1TUMOR SISTEM ALIMENTARI

TUMOR SISTEM TUMOR SISTEM ALIMENTARIALIMENTARI

Reparative lesion:

EPULIS

Excessive reparative process-Granulomatous epulis-Fibromatous epulis-Giant cell epulis-Haemangioform epulis-Pregnancy epulis

LEUKOPLAKIA- white patches of keratosis- premalignant lesion- hyperkeratosis, hyperplasia of the squamous epithelium- dysplastic changes

SQUAMOUS CELL CARCINOMA

Pleomorphic adenoma (parotid)Pleomorphic adenoma (parotid)

Pleomorphic adenoma (parotid)Pleomorphic adenoma (parotid)

Pleomorphic adenoma (gross)Pleomorphic adenoma (gross)

Pleomorphic adenoma Pleomorphic adenoma

Pleomorphic adenomaPleomorphic adenoma

Warthin tumorWarthin tumor

Benign tumor mostly occur in parotid gland

Warthin tumorWarthin tumor

Cystic spaces lined by double-layered eosinophilic epithelium, and all embedded in lymphoid stroma

OncocytomaOncocytoma

Mostly in parotid gland

OncocytomaOncocytoma

Large granular appearing, eosinophilic-staining epithelial cells

Adenoid cystic carcinomaAdenoid cystic carcinoma

Minor salivary gland



Most characteristic appearance consists of cribriform pattern with masses of small, dark-staining cells arrayed arround

cystic spaces


Mucoepidermoid tumorMucoepidermoid tumor(Palatal gland)(Palatal gland)

Mostly in parotid gland

Mucoepidermoid tumorMucoepidermoid tumor(Low grade)(Low grade)

Comprised of mucus-producing and epidermoid omponents and cells intermediate between the two

Mucoepidermoid tumorMucoepidermoid tumor(moderate grade)(moderate grade)

Mucoepidermoid tumorMucoepidermoid tumor(High grade)(High grade)

Perforation of the cheek: cancer of the tongue

III. Diseases of the Esophagus

F.2. BARRET’S ESOPHAGUS

Columnar metaplasia (often of intestinal type with prominent goblet cells) ofesophageal squamous epithelium.Complication of long-standing gastroesophageal reflux, to be a well-known precursor of esophageal adenocarcinoma

III. Diseases of the EsophagusIII. Diseases of the Esophagus

G.1. Squamous Cell CarcinomaG.1. Squamous Cell Carcinoma

Arises most frequently in the upper and middle thirds of the esophagus

III. Diseases of the EsophagusIII. Diseases of the Esophagus

G2. AdenocarcinomaG2. Adenocarcinoma

Arises most frequently in the lower third, and mostly from aberrant gastric mucosa or Barret’s esophagus

STOMACH

ATROPHICGASTRITIS

H.pylori

Helicobacter pylori (gastric mucosa)(silver stain) x 300

H. PYLORY AND CHRONIC GASTRITIS

Intestinal metaplasia: stomach(alkaline phosphatase) x 50

OTHER GASTRITISOTHER GASTRITIS

Eosinophyillic gastritis:Eosinophyillic gastritis: food allergy ? food allergy ? Granulomatus gastritis:Granulomatus gastritis: tuberculosis, tuberculosis,

syphilis, sarcoidosis, fungi, Crohn syphilis, sarcoidosis, fungi, Crohn diseasedisease

Reflux gastritis:Reflux gastritis: duodenal and bile duodenal and bile refluxreflux

Menetrier disease (giant hypertrophic Menetrier disease (giant hypertrophic gastritis)gastritis)

Menetrier diseaseMenetrier disease (HYPERTROPHIC GASTROPATHY)(HYPERTROPHIC GASTROPATHY)

Severe hyperplasia of mucosal layer Severe hyperplasia of mucosal layer cells + glandular atrophy cells + glandular atrophy extreme extreme enlargement of gastric rugaeenlargement of gastric rugae

Hypertrophic gastropathy + hyper-Hypertrophic gastropathy + hyper-secretion: mucosal cells, parietal and secretion: mucosal cells, parietal and chief cells hyperplasia.chief cells hyperplasia.

