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Dr/ ABD ALLAH NAZEER. MD.
of gastric pathology.
Normal gross anatomy.
Normal volume is 1.5 liters, capacity is 3 liters, potentially more.
● Fine mosaic-like pattern of mucosa because of punctuations by gastric pits or
● Longitudinal infoldings of mucosa and submucosa known as rugae are coarser
proximally and when stomach is empty.
Cardia: Narrow conical portion distal to gstroesophageal junction
● Many authors claim that cardiac mucosa is reflux-associated epithelia and not
● Of note in the AJCC Cancer Staging Manual, 7th Edition (2010), carcinomas of the
esophagus and esophagogastric junction (the proximal 5 cm of the stomach) are
Fundus: ● Dome shaped proximal stomach
Body/corpus: ● Remainder of stomach to incisura angularis
Incisura angularis: Where stomach narrows before it joins duodenum
Antrum: Incisura angularis to pyloric sphincter (3-4 cm)
Pylorus: Muscular ring that controls flow of food content into proximal duodenum
Lesser curvature: Medial curvature of stomach on the right
Greater curvature: Lateral curvature of stomach.
Neuroendocrine tumors: classification NET G1/carcinoid large cell
neuroendocrine small cell
Carcinoma: general WHO
classification intestinal diffuse intramucosal GE
junction adenosquamous amphicrine hepatoid lymphoepithelioma-
like oncocytic Paneth cell rhabdoid sarcomatoid squamous cell
Lymphoma: general lymphoid hyperplasia anaplastic large cell diffuse
large B cell Hodgkin’s MALT mantle cell T cell
Stromal / other tumors: adenosarcoma alveolar soft parts
sarcoma choriocarcinoma elastofibroma follicular dendritic cell
sarcoma GANT GIST glomus granular cell Langerhans’ cell
histiocytosis leiomyoma lipoma malignant fibrous
histiocytoma metastases to stomach schwannoma synovial
Miscellaneous: staging-general staging-GIST staging-
neuroendocrine grossing specimens features to report histologic
Non-neoplastic anomalies: achalasia
of cardia arteriovenous
hernia gastric dilation gastric gland
metaplasia mucolipidosis pyloric
Congenital anomalies of the stomach
Children with hypertrophic pyloric stenosis may show gastric distension prominent,
peristaltic waves (caterpillar sign), and mottled retained gastric content.
A upper gastrointestinal series (barium meal) excludes other, more serious causes of
pathology, but the findings of a UGI series infer rather than directly visualize the
Plain film (abdominal radiograph): Non specific and may show a distended
stomach with minimal distal intestinal bowel gas.
Ultrasound: Ultrasound is usually the primary imaging modality 3, and its
advantages over a barium meal are that it directly visualizes the pyloric muscle and
does not use ionizing radiation. Unfortunately it is incapable of excluding other
diagnoses such as midgut volvulus.
The hypertrophied muscle is hypoechoic, and the central mucosa is hyperechoic. There
are measurement criteria that vary slightly from source to source. In a normal
situation, the pyloric muscle thickness (diameter of a single muscular wall on a
transverse image) should normally be less than 3 mm (most accurate 3) and the length
(longitudinal measurement) should not exceed 15 mm.
With the patient right side down the pylorus should be watched and should not be
seen to open.
Described sonographic signs include: antral nipple sign, cervix sign, target sign
Barium meals demonstrate delayed gastric emptying.
When some contrast does pass into the duodenum, the
pylorus appears elongated with a narrow lumen (string
sign) which may appear duplicated due to puckering of
the mucosa (double-track sign). The pylorus indents the
contrast-filled antrum (shoulder sign) or base of the
duodenal bulb (mushroom sign). Additionally the entrance
to the pylorus may be beak-shaped (beak sign).
Described barium signs include: