Level 2

Semester 4

 Module (GIT)
PRACTICAL FINAL REVISION GIT
Esophageal Varices

• Lower esophagus with

linear dark blue
submucosal dilated veins
known as varices.
• In cases with portal
hypertension (usually from
cirrhosis of the liver) the
submucosal esophageal
plexus of veins become
dilated (to form varices).
• These superficial varices
are prone to bleed.
Barrett’s esophagus

• Columnar-cell/intestinal
metaplasia with goblet
cells, above the
gastroesophageal
junction.
• The metaplasia results
from chronic
gastroesophageal reflux
disease (GERD).
Acute gastric ulcer

• The ulcer is shallow and

sharply demarcated,
with surrounding
hyperemia and erosions.
Helicobacter
Pylori Gastritis
• Spiral rod-shaped H. Pylori
bacteria are found at the
luminal surface epithelial
mucus.
• The rod-shaped bacteria are
seen stained with methylene
blue stain.
 Celiac Disease
A 27-year-old man has had a chronic diarrhea
with weight loss of 5 kg over the past year. On
physical examination there are no abnormal
findings. His d-xylose absorption is abnormally
low. He has elevated anti-endomysial and anti-
transglutaminase antibody titers. A jejunal
biopsy is performed and shown here in the right
panel (compared to the normal jejunum in the
left panel). He improves with a change in diet.
•
• Describe the microscopic picture.
 Celiac Disease
Normal Celia Disease
• Increased numbers of
lymphocytes
• Intraepithelial lymphocytosis,
crypt hyperplasia, and villous
atrophy
• Increased numbers of plasma
cells, mast cells, and eosinophils
Ulcerative Colitis
• A 32-year-old woman has a 10-year
history of intermittent, bloody diarrhea.
She has no other major medical
problems. On physical examination there
are no lesions palpable on digital rectal
examination, but a stool sample is
positive for occult blood. Colonoscopy
reveals a friable, erythematous mucosa
with focal ulceration that extends from
the rectum to the mid-transverse colon.
• Describe the gross picture
Ulcerative Colitis

• Describe the gross picture.

• Inflammation begins at recto sigmoid
colon and extends upward
• Inflammation tends to be continuous
along the mucosal surface and tends to
begin in the rectum.
• Inflammatory pseudopolyps.
• No skip lesions.
 Ulcerative
Colitis
• Mucosal mixed inflammation
with crypt distortion, crypt
abscesses, and superficial
mucosal ulceration.
• The glands demonstrate loss
of goblet cells and
hyperchromatic nuclei with
inflammatory atypia.
Ulcerative Colitis
• Mucosal acute and chronic
inflammation with crypt
abscesses, and inflammatory
pseudo-polyp formation.
• The submucosa shows intense
inflammation.
Chron’s Disease
• A 25-year-old man has noted cramping abdominal pain
for the past week associated with fever and low-volume
diarrhea. On physical examination, there is right lower
quadrant tenderness. Bowel sounds are present. His stool
is positive for occult blood. A colonoscopy reveals
mucosal edema and ulceration in the ascending colon,
but the transverse and descending portions of the colon
are not affected. Laboratory studies show serum anti-
Saccharomyces cerevisiae antibodies.
• Describe the gross picture.
Chron’s Disease
• Aphthous ulcer
• Multiple lesions elongated, serpentine ulcers oriented
along the axis of the bowel.
• Edema and loss of normal mucosal folds are common.
• Cobblestone appearance.
• Fissures
• Intestinal wall is thickened .
• Stricture formation.
 Chron’s Disease
• Describe the microscopic picture
• Abundant neutrophils
• Crypt abscess
• Ulceration
• Epithelial metaplasia
(pseudopyloric metaplasia or
Paneth cell metaplasia may occur in
the left colon)
• Mucosal atrophy
• Non-caseating granulomas
Macronodular cirrhosis
The liver is nodular, firm The
nodules seen here are larger than 3
mm and, hence, this is an example of
"macronodular" cirrhosis.

Viral hepatitis (B or C) is the most

common cause for macronodular
cirrhosis. Wilson's disease and
alpha-1-antitrypsin deficiency also
can produce a macronodular
cirrhosis
Micronodular cirrhosis
The regenerative nodules are quite
small, averaging less than 3 mm in
size. The most common cause for
this is chronic alcoholism. The
process of cirrhosis develops over
many years.

