Gastric polyps and tumors can be benign or malignant. Benign polyps include hyperplastic, fundic gland, and juvenile polyps. Rare polyp syndromes like Peutz-Jeghers syndrome and familial adenomatous polyposis can increase cancer risk. Gastric adenomas have a risk of malignancy depending on size and histology. Gastric carcinomas are usually adenocarcinomas and can be intestinal or diffuse type. Early detection of gastric cancer improves prognosis. Precancerous conditions include chronic gastritis and intestinal metaplasia.
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
Sites of the highest risk are the duodenum, for adenocarcinomas, and the ileum, for carcinoids and lymphomas.
In industrialized countries, small bowel cancers are predominantly adenocarcinomas;
In developing countries, lymphomas are much more common.
The incidence of small bowel cancer rises with age and has generally been higher among males than among females.
The risk factors for small bowel cancer include
Dietary factor
Cigarette smoking,
Alcohol intake,
Medical conditions -Crohn's disease, familial adenomatous polyposis, cholecystectomy, peptic ulcer disease, and cystic fibrosis.
The protective factors may include rapid cell turnover, a general absence of bacteria, an alkaline environment, and low levels of activating enzymes of precarcinogens.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
3. Introduction
• Gastric polyps are defined as luminal lesions
projecting above the plane of the mucosal
surface
• Develop as a result of epithelial/stromal cell
hyperplasia, inflammation, ectopia or neoplasia
• A gastric polyp has the potential to become
cancerous – most will remain benign but in a
minority of cases it will progress into cancer
4. Classification
• Enlarged Mucosal folds are also included because there
is some clinical overlap between prominent folds and
polyposis
• Although histologic examination is the key to differential
diagnosis, much practical diagnostic help can also be
obtained by determining
▫ If a biopsy comes from a discrete polyp / from a prominent
mucosal fold
▫ Whether a polyp is sessile/pedunculated
▫ Whether polyps are present in other parts of GI tract
▫ Whether the surrounding mucosa is normal
5.
6. Peutz-Jeghers Syndrome
• Also known as Hereditory Intestinal Polyposis Syndrome
• Autosomal dominant genetic disease, characterised by
development of hamartomatous polyps in GI tract and
hyperpigmented macules on the lips and oral mucosa
• Caused by : Mutation of the serine/ threonine kinase
gene(STK11/LKB1)
• Commonly present in childhood / adolescence
• Size : 1-3 cms.
• Surface : Coarsely lobulated with short, broad stalk
7. • Histologically :
▫ The most useful diagnostic feature is : presence of a
core of finely arborizing branches of smooth muscle
from muscularis mucosae
▫ The core is covered with abundant mucosa, identical
with that of stomach, but often disorganized.
▫ Predominantly, consist of surface and foveolar
epithelium, although occasional antral glands and
small cysts may be found
▫ Inflammation is usually not prominent
▫ Low risk of developing into carcinoma
8. A 21-year-old female was referred to the
department of surgery as an emergency
with the complaints of abdominal pain and
bilious vomiting for the past 14 days
F/H : Similar lesions in family
G/E : mucocutaneous macules noted on
lips
On Operating table, intussusception of the
bowel was seen. A firm mass was palpable
in the lumen of the bowel. A segmental
resection was done as the mass was
completely obstructing the lumen and a
polypoidal mass was found. It was sent for
histopathological examination.
