logging in or signing up Gastric biopsy srajendiran Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 361 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: September 03, 2010 This Presentation is Public Favorites: 0 Presentation Description This presentation was made in apple key note and then converted to PPT. Hence some slides may look odd...Sorry for that. If you want any addition, correction, please let me know Have a great time Dr. S. Rajendiran SRMC & RI, Porur, Chennai, India Comments Posting comment... Premium member Presentation Transcript Slide 1: A....B....C....of Endoscopic Gastric Biopsies Dr. S. Rajendiran Sri Ramachandra University Porur, Chennai, India Game Plan : Game Plan Introduction Histology Approach to Gastric Biopsy Case studies OLGA staging Take home message Introduction : Introduction Gastric Lesion Neoplastic Non-neoplastic Chronic Gastritis Introduction - EGD : Introduction - EGD Esophago-gastro-duodenoscopy Indications Contraindications Complications Invasive Procedure....... ......think twice ......if not thrice before saying .........inadequate biopsy.........re-biopsy is suggested Slide 5: If you don't see the lesion..........??? Slide 9: Deepers Call Clinician If you don't see lesion Introduction : Introduction Sampling of Corpus and Antrum Must Place the biopsy in wet card board linearly and fix it immediately in 10% formalin Histology : Histology Cardia Fundus Body Antrum Pylorus Histology : Histology Surface mucinous cells : Surface mucinous cells Gastric Fundus/Body : Gastric Fundus/Body Slide 15: Gastric Cardia/Antrum Gastric Mucin - Neutral : Gastric Mucin - Neutral Gastric endocrine cells : Gastric endocrine cells G cell: Gastrin - Predominantly antral ECL cell: Histamine - Predominantly Body D cell: Somatostatin EC cell: Seratonin Gastric cells and products : Gastric cells and products Approach to gastric biopsy : Approach to gastric biopsy Surface epithelium Glands Lamina propria Muscularis mucosa Submucosa Slide 20: Both Antrum and Body/fundus has to be biopsied Surface epithelium : Surface epithelium Ulceration Loss of mucin Irregular pits Hyperplasia Architectural changes Cytological changes Regeneration, Villiform changes Inflammation (Acute and Chronic) Organisms (H. pylori) Intestinal metaplasia Dysplasia (low & High grade) Slide 22: Surface ulceration & hemorrhage Slide 23: Villiform changes Active inflammation Slide 24: Intestinal metaplasia Mucin Gastric -Neutral IM - Acidic Slide 25: H. pylori Slide 26: Dysplasia 1. Loss of mucin 2. Stratification 3. Mitosis 4. Apoptosis Normal Slide 27: HG Dysplasia 1. Loss of polarity 2. Nuclei reaching the surface 3. Prominent nucleoli Glands : Glands Irregular size, shape & distribution “Cryptitis, Crypt abscess” Architectural changes Cytological changes Inflammation (Acute and Chronic) Organisms (H. pylori, CMV) Metaplasia (intestinal, pyloric, pancreatic) Atrophy Dysplasia (low & High grade) Endocrine cell hyperplasia (to be confirmed by IHC) Slide 29: Glands: Irregular size, shape and distribution Slide 30: Neutrophils on the epithelium Neutrophils in gland space Slide 31: H. pylori Slide 32: Intestinal metaplasia Mucin Gastric -Neutral IM - Acidic Slide 33: Normal Pyloric metaplasia Slide 34: Pancreatic acinar metaplasia Trypsin Amylase Slide 35: Atrophy Slide 36: Dysplasia 1. Loss of mucin 2. Stratification 3. Mitosis 4. Apoptosis Lamina propria : Lamina propria Edema Muscularisation Inflammation - Acute (abscess), Chronic (lymphoid follicles, granulomas) Organisms (TB, CMV) Fibrosis Atypical/ foreign cells (radiation/inflammatory/benign/malignant) Slide 38: Edema of lamina propria Slide 39: Muscularisation of lamina propria Slide 40: Inflammation of