Escolar Documentos
Profissional Documentos
Cultura Documentos
Irianiwati
Department of Pathology
GMU, Yogyakarta
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ORAL PATHOLOGY
I. Diseases of the Mouth & Jaw
A. Congenital Disorders
B. Inflammatory disorders
C. Tumors and tumor-like conditions
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Inflammatory disorders
Oral candidiasis:
- local lesion, white, membranous, caused by Candida albican
- occurs most commonly in debilitated infants and children,
immunocompromized patient, and diabetics
- White plaques consisting of enmeshed fungal hypae
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Vesicles
Herpes labialis:
- most common lesion caused by HSV (HSV-1)
- tends to recur, with activation by febrile illness, trauma,
sunshine, menstruation
- vesiculation, ulceration of the oral mucosa
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Ulceration
Granulation process
Apthous stomatitis:
- Single/ multiple small ulcers in the oral mucosa
- painful, heal spontaneously after several days
-Tend to recurrent
-Microscopic: ulcer, granulation
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Lymphocytes
Tubercle epitheloid
Caseous necrosis
Tuberculosa
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hyperkeratosis
acanthosis
Leucoplakia:
- white patches of keratosis :
- premalignant lesion
- hyperkeratosis, hyperplasia of the squamous epithelium
- dysplastic changes
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Nests of epithelial tumor
Hydropic degenaration
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Dermoid cyst (mature teratoma):
ecodermal
Mesodermal
endodermal
Epidermoid cyst
Keratin mass
Epidermal layer
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lumen
Granulation tissue
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Diseases of the esophagus:
Tracheo-esophageal fistula
Heterotopic of gastric tissue
Esophageal diverticula
Achalasia
Esophageal varices
Hernia esophagus
Inflammatory disease
Barrets esophagus
Neoplasma of the esophagus
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Pleomorphic adenoma
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Tumor of salivary glands
Cylindroma/ adenoid cystic carcinoma
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Tracheoesophageal fistula
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III. Diseases of the Esophagus
A.1. Tracheoesophageal fistula
Congenital disorder, is suggested in a newborn by copious salivation associated with
choking, coughing, and cyanosis on attempts at food intake
The most common variant (90%), the lower portion of the esophagus communicates
With the trachea near the tracheal bifurcation, the upper esophagus ends in a blind
pouch
Associated abnormality: maternal polyhydramnion
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III. Diseases of the Esophagus
C. Achalasia
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III. Diseases of the Esophagus
D. Esophageal varices
-Localized dilatation of veins
-Portal hypertension
- cirrhosis hepatis
- Haematemesis
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Dilated veins in the mucosa and muscularis propria of the esophagus
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III. Diseases of the Esophagus
F. Inflammatory and related disorders
of the esophagus
1. Gastroesophageal reflux
2. Barrets esophagus
3. Candida esophagitis
4. Viral esophagitis
5. Esophageal stricture
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III. Diseases of the Esophagus
F. 1. Gastroesophageal reflux
Reflux of gastric acid contents into the esophagus esophagitis,
stricture, ulceration, or columnar metaplasia (Barrets esophagus)
Usually characterized by burning pain (often manifests by substernal
pain or heartburn) relieved by antacids
Associated:
- most commonly with hiatal hernia and incompetent lower
esophageal sphincter
- with excessive use of alcohol & tobacco, and with increased gastric
volume
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Reflux esophagitis: edema epithelial
leucocytes pmn and eosinoplilia
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III. Diseases of the Esophagus
F.2. BARRETS ESOPHAGUS
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Adenocarcinoma in barrets esophagus
Invasive to the cardia
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III. Diseases of the Esophagus
F. 3. Candida esophagitis
Etiology: Candida (Monilia) albicans
Manifest clinically by white adherent mucosal patches and
painful, difficult swallowing
Often assciated with:
- antibiotic therapy
- diabetes mellitus
- malignancy
- immunodeficiency
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III. Diseases of the Esophagus
F. 4.a. Viral esophagitis
Herpetic esophagitis
Characterized by painful and difficult swallowing
Tends to occur in immunosuppressed patient, caused
by HSV-1 infection
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III. Diseases of the Esophagus
F. 4.b. Other esophagitis
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III. Diseases of the Esophagus
F. 5. Esophageal stricture
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III. Diseases of the Esophagus
G. Carcinoma of the esophagus
Aggressive tumor manifest clinically by dysphagia, weight loss,
and anorexia, and occasionally by pain or hematemesis
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Squamous cell carcinoma of the esophagus
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III. Diseases of the Esophagus
G2. Adenocarcinoma
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Pathology of the
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I. Diseases of the Stomach
A. Congenital Pyloric Stenosis
B. Gastritis
C. Peptic Ulcer of the Stomach
D. Malignant Tumor of the Stomach
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I. Diseases of the Stomach
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I. Diseases of the Stomach
B. Gastritis: 1. Acute (erosive) gastritis
a. Causes
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Cigarette smoking
- heavy alcohol intake
- Burn injury (severe) Curling ulcer
- ingestion of strong acid or alkaline
b. Characteristic
- focal damage of mucosa with acute inflammation, necrosis,
and hemorrhage
- may be manifest as gastric ulcer often multiple
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Acute gastritis
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I. Diseases of the Stomach
B. Gastritis: 2. Chronic gastritis
- Helicobacter pylori associated gastritis
- gram neg. organism, in the surface
epithelium beneath the mucous barrier
- cells desquamation and lead to polymorph
and chronic inflammatory cells
- predominantly affects the anthrum
- most common form of gastritis
- often has increased gastric acid
- young adulthood and early middle age
- associated with gastric cancer
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HISTOLOGIC PICTURE OF CHRONIC
GASTRITIS
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ATROPHIC
GASTRITIS
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H.pylori
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H. PYLORY AND CHRONIC GASTRITIS
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OTHER GASTRITIS
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Menetrier disease (HYPERTROPHIC GASTROPATHY)
Severe hyperplasia of mucosal layer
cells + glandular atrophy extreme
enlargement of gastric rugae
Hypertrophic gastropathy + hyper-
secretion: mucosal cells, parietal and
chief cells hyperplasia.
