Upper git and salivary gland

1. UPPER GIT AND SALIVARY GLAND
Part - 1
DR. SHAMEERA

2. ORAL CAVITY

3. •A white patch or plaque that cannot be scraped off
• Cannot be characterized as any other disease, clinically
or pathologically (WHO)
•Aged 40-70 years,
•male
•tobacco use, alcohol, ill-fitting dentures, chronic exposure
of persistent irritants, HPV-16
PRE MALIGNANT LESIONS OF ORAL CAVITY
LEUKOPLAKIA

4. LEUCOPLAKIA
All leucoplakias are considered
premalignant, until proved
otherwise
MICROSCOPY:
Characterized by hyperkeratosis
Acanthosis
Variable dysplasia &
inflammation

5. ERYTHROPLAKIA
• Red, velvety, eroded area, level or
depressed; associated with highly
atypical epithelial changes with
thin and atrophic epithelium &
prominent vasculature

7. SQUAMOUS CELL CARCINOMA OF ORAL CAVITY
• Usually ages 50-70 years
• 90% men
• Risk factors
• Alcohol, chewing tobacco, marijuana, betel quid
and paan (India)
• Poor oral hygiene, sunlight
• Family history of head and neck cancer

8. SQUAMOUS CELL CARCINOMA OF ORAL CAVITY
What are the viral infections associated with SCC
of oral cavity?
• HPV infection
• EBV infection

9. FAVOURED SITES OF SQUAMOUS CELL
CARCINOMA

10. Squamous cell carcinoma
• Favoured sites: Ventral surface of tongue, floor
of the mouth, lower lip, soft palate, gingiva
• Initially resemble leukoplakia, then form
masses with necrosis, ulcers and rolled borders;
induration is relatively specific for invasion
• M/E: can be verrucous or well differentiated or
anaplastic or sarcomatoid

11. Squamous cell carcinoma

12. CLASSIFICATION OF SALIVARY GLAND TUMORS

14. PLEOMORPHIC ADENOMA
•Also called mixed tumors because of histological
diversity
•All the neoplastic elements are of either epithelial
or myopeithelial reserve cell origin
•Radiation exposure increases the risk

15. PLEOMORPHIC ADENOMA

16. PLEOMORPHIC ADENOMA - GROSS
•Rounded, well-circumscribed
masse < 6 cm.
•Glistening in appearance because
of presence of mucoid material
•Capsule in some areas is not fully
developed with tongue like
extension of tumour into
surrounding area

17. This mixed tumor of the parotid gland
contains epithelial cells forming ducts and
myxoid stroma that resembles cartilage
MICROSCOPY
•The neoplasm is a mixed proliferation of both ductal
epithelium & mesenchymal component with a hyaline or
chondroid or myxomatous stroma.

18. WARTHIN TUMOR
• Benign neoplasm
• Arises exclusively in the parotid gland
• Smokers
• 10% bilateral
• 10% becomes malignant

19. OESOPHAGUS

20. BARRETT OESOPHAGUS
• Chronic GERD can lead to glandular metaplasia
of the lower oesophagus, known as Barrett
oesophagus
• Consist of transformation of squamous
epithelium into columnar epithelium with many
goblet cells
• Virtually all adenocarcinomas of the oesophagus
arise from Barrett epithelium

21. BARRETT OESOPHAGUS

22. Oesophageal tumors
(a) Squamous cell carcinoma
(b) Adenocarcinoma in the lower end of the
oesophagus from:
Barrett’s esophagus
Risk factors
GERD
Tobacco use
Radiation exposure

23. Adenocarcinoma of oesophagus

24. Squamous cell carcinoma of oesophagus

25. PEPTIC ULCER DISEASE
• Refers to chronic mucosal ulceration with areas of degeneration
and necrosis affecting the duodenum or stomach
Risk factors
• H. pylori infection
• Cigarette use
• NSAIDS / corticosteroids
• Cocaine
• Alcohol
• Psychological stress

26. PEPTIC ULCER - GROSS
• Gastric ulcers – pyloric antrum, posterior wall
• Duodenal ulcers – first part, anterior
• Round to oval, sharply punched-out defect with relatively
straight walls
• Margins are in level with the surrounding mucosa
• Depth of these ulcers varies, from superficial lesions involving
only the mucosa and muscularis mucosa to deeply excavated

27. • Base of a peptic ulcer is smooth and clean as a result of
peptic digestion of exudate
• Thrombosed or even patent blood vessels are evident in the
base of the ulcer
• Scarring may involve the entire thickness of the stomach;
puckering of the surrounding mucosa creates mucosal folds
that radiate from the crater in spoke like fashion
• The gastric mucosa surrounding a gastric ulcer is
edematous and reddened, owing to invariable gastritis

28. MICROSCOPY

29. H.pylori – Warthin – Starry silver stain

30. GASTRIC ADENOCARCINOMA
• Most common malignancy in the stomach
• Japan and South Korea have the highest
incidence (20 fold higher)

31. FACTORS ASSOCIATED WITH INCREASED INCIDENCE
OF GASTRIC CARCINOMA

32. MORPHOLOGY
• Location of gastric carcinomas within the stomach is
▫ Pylorus and antrum, 50% to 60%;
▫ Cardia, 25%; and the remainder in the body and
fundus.
▫ Lesser curvature is involved in about 40% and the
greater curvature in 12%.
• Favored location is the lesser curvature of the
antropyloric region.
• Though less frequent, an ulcerative lesion on the
greater curvature is more likely to be malignant than
benign.

33. LAUREN CLASSIFICATION OF GASTRIC CA
Intestinal type
• Those exhibiting an intestinal
morphology with the formation
of bulky tumors composed of
glandular structures
• predominates in high-risk areas,
and develops from precursor
lesions- intestinal metasplasia
from chronic gastritis
• mean age 55 years and a male-
to-female ratio of 2:1.
• Amplification of HER-2/NEU
and increased expression of β-
catenin are present in 20% to
30%
Diffuse type
• Those with diffuse, infiltrative
growth of poorly differentiated
discohesive malignant cells.
• Incidence of the diffuse type is
relatively constant, and the
tumors have no identifiable
precursor lesions.
• Mean age, 48, with an
approximately equal male-to-
female ratio.
• Loss of E-cadherin

34. GROSS

35. Gastric adenocarcinoma – Intestinal
type
an ill-defined, excavated central ulcer surrounded by
irregular, heaped-up borders

36. Diffuse infiltrative type
LINITIS PLASTICA

37. A, Intestinal type demonstrating gland formation by malignant cells,
which are invading the muscular wall of the stomach. B, Diffuse type
demonstrating signet-ring carcinoma cells

38. Metastasis
• Supraclavicular sentinel lymph node – Virchow
node
• Periumbilical lymph nodes – Sister Mary Joseph
nodes
• Left axillary lymph node – Irish node
• Ovary - Krukenberg tumor
• Pouch of Douglas – Blumer shelf