lamina propria Slide 41: Lymphoid follicles in lamina propria Granulomas in lamina propria Slide 42: CMV Slide 43: AFB Stain MAI Infection Slide 44: LP fibrosis Slide 45: CD 68 Gastric Xanthoma Slide 46: CK Poorly Differentiated Adenocarcinoma (Signet cells) Slide 47: CD 20 Metastatic NHL Muscularis mucosa : Muscularis mucosa Hyperplasia with LP extension Atypical cells (radiation/benign/malignant) Slide 49: Muscularis mucosa hyperplasia Slide 50: Tumor and Muscularis mucosa Submucosa : Submucosa Vascular changes (portal gastropathy, Dieulafoy’s lesion) Neural changes (Crohn's, ganglion cells mistaken for tumor cells) Atypical, foreign cells (radiation/inflammatory/benign/malignant) Slide 52: Text Dieulafoy’s lesion Slide 53: Cholesterol emboli and gastric ischemia Slide 54: Submucosa - Neural hypertrophy Slide 55: Submucosa -Ganglion cells Slide 56: Submucosa - Cancer cells Features to be graded : Features to be graded Chronic inflammation Neutrophilic activity H. pylori Intestinal Metaplasia Atrophy None, nil: 0% Mild: 1 to 30% Moderate: 31 to 60% Severe: >61% Updated Sydney System : Updated Sydney System Case Studies : Case Studies Case 1 : Case 1 60 year male Upper GI discomfort for the past 7 months Underwent EGD - erosions in the antrum Fundic and antral biopsies taken Slide 65: Case 1 Others: Nil Case 1 - Diagnosis : Case 1 - Diagnosis Case 2 : Case 2 38 year male Pain in the epigastrium History of renal transplant and immunosuppression Underwent EGD - irregular erythematous areas in the body Fundic and antral biopsies taken Slide 68: What do you see? Slide 70: Case 2 Others: CMV Inclusions Present Case 2 - Diagnosis : Case 2 - Diagnosis Case 3 : Case 3 45 year female Unexplained megaloblastic anemia for the past 5 months (Hb. 8 gms%) Underwent EGD - Gastric erosions, more in the body with relative antral sparing Fundic and antral biopsies taken Slide 76: Case 3 Others: Endocrine cell hyperplasia Pyloric metaplasia Case 3 - Diagnosis : Case 3 - Diagnosis Case 4 : Case 4 56 year female H/O malabsorbtion present 5 months. Duodenal biopsy showed evidence of celiac disease Now presented with dyspepsia Underwent EGD - Irregular nodularity Fundic and antral biopsies taken Slide 81: Case 4 Others: Increased theliolymphocytes (40%) Case 4 - Diagnosis : Case 4 - Diagnosis Case 5 : Case 5 66 year female Now presented with heart burn - 4 months H/O Rheumatoid Arthritis + Underwent EGD - pre-pyloric mucosal ulcerations Fundic and antral biopsies taken Slide 86: Case 5 Others: 1. Villiform surface changes 2. Edema of lamina propria 3. Muscularis mucosa Hyperplasia with ext. in to LP Case 5 - Diagnosis : Case 5 - Diagnosis OLGA grading & staging : OLGA grading & staging OLGA grading & staging : OLGA grading & staging Slide 92: International group of pathologists Linking patient’s gastritis and risk of malignancy Pathology report should have an explicit message in orienting a patient’s management Operative Link for Gastritis Assessment (OLGA) OLGA grading & staging Slide 93: Similar to chronic hepatitis score (HAI) Degree of Inflammation (grade 0 to IV) Degree of atrophy (stage 0 to IV) OLGA grading & staging Antral and fundic findings incorporated Risk of Gastric Cancer Stage 0: Lowest Stage IV: Highest OLGA - Staging : OLGA - Staging None, nil: 0% Score 1: 1 to 30% 2: 31 to 60% 3: >61% Slide 97: Take Home Message Introduction : Introduction Sampling of Corpus and Antrum Must If you don't see lesion Deepers Call Clinician Slide 99: Chronic inflammation Neutrophilic activity H. pylori Intestinal Metaplasia Atrophy Slide 100: None : 0% Score 1: 1 to 30% 2: 31 to 60% 3: >61% OLGA Staging A....B.....C....of Gastritis : A....B.....C....of Gastritis