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I. Diseases of the Stomach
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PEPTIC ULCER
Etiopathogenic mechanism:
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TRIGER FACTORS OF PEPTIC ULCER
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Cylindric epithelia
Necrotic debris
Glands hyperplasia
Edema
PEPTIC ULCER
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PEPTIC ULCER
Complications:
1. Bleeding
2. Perforation
3. Obstruction: due to Edema or cicatrix
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I. Diseases of the stomach
D. Tumors of the stomach (benign)
POLYP
Polypoid mass
>90% non neoplasm (inflammatory/ hyperplasia)
Sessile / pedunculated
20-25% multiple
Mostly occur in chronic gastritis
No malignant potential
ADENOMA
neoplasm 5-10% of gastric polyp
Sessile / pedunculated
distal anthrum predominant
Six decade, Male: female = 2:1
Some cases origin from chronic gastritis with intestinal
metaplasia
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hyperplastic polyp
Hyperplastic polyp
Peutz- jeghers
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I. Diseases of the stomach
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GASTRIC CANCER
Invasion
Early ( mucosa and sub- mucosa)
Advanced (invade the sub- mucosa)
Macroscopic growth
Exophytic
flat/ depressed
Excavation
Linitis plastica tumor cells diffusely infiltrate gastric wall
Histology
intestinal gland type
Diffuse: signet-ring cell
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The Growth of Gastric Cancer
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Other gastric tumors
MALIGNANT LYMPHOMA
40% malignant lymphoma of GIT
5% of gastric malignancy
B cell type predominant, MALT origin
CARCINOID TUMOR Carcinoid syndrome
Low grade malignancy
Metastasis to the liver
Multiple lesions
LEIOMYOMA
SECONDARY TUMORS (METASTASIS)
rare
Mostly from leukemia or general lymphoma
From breast / lung cancer diffuse linitis
plastica
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GASTRIC CARCINOMA
Prognosis:
Depend on the depth of tumor invasion
and metastasis process
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ULCUS CARCINOMATOSA
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Adenocarcinoma, NOS
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Diseases of the Intestine
A. CONGENITAL ABNORMALITIES
HERNIA
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Volvulus: rotation of the gut on its own mesenteric axis
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Invagination/ intususseption
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II. Diseases of the Small Intestine
A. Peptic Ulcer
B. Crohn Disease
C. Meckel Diverticulum
D. Malabsorption syndrome
E. Tumors of the Small Intestine
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II. Diseases of the Small Intestine
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II. Diseases of the Small Intestine
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II. Diseases of the Small Intestine
B. Crohns Disease
Chronic inflammatory condition of unknown etiology
Tends to affect young people in 2nd and 3rd decades of life
Occurs most frequently in Jewish descent
Cinical manifestations:
Abdominal pain and diarrhea
Malabsorption
Fever
Intestinal obstruction resulting from fibrous tissue
Fistulas: inter-intestine, between intestine bladder, vagina, skin
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II. Diseases of the Small Intestine
B. Crohns Disease
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Crohn Disease Ulcerative Colitis
May involve any portion of the gastrointestinal Affects only colon.
tract : ileocecal region, small intestine, colon.