A close-up view of a micronodular

cirrhosis in a liver with fatty change
demonstrates the small, yellow
nodules
Acute pancreatitis
Acute necrotizing biliary
pancreatitis. The patient had history
of acute cholecystitis and
cholelithiasis. There is hemorrhagic,
black-brown necrosis of the
pancreatic parenchyma and
peripancreatic fat
Normal liver
Chronic hepatitis
A portal tract is expanded by a
predominantly mononuclear
cell infiltrate. Although the
limiting plate is intact along
most of its extent, there is
interface hepatitis(piece meal
necrosis )
Chronic Viral hepatitis
Lobular changes :A large pink cell
undergoing "ballooning
degeneration" is seen below the
right arrow. At a later stage, a dying
hepatocyte is seen shrinking down
to form an eosinophilic "councilman
body" below the arrow on the left
Liver cirrhosis
hepatic cirrhosis manifests with
diffuse nodularity separating the
parenchyma into regenerative
nodules. The fibrous septa contain
chronic inflammatory cell infiltrates
and a ductular reaction. The
distorted parenchymal architecture
also shows abnormal vasculature
due to hepatocyte damage and
scarring.
Liver cirrhosis
Micronodular cirrhosis is seen along
with moderate fatty change
(macrovesicular steatosis). Note
the regenerative nodule surrounded
by fibrous connective
tissue extending between portal
regions.
 Level 2
Semester 4

▪ Module (GIT)
Practical session (3)
GIT TUMORS
 Learning Outcomes
• Describe the gross features of selected GIT
tumors
• Describe the microscopic findings of some
selected examples of GIT tumors
 GIT tumors
Jars (gross pathology)
1. Squamous cell carcinoma
esophagus
2. Gastric carcinoma
3. Familial adenosis polypi
4. Cancer colon
Slides (microscopic pathology)
1. Well differentiated gastric
adenocarcinoma
2. Signet ring gastric
carcinoma
3. Moderately differentiated
adenocarcinoma colon
4. Poorly differentiated
adenocarcinoma colon
5. Mucinous carcinoma colon
Gross pathology
Squamous cell
carcinoma
oesophegus

Part of esophagus
showed
irregular reddish,
ulcerated
exophytic mid-
esophageal mass as
seen on the mucosal
surface
Gastric carcinoma
A diffuse infiltrative
gastric
adenocarcinoma
which gives the
stomach a shrunken
"leather bottle"
appearance
with extensive
mucosal erosion and
a markedly
thickened gastric wall
(linitis plastica )
Familial adenosis
polypi
• colonic mucosa
showed numerous
small polyps .
• a carpet of small
adenomatous
polyps
• There is a 100% risk
over time for
development of
adenocarcinoma,
Cancer colon
First photo : distal
colon opened to show
infiltrative irregular
firm mass
Second photo is
another example of
an adenocarcinoma of
colon. This cancer is
more exophytic in its
growth pattern
(irregular, firm , show
necrosis )
Microscopic picture
Well differentiated
adenocarcinoma –
stomach
Gastric tissue showed
malignant neoplastic
growth formed of
variable size and
shape acini lined by
malignant epithelium
showing
pleomorphism,
hyperchromatic nuclei
with low grade atypia
Signet ring
carcinoma –stomach
Gastric tissue
infiltrated by
malignant neoplastic
growth showing
malignant cells with
signet ring pattern in
which the cells are
filled with mucin
vacuoles that push the
nucleus to one side
Moderately
differentiated adeno
carcinoma –colon
Section in
rectosigmoid showing
malignant neoplastic
growth
There is still a
glandular
configuration, but the
glands are irregular
and very crowded.
Poorly differentiated
adeno carcinoma –
colon
Malignant neoplastic
growth showing
individual malignant
cells showing
pleomorphism ,
increase nuclear
cytoplasmic ratio,
prominent nucleoli
Mucinous carcinoma –
colon

Section in colon
revealed malignant
neoplastic growth
showing pools of
mucin with scattered
malign cells

In order to make this

diagnosis, at least 50%
of the tumour must be
made up of
extracellular mucin.