9. Fig 1(Left Upper) : Note the
arborizing smooth muscle
architecture unique to PJS-type
polyp
Fig : 2 (Rt Lower) : Low power
microscopic view of a PJS-type
polyp with pseudo-invasion
10. Juvenile Polyps
• Also called retention polyp
• Surface : Rounded, smooth-surfaced lesion
• Size : 1-2 cm in diameter
• Occurs due to mutation of SMAD4
gene(chromosome 18) / PTEN
gene(chromosome 10)
11. • Histologically :
▫ Consists of principally lamina propria which contains
irregularly shaped cysts lined by normal gastric
epithelium
▫ Repeated episodes of torsion may produce stromal
hemorrhage, surface ulceration, and secondary
chronic inflammation
• Small, but definite risk of colorectal cancer & gastric
cancer with patient with juvenile polyposis
12. Hyperplastic Polyps
• Also called regenerative/ hyperplaseogenous polyp
• Common in both children & adults(Most common
b/w 5th & 6th decade)
• Occurs mostly at junction of pyloric & corpus
mucosa
• Multiple, avg. size 1.4 cms
• Surface : coarsely lobulated
• Small polyp : Sessile, Large : short, broad stalk
13. • Presumed histiogenesis : Exagerrated
regenerative response to mucosal damage
• Adjacent non polypoid mucosa shows chronic
atrophic gastritis
• Rarely undergo malignant change(2%)
• Malignant change confined to lesions greater
than 2cms
14. • Histologically
▫ Elongated, distorted & branched gastric foveolae
▫ Often abundant lamina propria, which may be
inflammed & edematous
▫ Frequently foveolar cells are hypertrophic with excess
superficial cytoplasm with/without intestinal
metaplasia
▫ Nuclei are typically bland(resemble normal gastric
pit) but in areas of heavy inflammation , regeneration
can produce nuclear enlargement with prominent
nucleoli
16. Fig A : Hyperplastic Polyp showing cork screw shaped
foveolar gland
Fig B : Polyp with Ulceration
17. Fundic Gland Polyp
• Accounts for 50% of all gastric polyps
• Occur as isolated sporadic lesion that are usually of
little clinical significance
• However, fundic gland polyposis(10 or more polyps)
has been described in two clinical situations
▫ Following drug therapy for gastric acid suppression
▫ In Familial adenomatous polyposis(FAP) where many
hundred’s of polyp are present
18. • In FAP
▫ The polyps are true neoplastic lesions, showing
mutation in APC gene
▫ 25-50% prevalence of dysplasia in the foveolar
epithelium
▫ May rarely give rise to adenocarcinoma
19. • In sporadic & drug therapy related polyps
▫ They are non dysplastic
▫ Do not show APC mutation
▫ May have point mutation of beta-catenin
(CTNNB1) gene
20. • Macroscopically : Minute mucosal bumps : 1-
16mm in diameter, occur in gastric body &
fundus
• Microscopically :
▫ Single/ small groups of cystically dilated fundic
glands, lined by attenuated but otherwise normal
layer of chief cells, parietal cells & mucous neck
cells
▫ Inflammation is typically minimal/ absent
21. Consists of dilated gland lined by an attenuated , but otherwise normal epithelium
22. Adenomas
• Comprise 7-10 % of all gastric polyps
• Most are sessile & grow in tubulo villous / pure villous pattern
• Pure pedunculated tubular lesions are rare
• Usually Solitary lesions < 2cms
• Histologically : Two types of lesion
▫ Adenomas showing intestinal differentiation(goblet cells &/or
paneth cells)
▫ Adenomas showing gastric differentiation(columnar cells
containing neutral mucin)
23. • Polyps larger than 2cms & those with intestinal
differentiation have significant chance of becoming
malignant(Overall, carcinoma may be present upto
30% of gastric adenomas)
• Adenomas
▫ With intestinal differentiation , arise in background
mucosa that shows intestinal metaplasia
▫ With gastric differentiation , arise in mucosa that is
either normal/shows minor inflammatory feature
24. • By definition, all GI adenomas have epithelial dysplasia
that is classified as low/high grade
• Both grades include :