Gastrinoma Gastrinoma excessive gastrin excessive gastrin excretion excretion gastric glandular gastric glandular hyperplasia (Zollinger-Ellison hyperplasia (Zollinger-Ellison syndrome)syndrome)

Sometimes with severe loss of plasma Sometimes with severe loss of plasma proteins from the altered mucosaproteins from the altered mucosa

Risk of peptic ulcerRisk of peptic ulcer

TRIGER FACTORS OF PEPTIC ULCER

PEPTIC ULCER

Cylindric epithelia

Necrotic debris

Granulation tissue with lymphocytic infiltration

Glands hyperplasia

Edema

POLYPPOLYP- - Polypoid massPolypoid mass– >90% non neoplasm (inflammatory/ >90% non neoplasm (inflammatory/

hyperplasia)hyperplasia)– Sessile / pedunculatedSessile / pedunculated– 20-25% multiple20-25% multiple– Mostly occur in chronic gastritisMostly occur in chronic gastritis– No malignant potentialNo malignant potential

ADENOMAADENOMA– neoplasm neoplasm 5-10% of gastric polyp 5-10% of gastric polyp– Sessile / pedunculatedSessile / pedunculated– distal – antrum predominant distal – antrum predominant – Six decade, Male: female = 2:1Six decade, Male: female = 2:1– Some cases origin from chronic gastritis with Some cases origin from chronic gastritis with

intestinal metaplasiaintestinal metaplasia

I. Diseases of the stomach

D. Tumors of the stomach (benign)

I. Diseases of the stomachI. Diseases of the stomach

D. Tumors of the stomach (malignant)D. Tumors of the stomach (malignant)

90-95% of gastric malignancy90-95% of gastric malignancy High incidence: japan, Chili, Costa Rica, China High incidence: japan, Chili, Costa Rica, China Location: Location: - 40-50% pylorus/anthrum; 25% cardia- 40-50% pylorus/anthrum; 25% cardia

- 40% minor curvature; 12% c. major40% minor curvature; 12% c. major- Etiology:Etiology:

- DietDiet- Chronic atrophic gastritisChronic atrophic gastritis- H. pylori H. pylori infectioninfection- partial gastrectomypartial gastrectomy- Gastric Adenoma Gastric Adenoma - Genetic : A blood group, family factorGenetic : A blood group, family factor

GASTRIC CANCERGASTRIC CANCER– InvasionInvasion

Early ( mucosa and submucosa)Early ( mucosa and submucosa)Advanced (invade the submucosa)Advanced (invade the submucosa)

– Macroscopic growthMacroscopic growthExophyticExophyticflat/ depressedflat/ depressedExcavationExcavation

Linitis plastica –Linitis plastica – tumor cells diffusely infiltrate tumor cells diffusely infiltrate gastric wall gastric wall leather bottle appearance leather bottle appearance

– HistologyHistology intestinal gland typeintestinal gland typeDiffuse: Diffuse: signet-ring cellsignet-ring cell

The differences between a The differences between a benign and a malignant ulcerbenign and a malignant ulcer

Benign or malignant? Benign or malignant?

Answer :Answer :

Benign. Benign. Clear, sharp, punched out borders. Clear, sharp, punched out borders.

No neoplastic mass present. Benign No neoplastic mass present. Benign peptic ulcer.peptic ulcer.

Benign or malignant? Benign or malignant?

Malignant. Malignant. Large ulcer. The margins are Large ulcer. The margins are

irregular and you can see the mass irregular and you can see the mass under the ulcer. under the ulcer.

