Neoplasma Sistem Gastrointestinal

Bagian Patologi Anatomi FK. UNISSULA Modul Pencernaan 2007

Esophageal squamous cell carcinoma, gross [ENDOSCOPY

This irregular reddish, ulcerated exophytic mid-esophageal mass as seen on the mucosal surface is a squamous cell carcinoma. Endoscopic views of an ulcerated mid-esophageal squamous cell carcinoma causing lumenal stenosis are seen below. Risk factors for esophageal squamous carcinoma include mainly smoking and alcoholism in the U.S. In other parts of the world dietary factors may play a role.

Esophageal squamous cell carcinoma, high power microscopic

At high power, these infiltrating nests of neoplastic cells have abundant pink cytoplasm and distinct cell borders typical for squamous cell carcinoma. Esophageal carcinomas are not usually detected early and, therefore, have a very poor prognosis.

Gastric adenocarcinoma, linitis plastica type, gross

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

Gastric adenocarcinoma, medium power microscopic

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

Gastric adenocarcinoma, low power microscopic

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.

Gastric adenocarcinoma, high power microscopic [IPX

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.

Gastric adenocarcinoma, signet ring pattern, high power microscopic

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.

Carcinoid tumor of small intestine, low power microscopic

The carcinoid tumor is seen here to be a discreet, though not encapsulated, mass of multiple nests of small blue cells in the submucosa

Carcinoid tumor of small intestine, high power microscopic

At high magnification, the nests of carcinoid tumor have a typical endocrine appearance with small round cells having small round nuclei and pink to pale blue cytoplasm. Rarely, a malignant carcinoid tumor can occur as a large bulky mass. Metastatic carcinoid to the liver can rarely result in the carcinoid syndrome.

Colon, adenomatous polyp (tubular adenoma), gross [ENDOSCOPY]

A small adenomatous polyp (tubular adenoma) is seen here. This lesion is called a "tubular adenoma" because of the rounded nature of the neoplastic glands that form it. It has smooth surfaces and is discreet. Such lesions are common in adults. Small ones are virtually always benign. Those larger than 2 cm carry a much greater risk for development of a carcinoma, having collected mutations in APC, DCC, K-ras, and p53 genes over the years. The colonoscopic appearance of rectal polyps that proved to be tubular adenomas are seen below

Colon, adenomatous polyp (tubular adenoma) , low power microscopic [ENDOSCOPY]

This small adenomatous polyp (tubular adenoma) on a small stalk is seen microscopically to have more crowded, disorganized glands than the normal underlying colonic mucosa. Goblet cells are less numerous and the cells lining the glands of the polyp have hyperchromatic nuclei. However, it is still well-differentiated and circumscribed, without invasion of the stalk, and is benign. Two colonoscopic views of a small polyp that proved to be a tubular adenoma is seen below.

Colon, familial adenomatous polyposis , gross

This is familial polyposis in which the mucosal surface of the colon is essentially a carpet of small adenomatous polyps. Of course, even though they are small now, there is a 100% risk over time for development of adenocarcinoma, so a total colectomy is done, generally before age 20.

Colon, adenomatous polyp (tubular adenoma) compared to normal mucosa, medium power microscopic

A microscopic comparison of normal colonic mucosa on the left and that of an adenomatous polyp (tubular adenoma) on the right is seen here. The neoplastic glands are more irregular with darker (hyperchromatic) and more crowded nuclei. This neoplasm is benign and well-differentiated, as it still closely resembles the normal colonic structure

Colon, villous adenoma, composite gross [ENDOSCOPY

The gross appearance of a villous adenoma is shown above the surface at the left, and in cross section at the right. Note that this type of adenoma is sessile, rather than pedunculated, and larger than a tubular adenoma (adenomatous polyp). A villous adenoma averages several centimeters in diameter, and may be up to 10 cm. On colonoscopy, a sessile polyp is seen below.

Colon, villous adenoma, composite low power microscopic

Microscopically, a villous adenoma is shown at its edge on the left, and projecting above the basement membrane at the right. The cauliflower-like appearance is due to the elongated glandular structures covered by dysplastic epithelium. Though villous adenomas are less common than adenomatous polyps, they are much more likely to have invasive carcinoma in them (about 40% of villous adenomas).

Colon, adenocarcinoma, gross [XRAY][ENDOSCOPY]

An encircling adenocarcinoma of the rectosigmoid region is seen here. There is a heaped up margin of tumor at each side with a central area of ulceration. This produces the bleeding that allows detection through a stool guaiac test. Normal mucosa appears at the right. The tumor encircles the colon and infiltrates into the wall. Staging is based upon the degree of invasion into and through the wall. The colonoscopic views of a smaller rectal adenocarcinoma, but still with an ulcerated surface, are shown below.

Colon, adenocarcinoma, low power microscopic

The edge of the carcinoma arising in the villous adenoma is seen here. The neoplastic glands are long and frond-like, similar to those seen in a villous adenoma. The growth is primarily exophytic (outward into the lumen) and invasion is not seen at this point. Grading and staging of the tumor is done by the surgical pathologist who will examine multiple histologic sections of the tumor

Colon, adenocarcinoma, medium power microscopic

Microscopically, a moderately differentiated adenocarcinoma of colon is seen here. There is still a glandular configuration, but the glands are irregular and very crowded. Many of them have lumens containing bluish mucin.

Colon, adenocarcinoma, medium power microscopic

Here is an adenocarcinoma in which the glands are much larger and filled with necrotic debris.

Colon, adenocarcinoma, high power microscopic [IPX]

At high magnification, the neoplastic glands of adenocarcinoma have crowded nuclei with hyperchromatism and pleomorphism. No normal goblet cells are seen.