▫ Enlargement, elongation & hyperchromasia of epithelial
cell nuclei
▫ Epithelial crowding
▫ Pseudostratification
• High grade dysplasia includes more cytologic atypia with
irregular artitecture, including glandular budding &
gland within gland or cribriform structures
26. Zollinger -Ellison Syndrome
• Triad of
▫ Gastric acid hypersecretion
▫ Severe peptic ulceration
▫ Non beta cell islet tumor of pancreas(gastrinoma)
• Increase in mass of body glands with normal
sized antral glands & gastric foveolae(d/t excess
production of gastrin)
• Excess gastrin has trophic effect on parietal
cells, causing them to enlarge & proliferate
27. • Gross :
▫ Mucosal folds in gastric body are enlarged & thrown
into cerebriform pattern
• Histologically
▫ Gland thickness is expanded approx 2 times of normal
▫ Glands consist of hypertrophied & hyperplastic
parietal cells that appear to crowd out chief & mucous
neck cells
▫ Gland lumen may be dilated , producing small cysts
▫ Hyperplastic endocrine cells may also be present in
the corpus glands
28. Menetrier Disease
• Poorly defined entity
• Diagnosis criteria for this disease (Given by
Appleman) includes
▫ Giant Mucosal folds involving the corpus & possibly
antrum
▫ Low acid production, even after stimulation
▫ Mucosal protein loss
▫ Histologic findings of corpus foveolar hyperplasia &
glandular atrophy
29. • Histologic features :
▫ Elongation of gastric foveolae on the surface of
folds & may have cork screw appearance
▫ Often cystically dilated with mucus accumulation
▫ Cysts extends into deeper mucosal layer & even
occasionally the submucosa, with resulting corpus
gland atrophy
34. GASTRIC CARCINOMA
• Majority of gastric cancers are adenocarcinoma
• Definition of W.H.O
▫ “A malignant epithelial tumor of stomach mucosa with
glandular differentiation”
• Early symptoms resemble those of chronic gastritis,
including dyspepsia, dysphagia & nausea
• As a result these tumors are often discovered at
advanced stages, when symptoms such as weight
loss, anorexia etc. trigger further diagnostic
evaluation
35. Epidemiology
• Geographical Distribution
▫ In Japan & eastern europe, the incidence is upto 20 fold higher than in
north america & south east asia
• Time Trends
▫ Decline in incidence has been observed worldwide from past few decades
▫ Reason : Decrease consumption of dietary carcinogen such as : N-
Nitroso compounds & benzo(a) pyrene
• Age & Sex Distribution
▫ Rare in age < 30 yrs., highest in old age groups
▫ Intestinal type : Male> Female
▫ Diffuse type : Affects young females more(d/t hereditary characterstics :
germline mutation of CDH1 gene)
36. Aetiology
• Diet
▫ Increased Risk
Smoked or cured meats or fish, pickeled vegetables, chilli
peppers
Exposure to nitrosamines, alcohol, tobacco & Inorganic
dusts
▫ Decreased Risk
Fruits, vegetables, carotenoids, folates etc.
• Bile Reflux
▫ Increased Risk after 5-10 yrs. Of gastric surgery
(Bilroth II) which increases Bile reflux
37. • Helicobacter Pylori Infection
▫ Strong association with the organism
▫ Induces the phenotypic change & leads to
formation of adenocarcinoma
▫ Sequential Steps involved
Chronic gastritis
Multifocal atrophy
Intestinal metaplasia
Intraepithelial neoplasia
38.
39. • Precursor lesion
▫ Gastritis & Intestinal metaplasia
▫ Intraepithelial neoplasia(dysplasia)
• Location
▫ Most frequent site of sub cardial stomach cancer is
the distal stomach i.e the antro-pyloric region,
more on lesser curvature than greater curvature
40. • Classification
• Two widely used : Lauren & WHO
▫ Lauren
List three histologic types
Intestinal
▫ These form recognizable glands that range from well differentiated to
moderately differentiated tumors, sometimes with poorly differentiated
with advancing margin.
▫ Typically arise on background of intestinal metaplasia
Diffuse
▫ Consist of poorly cohesive cells diffusely infilterating the gastric wall with
little / no gland formation.