Answer :Answer :

The Growth of Gastric CancerThe Growth of Gastric Cancer

Sessile adenoma

Dysplasia: characterized by a flat lesion

Other gastric tumorsOther gastric tumors

MALIGNANT LYMPHOMAMALIGNANT LYMPHOMA– 40% malignant lymphoma of GIT40% malignant lymphoma of GIT– 5% of gastric malignancy5% of gastric malignancy– B cell type predominant, MALT originB cell type predominant, MALT origin

CARCINOID TUMORCARCINOID TUMOR Carcinoid syndromeCarcinoid syndrome– Low grade malignancyLow grade malignancy– Metastasis to the liverMetastasis to the liver– Multiple lesionsMultiple lesions

LEIOMYOMALEIOMYOMA SECONDARY TUMORS (METASTASIS)SECONDARY TUMORS (METASTASIS)

– rarerare– Mostly from leukemia or general Mostly from leukemia or general

lymphoma lymphoma – From breast / lung cancer From breast / lung cancer diffuse diffuse

linitis plasticalinitis plastica

Early Gastric CarcinomaEarly Gastric Carcinoma


Scanning power view of histologic section


Scanning power view of histologic section

Gastric Gastric CarcinomaCarcinoma





Signet ring cells

Signet ring cells (PAS +)

Gastric Carcinoid TumorGastric Carcinoid Tumor






Gastro-Duodenal junctionGastro-Duodenal junction

Circular muscle

Longitudinal muscle

Stomach: Glandular arrangement

Pyloric sphincter

Duodenum: villous arrangement

Brunner’s gland

Duodenum Duodenum

Mucosa

Villi

Submucosa

Muscularis mucosae

Circular layer

Longitudinal layer Brunner’s gland

DuodenumDuodenum

Glands

Submucous

Muscularis mucosa

Lamina propria

Villi

Crypt of Lieberkuhn

DuodenumDuodenum(PAS staining) (PAS staining)

Goblet cells

Brunner’s gland

DuodenumDuodenum

Small IntestineSmall Intestine

Mucosa

Villi

Muscularis mucosae

Circular muscle layer

Longitudinal muscle

Peyer’s patches

Plicae circulares

Vascular submucosa

Serosa

Small IntestineSmall IntestineVilli

Lamina propria

Crypt of Lieberkuhn

Muscularis mucosae

Ileocecal JunctionIleocecal Junction

Lymphoid tissue

Small intestine Muscularis propria Large intestine

II. Diseases of the Small IntestineII. Diseases of the Small Intestine

A. Peptic UlcerA. Peptic Ulcer

B. Crohn DiseaseB. Crohn Disease

C. Meckel DiverticulumC. Meckel Diverticulum

D. Malabsorption syndromeD. Malabsorption syndrome

E. E. Tumors of the Small IntestineTumors of the Small Intestine

Colon Colon

Lymphoid aggregates

Circular layer

Longitudinal layer

ColonColon

ColonColon

ColonColon

Recto-anal JunctionRecto-anal Junction

The junction

Squamous epithelia

Rectal mucosa

Adenomatous polypAdenomatous polyp

Colon adenomaColon adenoma

What kind of polyp is this? What kind of polyp is this?

The answer :The answer :

tubulovillous adenomatubulovillous adenoma

This is a gross morphologic term and does This is a gross morphologic term and does not describe the histopathologic features of not describe the histopathologic features of the lesion.the lesion.

It could be It could be adenomatousadenomatous or a simple type of or a simple type of polyp. polyp.

A correct diagnosis of a polyp can only be A correct diagnosis of a polyp can only be given after a histologic examination.given after a histologic examination.

What kind of polyp is this? What kind of polyp is this?