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II. Diseases of the Small Intestine
C. Meckel Diverticulum
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II. Diseases of the Small Intestine
D. Malabsorption syndrome
Celiac Disease
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II. Diseases of the Small Intestine
D. Malabsorption syndrome
Disorders Morphologic Features Comments
Celiac disease Flat mucosal surface with marked Gluten sensitivity
villous atrophy
Tropical sprue Micros: no change abnormalities Probable infectious origin;
similar to those of celiac disease often respond to antibiotics
Whipple disease PAS+ macrophages in mucosal Most common: small intestine;
Tropheryma whippelii EM arthralgia, cardiac & neuro. S
Disaccharidase No characteristic histologic change Sited in brush border of
deficiency mucosal cell of small intestine;
Lactase def.milk intolerance
Abetalipoproteinemia No characteristic features in the in- Hereditary deficiency of apo-
testine; circulating acanthocytes protein-B
Intestinal Generalized dilatation of the small Marked gastrointestinal pro-
lymphangiectasia intestinal lymphatics tein loss hypoproteinemia
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Celiac disease: villous atrophy, crypt hyperthrophy, lymphocyte and plasma cells
infiltrates
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Tropical sprue
Partial villous athrophy
Inflammatory cells in the lamina propria
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II. Diseases of the Small Intestine
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Carcinoid; chromoganin positive
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The Spread of Tumor
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III. Diseases of the Colon
A. Hirschprung disease
B. Diverticula
C. Vascular diseases of the colon
D. Inflammatory disorders of the colon
E. Tumors
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III. Diseases of the Colon
A. Hirschprung disease
Dilatation of colon due to the absence of ganglion cells
of the submucosal and myenteric neural plexuses
Dilatation is proximal to aganglionic segment
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Aganglionic colon
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III. Diseases of the Colon
B. Diverticula
Most common in old person, and almost always multiple
Most frequently involve the sigmoid colon
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Diverticulosis of the Sygmoid
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III. Diseases of the Colon
-results in mucosal, mural, and trans mural infarction involving the wall of the intestine
-is almost always caused by arteriosclerotic occlusion (at least 2 of the major mesen-
teric vessels)
-most often affects the splenic flexures and rectosigmoid junction (watershed areas)
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Ischemic bowel disease
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III. Diseases of the Colon
D. Inflammatory disorders of the colon
Ulcerative Colitis
Often grouped with Crohn disease as inflammatory bowel disease; unknown
etiology; similar geographic & racial distribution family history; similar
extraintestinal manifestation: polyarthritis, uveitis & episcleritis, sclerosing
cholangitis, sacroiliitis, skin: erythema nodosum and pyoderma gangrenosum
Characteristics
- mucosal inflammation & ulceration limited to the large intestine
- confined to the mucosa & submucosa crypt abscess
- red, granular appearance of the mucosa
- pseudopolyp
- chronic diarrhea with passage of blood & mucus (bleeding is the most frequent
clinical manifestation)
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Ulcerative Colitis
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ENTERITIS TUBERCULOSA
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III. Diseases of the Colon: E. Tumors: Polyps
Type Comments
Non-neoplastic polyps
Hyperplastic polyp No clinical significance
Inflammatory polyp
- Lymphoid polyp Rectal mucosa; may be reactive
- Inflammatory pseudopolyp @ ulcerative colitis and others, granulation tissue
Hamartomatous polyp
- Juvenile polyp Most frequently in children
- Peutz-Jeghers polyp @ Peutz-Jeghers syndrome
Neoplastic polyps
Tubular adenoma Often multiple (hereditary multiple polyposis
syndrome) increased risk of malignancy
Tubulovillous adenoma Greater malignant potential
Villous adenoma High potential for malignant change
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Familial Adenomatous Polyposis
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Adenomatous polyp
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III. Diseases of the Colon: E. Tumors: adenocarcinoma
One of the most common neoplasm of the intestine
Peak age incidence: 6th 7th decades
Associated with increased CEA (carcinoembryonic antigen) to
follow the course of the disease
Develops through model of: adenoma carcinoma sequence
Predisposing factors:
1. Adenomatous polyp
2. Inherited multiple polyposis syndrome
3. Long-standing ulcerative colitis
4. Genetic factors: 4X increase of incidence among relatives of the cancer patients
5. A low fiber, high animal fat diet
Characteristics:
- left colon napkin-ring (annular) often producing early obstruction
- right colon polypoid chronic blood loss anemia
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Dukes Stage
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ASTLER - COLLER
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In the earliest histologic lesions, atypical
lymphoid cells may be seen infiltrating the
mucosa, with effacement and loss of
glands and massive expansion of
lymphoid tissue
monotonous infiltrate of malignant cells,
consisting of a mixture of small
lymphocytes and immunoblasts in varying
proportions
Most gut lymphomas are of B-cell type
(over 95%)
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IV. Diseases of the Appendix
A.Inflammatory diseases
1. Acute appendicitis
2. Chronic appendicitis
CHRONIC APENDICITIS