▫ The cells appear round & small arranged as single/clustered in
abortive, lacy gland like/reticular formation. These tumor resemble signet
ring type as classified in WHO classification
▫ Most cases of LEATHER BOTTLE STOMACH(linitis plastica) is classified
as diffuse
▫ Mitotic rate is lower in diffuse than intestinal type
▫ Desmoplasia is more pronounced
▫ Inflammation is less evident
Mixed
46. • W.H.O classification
▫ Tubular
Consist of prominent dilated/slit like & branching
tubules varying in their diameter; acinar structures
may be present
Tumor cells are columnar, cuboidal or flattened by
intraluminal mucin
Clear cells may also be present
Cytologic atypia varies from low to high grade
Poorly differentiated variant is sometimes called
solid carcinoma
Tumors with prominent lymphoid stroma are
sometimes called medullary carcinoma/ carcinomas
with lymphoid stroma
47. ▫ Papillary
Well differentiated exophytic carcinomas with finger
like processes lined by cylindrical/ cuboidal cells
supported by fibro vascular connective tissue cores
Cells maintain their polarity
Invading tumor edge is usually sharply demarcated
from surrounding structures from surrounding
structures
May be infilterated by acute & chronic inflammatory
cells
48. ▫ Mucinous
By definition >50% tumors consists of extracellular
mucinous pools
Two major growth pattern
Glands lined by a columnar mucous secreting
epithelium together with interstitial mucin
Chains or irregular cell clusters floating freely in
mucinous flakes
Signet ring cells when present do not dominate the
picture
49.
50. ▫ Signet ring cell carcinoma
>50 % of tumor consist of isolated/small groups of
malignant cells containing intracytoplasmic mucin
Tumor cells have 5 morphologies
1. Nuclei push against cell membranes creating a classical
signet ring cell appearance d/t an
expanded, globoid, optically clear cytoplasm. These contain
acid mucin & stain with Alcian blue at pH 2.5
2. Other diffuse carcinomas contain cells with central nuclei
resembling histiocytes & show little/no mitotis
3. Small, deeply eosinophilic cells with prominent but
minute, cytoplasmic granules containing neutral mucin
4. Small cells with little/ no mucin
5. Anaplastic cells with little/ no mucin
51. ▫ Signet ring cell carcinoma(contd.)
Special stains :
Mucin detection : PAS, mucicarmine, Alcian blue
IHC : Cytokeratin
Several Condition which mimic Signet Ring
carcinoma :
Signet ring lymphoma
Lamina propria muciphages
Xanthomas
Detached/dying cells associated with gastritis
54. Early gastric cancer
• Carcinoma limited to mucosa / mucosa &
submucosa regardless of nodal status
• Lesions may be categorised as :
▫ Flat
▫ Elevated
▫ Depressed
▫ Excavated
▫ Combined forms
• Most tumors are 2cms or less in diameter
• Importance of correctly identifying early gastric
cancer lies in excellent result of surgical treatment
55. Grading
• Well differentiated
▫ An adenocarcinoma with well formed glands, often resembling
metastatic intestinal epithelium
▫ >95% consist of glands
• Moderately differentiated
▫ Intermediate between well & poorly differentiated
▫ 50-95% consist of glands
• Poorly differentiated
▫ Adenocarcinomas consisting of irregular glands recognised with
difficulty/single cells that remain isolated or/are arranged in small/large
clusters with mucin secretion or acinar structures
▫ 49% or < consist of glands
56. Endocrine tumors
• Definition of W.H.O
▫ “Most endocrine tumors of stomach are well
differentiated, non functioning enterochromaffin-
like(ECL) cell carcinoids arising from the oxyntic
mucosa in the corpus /fundus”
• Three types
▫ Type I : associated with autoimmune chronic
atrophic gastritis
▫ Type II : associated with MEN-I & Z.E syndrome
▫ Type III : sporadic
57.
58. • Type I
▫ Most common(74%)
▫ Average age of onset is 63 yrs.
▫ Sex : F>M(2.5 :1)
▫ Underlying cause : CAG from pernicious anemia
▫ Associated with achlorhydria, antral G cell hyperplasia &
hypergastremia
▫ Pathogenesis :
Gastrin is trophic for ECL, which proliferate resulting in initially in
simple hyperplasia and later into nodular hyperplasia & finally
into neoplasia
59. • Type I(contd.)
▫ Histologically :
Carcinoid tumor appear as small cluster/ribbons of
cells at base of mucosa
Individual cells are regular, with rounded nuclei
having diffuse chromatin pattern
Cytoplasm is grayish & not obviously granular
Immunopositive : Chromogranin , synaptophysin
60. • Type II
▫ Constitute 6 % of all gastric endocrine tumors
▫ Mean Age : 50 yrs.