You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Gastric biopsy srajendiran Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 361 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: September 03, 2010 This Presentation is Public Favorites: 0 Presentation Description This presentation was made in apple key note and then converted to PPT. Hence some slides may look odd...Sorry for that. If you want any addition, correction, please let me know Have a great time Dr. S. Rajendiran SRMC & RI, Porur, Chennai, India Comments Posting comment... Premium member Presentation Transcript Slide 1: A....B....C....of Endoscopic Gastric Biopsies Dr. S. Rajendiran Sri Ramachandra University Porur, Chennai, India Game Plan : Game Plan Introduction Histology Approach to Gastric Biopsy Case studies OLGA staging Take home message Introduction : Introduction Gastric Lesion Neoplastic Non-neoplastic Chronic Gastritis Introduction - EGD : Introduction - EGD Esophago-gastro-duodenoscopy Indications Contraindications Complications Invasive Procedure....... ......think twice ......if not thrice before saying .........inadequate biopsy.........re-biopsy is suggested Slide 5: If you don't see the lesion..........??? Slide 9: Deepers Call Clinician If you don't see lesion Introduction : Introduction Sampling of Corpus and Antrum Must Place the biopsy in wet card board linearly and fix it immediately in 10% formalin Histology : Histology Cardia Fundus Body Antrum Pylorus Histology : Histology Surface mucinous cells : Surface mucinous cells Gastric Fundus/Body : Gastric Fundus/Body Slide 15: Gastric Cardia/Antrum Gastric Mucin - Neutral : Gastric Mucin - Neutral Gastric endocrine cells : Gastric endocrine cells G cell: Gastrin - Predominantly antral ECL cell: Histamine - Predominantly Body D cell: Somatostatin EC cell: Seratonin Gastric cells and products : Gastric cells and products Approach to gastric biopsy : Approach to gastric biopsy Surface epithelium Glands Lamina propria Muscularis mucosa Submucosa Slide 20: Both Antrum and Body/fundus has to be biopsied Surface epithelium : Surface epithelium Ulceration Loss of mucin Irregular pits Hyperplasia Architectural changes Cytological changes Regeneration, Villiform changes Inflammation (Acute and Chronic) Organisms (H. pylori) Intestinal metaplasia Dysplasia (low & High grade) Slide 22: Surface ulceration & hemorrhage Slide 23: Villiform changes Active inflammation Slide 24: Intestinal metaplasia Mucin Gastric -Neutral IM - Acidic Slide 25: H. pylori Slide 26: Dysplasia 1. Loss of mucin 2. Stratification 3. Mitosis 4. Apoptosis Normal Slide 27: HG Dysplasia 1. Loss of polarity 2. Nuclei reaching the surface 3. Prominent nucleoli Glands : Glands Irregular size, shape & distribution “Cryptitis, Crypt abscess” Architectural changes Cytological changes Inflammation (Acute and Chronic) Organisms (H. pylori, CMV) Metaplasia (intestinal, pyloric, pancreatic) Atrophy Dysplasia (low & High grade) Endocrine cell hyperplasia (to be confirmed by IHC) Slide 29: Glands: Irregular size, shape and distribution Slide 30: Neutrophils on the epithelium Neutrophils in gland space Slide 31: H. pylori Slide 32: Intestinal metaplasia Mucin Gastric -Neutral IM - Acidic Slide 33: Normal Pyloric metaplasia Slide 34: Pancreatic acinar metaplasia Trypsin Amylase Slide 35: Atrophy Slide 36: Dysplasia 1. Loss of mucin 2. Stratification 3. Mitosis 4. Apoptosis Lamina propria : Lamina propria Edema Muscularisation Inflammation - Acute (abscess), Chronic (lymphoid follicles, granulomas) Organisms (TB, CMV) Fibrosis Atypical/ foreign cells (radiation/inflammatory/benign/malignant) Slide 38: Edema of lamina propria Slide 39: Muscularisation of lamina propria Slide 40: Inflammation of lamina propria Slide 41: Lymphoid follicles in lamina propria Granulomas in lamina propria Slide 42: CMV Slide 43: AFB Stain MAI Infection Slide 44: LP fibrosis Slide 45: CD 68 Gastric Xanthoma Slide 46: CK Poorly Differentiated Adenocarcinoma (Signet cells) Slide 47: CD 20 Metastatic NHL Muscularis mucosa : Muscularis mucosa Hyperplasia with LP extension Atypical cells (radiation/benign/malignant) Slide 49: Muscularis mucosa hyperplasia Slide 50: Tumor and Muscularis mucosa Submucosa : Submucosa Vascular changes (portal gastropathy, Dieulafoy’s lesion) Neural changes (Crohn's, ganglion cells mistaken for tumor cells) Atypical, foreign cells (radiation/inflammatory/benign/malignant) Slide 52: Text Dieulafoy’s lesion Slide 53: Cholesterol emboli and gastric ischemia Slide 54: Submucosa - Neural hypertrophy Slide 55: Submucosa -Ganglion cells Slide 56: Submucosa - Cancer cells Features to be graded : Features to be graded Chronic inflammation Neutrophilic activity H. pylori Intestinal Metaplasia Atrophy None, nil: 0% Mild: 1 to 30% Moderate: 31 to 60% Severe: >61% Updated Sydney System : Updated Sydney System Case Studies : Case Studies Case 1 : Case 1 60 year male Upper GI discomfort for the past 7 months Underwent EGD - erosions in the antrum Fundic and antral biopsies taken Slide 65: Case 1 Others: Nil Case 1 - Diagnosis : Case 1 - Diagnosis Case 2 : Case 2 38 year male Pain in the epigastrium History of renal transplant and immunosuppression Underwent EGD - irregular erythematous areas in the body Fundic and antral biopsies taken Slide 68: What do you see? Slide 70: Case 2 Others: CMV Inclusions Present Case 2 - Diagnosis : Case 2 - Diagnosis Case 3 : Case 3 45 year female Unexplained megaloblastic anemia for the past 5 months (Hb. 8 gms%) Underwent EGD - Gastric erosions, more in the body with relative antral sparing Fundic and antral biopsies taken Slide 76: Case 3 Others: Endocrine cell hyperplasia Pyloric metaplasia Case 3 - Diagnosis : Case 3 - Diagnosis Case 4 : Case 4 56 year female H/O malabsorbtion present 5 months. Duodenal biopsy showed evidence of celiac disease Now presented with dyspepsia Underwent EGD - Irregular nodularity Fundic and antral biopsies taken Slide 81: Case 4 Others: Increased theliolymphocytes (40%) Case 4 - Diagnosis : Case 4 - Diagnosis Case 5 : Case 5 66 year female Now presented with heart burn - 4 months H/O Rheumatoid Arthritis + Underwent EGD - pre-pyloric mucosal ulcerations Fundic and antral biopsies taken Slide 86: Case 5 Others: 1. Villiform surface changes 2. Edema of lamina propria 3. Muscularis mucosa Hyperplasia with ext. in to LP Case 5 - Diagnosis : Case 5 - Diagnosis OLGA grading & staging : OLGA grading & staging OLGA grading & staging : OLGA grading & staging Slide 92: International group of pathologists Linking patient’s gastritis and risk of malignancy Pathology report should have an explicit message in orienting a patient’s management Operative Link for Gastritis Assessment (OLGA) OLGA grading & staging Slide 93: Similar to chronic hepatitis score (HAI) Degree of Inflammation (grade 0 to IV) Degree of atrophy (stage 0 to IV) OLGA grading & staging Antral and fundic findings incorporated Risk of Gastric Cancer Stage 0: Lowest Stage IV: Highest OLGA - Staging : OLGA - Staging None, nil: 0% Score 1: 1 to 30% 2: 31 to 60% 3: >61% Slide 97: Take Home Message Introduction : Introduction Sampling of Corpus and Antrum Must If you don't see lesion Deepers Call Clinician Slide 99: Chronic inflammation Neutrophilic activity H. pylori Intestinal Metaplasia Atrophy Slide 100: None : 0% Score 1: 1 to 30% 2: 31 to 60% 3: >61% OLGA Staging A....B.....C....of Gastritis : A....B.....C....of Gastritis