cancer of
through the muscularis propria and is
present within subserosal adipose tissue (left). Areas of chalky necrosis are
present within the colon wall (arrow).
 TE

igure 17.53 Metastatic colorectal carcinoma. (A) Lymph node

astasis, Note the glandular structures within the subcapsular sinus. (
itary subpleural nodule of colorectal carcinoma metastatic to the lung
C) Liver contain two and smaller metastases. Note the
s aining
central
large many
necrosis within metastases.

Tanges fwo 1 rates