▫ Sex : M=F
▫ Morphology :
Almost same as type I, occasionally may become large &
metastasize to regional nodes
Background mucosa shows parietal cell hyperplasia
61. • Type III
▫ Constitute 13% of all gastric endocrine tumors
▫ Mean Age : 55 yrs.
▫ Sex : M>F(2.8:1)
▫ Not accompanied by hypergastrinemia/atrophic
gastritis/pernicious anemia
▫ Commonly found in corpus
▫ Behave in malignant fashion if lesion is > 2cms/show
angio invasion/deep muscle invasion
62. GI carcinoid tumor (neuroendocrine carcinoma).
A, Gross cross-section of a submucosal tumor nodule.
B, Microscopically the nodule is composed of tumor cells embedded in dense fibrous tissue.
C, In other areas, the tumor has spread extensively within mucosal lymphatic channels.
D, High magnification shows the bland cytology of carcinoid tumors. The chromatin texture, with fine and
coarse clumps, is frequently described as a "salt and pepper" pattern. Despite their innocuous appearance,
carcinoids can be extremely aggressive clinically.
E, Electron microscopy reveals cytoplasmic dense core neurosecretory granules
63. Extreme endocrine cell hyperplasia is present, resulting in microcarcinoid nodules in gastric mucosa
64. GASTRIC LYMPHOMAS
• Definition of WHO
▫ “Primary gastric lymphomas are defined as lymphomas
originating from the stomach & contiguous lymph nodes”
• Lymphomas at this site is considered as primary if the
main bulk of disease is located in stomach
• Majority of gastric lymphomas are high grade B-cell
lymphomas, some of which have developed through
progression from low grade lyphomas of mucosa
associated lymphoid tissue(MALT)
• The low grade lesions are exclusively B-cell MALT
lyphomas
65. • 40% NHL arise in extranodal site, out of which GI
tract is the most commonest
• Constitutes over 10 % of all gastric malignancy
• Age : Common in >50 yrs
• Sex : M=F
• Etiology
▫ H. Pylori
▫ Immunosuppression
66. MALT Lymphomas
• Pathogenesis
▫ The normal gastric mucosa contains scattered
lymphocytes & plasma cells but is devoid of organised
lymphoid tissue
▫ First step in development of primary gastric
lymphoma is acquisition of organised lymphoid tissue
from which lymphoma can arise
▫ In most cases it is associated with H.Pylori
▫ H. Pylori do not directly stimulate MALT lymphoma
cells but cause secretion of IL-2 from adjacent T cells
& induce IL-2 receptors on tumor cells themselves
67. • MALT lymphoma is low grade lymphoma
• It may transform to high grade i.e DLBCL
• Five cardinal histologic features of MALT lymphoma
▫ An infilterate of small lymphocyte & small cleaved
follicle centre(Centrocyte-like - CCL) cells
▫ Lymphoid follicles
▫ Neoplastic plasma cells
▫ Lymphoepithelial lesions
▫ Dutcher bodies(PAS-positive intranuclear inclusion)
68. ▫ Lymphocytic infiltrating the epithelium of the
stomach is highly characteristic of MALT
lymphomas, but can also be present in
lymphocytic gastritis
▫ To be suggestive of lymphoma, the infiltrate must
be present as a lymphoepithelial lesion(a
discrete cluster of three/more lymphocyte)