Ulcerative ColitisUlcerative Colitis

Familial Adenomatous PolyposisFamilial Adenomatous Polyposis

Polyposis of the colon

ULCUS CARCINOMATOSAULCUS CARCINOMATOSA

Ulcerating carcinoma of the colon

Adenocarcinoma of the colon

Colon CarcinomaColon Carcinoma

Adenocarcinoma of the colon(PAS) x 100

Mucinous carcinoma of the colon

Signet-ring cell carcinoma of the colon(HE) x 100

Adenocarcinoma, NOS

CEA: carcinoma of the colon(IH) x 50

Peritoneal carcinosis: metastatic rectal carcinoma

Dukes’ StageDukes’ Stage

ASTLER - ASTLER - COLLERCOLLER

Five-year survival rateFive-year survival rateA – tumor terbatas di mukosa A – tumor terbatas di mukosa 100%100% B1 – sampai dengan muskularis propria, B1 – sampai dengan muskularis propria, belum sampai ke limfonodibelum sampai ke limfonodi 67%67%B2 – menembus muskularis propria, B2 – menembus muskularis propria, belum sampai ke limfonodi belum sampai ke limfonodi 54%54%C1 – sampai dengan muskularis propria,C1 – sampai dengan muskularis propria, sudah sampai limfonodi sudah sampai limfonodi 43%43%C2 – menembus muskularis propria,C2 – menembus muskularis propria, sudah sampai limfonodi sudah sampai limfonodi 22%22%D – metastasis jauh D – metastasis jauh sangat rendah sangat rendah

SINDROM CARCINOID DIARRHOEA FLUSHING --------- > CYANOSIS HYPOTENSION DYSPNEU EDEMA / ASCITES STENOSIS OF TRICUSPID OF PULMONARY VALVES

Carcinoid of the appendix(HE) x 75

(IH; chromogranin) x 75

Practical Work:

Hepatobiliary & Pancreas

Normal liverNormal hepatic lobe (EvG)

Normal hepatocytes

Diagram of the liver lobule

(Vena centralis)

Simple hepatic acinus

Acinar agglomerate

Hepatic Lobule

Collagenous tissue

Central vein Portal tract

Hepatic Lobule

Central veinPortal tract

Hepatic Lobule

Central vein

Portal tract

Collagenous tissue

Portal Tract

Hepatic artery

Lymphatics

Hepatocytes (anatomosing plates)

Hepatic portal vein

Bile ductules

Hepatic sinusoid

Liver parenchyme

Glycogen granulesBinucleate cells

Sinusoid lining cells

Sinusoid lining cells

Kupffer cells

Endothelial cells

Bile canaliculi

Canals of Hering

Bile canaliculi

Binucleate cells

Walls of the canaliculi

Fetal Liver

Erythroid

Myeloid precursorsMegakaryocytes

Chronic Hepatitis

Piecemeal necrosis, irregular interface between parenchyma and connective tissue

Chronic Hepatitis

The outlines of the enlarged and inflamed portal tract are blurred by iecemeal necrosis

Chronic Hepatitis

Spikes of inflammation extent from portal connective tissue into the parenchyma

Chronic Hepatitis

Reticulin staining: fibrosis is more clearly seen

Chronic Hepatitis

Bridging necrosis

Chronic Hepatitis (C)

Lymphoid tissue with germinal center

Cirrhosis Hepatis

Cirrhosis Hepatis

liver cirrhosis

Micronodular Macronodular

Cirrhosis Hepatis

Cirrhosis Hepatis

Hepatocellular regenration

Cirrhosis Hepatis

Recently formed bridging necrosis

Cirrhosis Hepatis

Micronodular pattern

Liver cirrhosis

active septum passive septum

Cirrhosis Hepatis

Steatosis

Microcystic Steatosis

Periportal Steatosis

Hepatocellular Carcinoma




Hepatocellular carcinoma


Bile productionLeft: moderately diff. (abundant); right: poorly diff.(hardto find)



Cholangiocarcinoma

The large tumor has an irregular, infiltrative margin. The central white area is calcified. No cirrhosis in non-neoplastic liver.

Intrahepatic Cholangiocarcinoma

The yellow foci of necrosis in the large mass


Moderately diff. glandular lumina are present (left), but not well-formed; on the right there are glandular lumna as well

as solid areas.


Vascular spread is shown in sinusoid (left), and in portal vein branches (right)


Hepatocyte antigen positive in normal liver cell (left), while the

tumor on the right is negative

Cytokeratin 7, cytoplasmic staining

Gall Bladder

Muscular layer

Collagenous adventitial coat (serosa)Submucosa

Gall Bladder

Spiral valve of Heister: the wall of cystic duct which is formed into a twisted mucosa-covered fold.

Pancreas Intralobular duct Septa

Islet of LangerhansFat cells

Pancreas

Glandular acini

Supporting tissue

Pancreas

Intercalated ducts

Centroacinar cells

Interlobular ducts

Pancreas Ectopic

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1TUMOR SISTEM ALIMENTARI