By Laura Lamps MD, Andrew Bellizzi MD, Wendy L. Frankel MD, Scott R. Owens MD, Rhonda Yantiss MD
nearly 20 million gastrointestinal tract biopsies are played every year within the usa. whereas a lot of those are hassle-free, a few are histologically sophisticated or contain a fancy differential prognosis. This concise visible consultant to the total diversity of neoplastic gastrointestinal specimens presents the training pathologist or trainee with a transparent research and prognosis of either universal and almost certainly deceptive editions of ailment. The authors conceal the total tubular GI tract with over six hundred top of the range photos and a concise description of the most important gains of every entity: definitions and terminology, gross and morphologic gains, differential diagnoses, priceless ancillary checks, staging and grading parameters, and exact medical issues. photos depict differential analysis beneficial properties, usually obvious editions that may probably bring about misclassification or misdiagnosis, and correlated molecular and immunologic recommendations.
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Many sarcomas also contain focal areas of epithelioid morphology that mimic carcinomas. Conversely, sarcomatoid carcinomas can be confused with sarcomas, and may lack CK positivity. 10B) frequently has well developed epithelioid features as well. In such cases, a previous history of a cutaneous pigmented lesion, less cohesive tumor cells with cytoplasmic pigment and prominent nucleoli, and positive melanoma markers are all helpful. 10C) can be composed of large epithelioid cells arranged in nests or pseudoglands, and are well-known mimics of adenocarcinomas.
8 In this rectal biopsy showing prolapsed glands in the submucosa, there is no cytologic atypia and the crypts are surrounded by hypertrophic and disorganized fibromuscular fibers (A–B). In this tubulovillous adenoma with submucosal epithelial displacement, the downwardly displaced epithelium shows continuity with the surface epithelium (C). At higher power, the misplaced glands show the same degree of atypia as the surface adenomatous glands (D). Note also the lack of desmoplastic stroma. 2 Approach to Epithelial Neoplasms of the Gastrointestinal Tract Approximately 10% of Peutz–Jeghers polyps contain misplaced epithelium, which may herniate into the submucosa, muscularis propria, or subserosa with frequent associated mucin-containing cysts.
The morphologic features, together with history, site, and background histologic findings are very helpful in this initial determination. Once an epithelial neoplasm is confirmed, attention should be focused on whether it is benign or malignant. Malignant neoplasms in the GI tract can be primary, but the possibility of metastatic disease should be always considered (see section on primary versus metastatic epithelial malignancy). If a primary tumor is diagnosed in a resection specimen, it must then be graded and staged (see Chapters 7–12 for more details).
Neoplastic Gastrointestinal Pathology by Laura Lamps MD, Andrew Bellizzi MD, Wendy L. Frankel MD, Scott R. Owens MD, Rhonda Yantiss MD