▫ In lymphocytic gastritis , the lymphocytes(Which
are T cells rather than B cells) are usually present
as single cells within the epithelium
69. ▫ Immunophenotype
Positive : CD20
Negative : CD5,CD10, Bcl-6, Cyclin D1
Note : CD5 negativity is useful in differentiating
from other small cell lymphoma
70. MALT lymphoma producing expansion of submucosa in an ill defined nodular pattern & showing follicular colonization
73. Diffuse Large Cell B-cell Lymphomas
▫ Most high grade gastric lymphomas are DLBCL
▫ Major diagnostic challenge is to separate DLBCL
from poorly differentiated carcinoma
▫ Lymphoma cells tend to infiltrate widely in the
lamina propria in a sheet like fashion, but they
often spare existing gastric pits & glands
▫ In contrast to MALT lymphomas, lymphoepitheial
lesion is not a common finding
74. DLBCL(Contd.)
▫ Carcinomas tend to destroy mucosal structures as
they infiltrate
▫ Cells of lymphoma are totally non cohesive with
no tendency to form clumps/cords
▫ Nuclei of DLBCL are characteristically vesicular
with prominent nucleoli & nuclear membrane
77. MESENCHYMAL TUMORS
• Definition of WHO
▫ “Most gastrointestinal mesenchymal neoplasms are
GIST/smooth muscle types”
• Previously the term GIST was applied to
mesenchymal tumors of all type
• At, present the diagnosis should be restricted to
neoplasm arising from Interstitial cells of Cajal(GI
pacemaker cells)
• Tumors arising from smooth muscle should be
called leiomyoma/leiomyosarcoma & thise arising
from the nerves should be called
shwannoma/neurosarcoma
78.
79. GIST(Gastrointestinal Stromal Tumor)
• Accounts for 2% of all malignant gastric tumors
• Typically defined as “tumors whose behaviour is
driven by mutations in Kit gene/PDGFRA gene
and may/may not stain positive for kit”
• Age : B/w 5th & 8th decade
• Sex : M=F
80. GIST(Contd.)
• Pathophysiology
▫ Thought to arise from interstitial cells of cajal(ICC)
▫ What is ICC ?
The Interstitial cell of Cajal (ICC) is a type of interstitial
cell found in the gastrointestinal tract that serves as a pacemaker
which creates the basal electrical rythym leading to contraction of
the smooth muscle(peristalsis)
▫ Most of GIST arise because of mutation of c-kit gene
▫ C-kit/CD117 is expressed in ICC
▫ Most are sporadic, some are hereditary
81. GIST(Contd.)
• Gross
▫ Solitary rounded or lobulated lesions with a clearly
defined margin
▫ Primarily involve the muscularis propria & submucosa
▫ Larger tumor bulge into gastric lumen & have attenuated
mucosa covering their surface
• C/S
▫ Flat, whorled appearance with tumor substance usually
firm with foci of necrosis/hemorrhage
▫ Large tumors may be cystic in middle
82. GIST(Contd.)
• Eight different histologic subtypes
▫ Spindle(4) & Epithelioid(4)
▫ Spindle type
20% of all stromal tumor
Subtypes :
Sclerosing(most common)
Palisading vacuolated
Hypercellular
Sarcomatous
83. GIST(Contd.)
▫ Spindle type(contd.)
Sclerosing
▫ Composed of interlacing fascicles & whorls of uniform elongated
cells, with cigar-shaped vesicular nuclei & eosinophilic cytoplasm
Palisading
▫ Close resemblance to schwannoma
Hypercellular
▫ Tightly packed uniform spindle cell without significant
atypia/mitotic activity
Sarcomatous
▫ Significant mitotic activity & pleomorphism
84. GIST(Contd.)
▫ Epithelioid type
Involve the corpus & antrum
Subtypes
Sclerosing
▫ Syncytial pattern, composed of round cells with clear/lightly eosinophilic
cytoplasm
▫ Clearing of cytoplasm is result of fixation artefact
▫ Sometimes vacuolation in cytoplasm is eccentric giving false impression of
signet ring cells
Dyscohesive variant
▫ Epithelioid cells surrounded by lacunar spaces
Hypercellular
Sarcomatous
85. • Immunophenotype : 95% positive for CD117
• Prognosis
▫ Four broad group depending upon gross size & mitotic activity/50 hpf
Very Low malignant potential
Less than 2cms with <5 mitoses/50 hpf
Low malignant potential
2-5cms with <5 mitoses/50 hpf
Intermediate malignant potential
<5cms with 6-10 mitoses/50 hpf
▫ Or
5-10cms with <5 mitoses/50 hpf
High malignant potential
>5cms with >5 mitoses/50 hpf
▫ Or
>10cms with any number of mitoses
▫ Or
Any size with >10 mitoses/ hpf
86. Low grade spindle cell GIST composed of interlacing fascicles of cells with cigar
shaped nuclei