Elsevier

Surgery (Oxford)

Volume 38, Issue 11, November 2020, Pages 687-693
Surgery (Oxford)

Basic Science
Pathology of the oesophagus and stomach

https://doi.org/10.1016/j.mpsur.2020.08.007Get rights and content

Abstract

The oesophagus is subject to a number of disorders affecting motility (swallowing) including gastro-oesophageal reflux disease, malignancy and disorders of neuromuscular function, such as achalasia. Most neoplasms of the oesophagus and stomach are epithelial in nature. Benign epithelial neoplasms usually take the form of polypoid lesions, such as oesophageal squamous papillomas, gastric adenomas, hyperplastic and fundic gland polyps. Malignant epithelial neoplasms of the oesophagus are divided into squamous cell carcinoma and adenocarcinoma, whereas malignant gastric neoplasms are predominantly adenocarcinomas. Each tends to develop in the context of dysplastic epithelial changes. Gastric carcinomas and lymphomas are associated with Helicobacter pylori infection. Stromal tumours of the stomach are important in that they have a distinctive molecular pathology and linked targeted therapy. This educational article provides an overview of the incidences, aetiologies and histological features of some of the most common mechanical, inflammatory and neoplastic pathologies encountered in the oesophagus and stomach. The emphasis is on clinical application.

Section snippets

Atresia

During embryonic development of the upper gastrointestinal tract, the laryngotracheal diverticulum develops from the ventral foregut during week 4 of gestation. Anomalies occur from faulty division of the foregut into these oesophageal and tracheal channels. Tracheal dominance with oesophageal stenosis or atresia is the more common form of unequal division and a fistula is usually present. Pure oesophageal atresia without a fistula is rare. Oesophageal atresia with tracheo-oesopheal fistula is

Squamous papilloma

Squamous papilloma is the most common benign neoplasm of the oesophagus, which usually occurs in the lower third. The lesions have a multi-lobulated appearance with a granular, or warty surface and a firm consistency. They are usually small (15 mm diameter) and may be multiple. Histologically, they have a papillary architecture and a central core of vascular connective tissue covered by stratified squamous epithelium. There is no atypia or dysplasia. Cytological changes suggestive of Human

Gastritis and peptic ulcer disease

Peptic ulcer disease represents a heterogeneous group of disorders which are characterized by inflammation and ulceration of the gastric or duodenal mucosa that occurs when the normal mucosal defence system is overwhelmed by noxious stimuli such as acid, pepsin, bile, drugs and ischaemia. The main factors that may predispose to ulcer formation are NSAIDs, including aspirin, corticosteroids and Helicobacter pylori infection. Gastric ulcers are most common in the antral/pre-pyloric region.

H.

Gastric neoplasms

Gastric polyps are a heterogeneous group of lesions found in 6% of upper GI endoscopies. Epithelial polyps are the most prevalent type of gastric polyp, which can be further subdivided into hyperplastic polyps (and variants) and neoplastic polyps, including adenomas, which by definition exhibit dysplasia. Fundic gland (cystic) polyps (FGPs) have been traditionally regarded as hamartomatous lesions but increasing evidence suggests they may be neoplastic. FGPs are the most common gastric polyps

Lymphoma

The gastrointestinal tract accounts for 30–50% of primary extra-nodal lymphomas and the stomach is the most commonly involved site (50–60% of cases). In adults, non-Hodgkins lymphoma is the second most common neoplasm of the stomach, following adenocarcinoma. Lymphomas are the most common gastric tumour type in childhood. There is a preponderance for B-cell lymphomas, with diffuse large B-cell lymphoma (DLBCL) and marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma)

Gastro Intestinal Stromal Tumour (GIST)

GISTs are the most common mesenchymal neoplasms of the GI tract and are believed to arise from or show differentiation towards the gut pacemaker cells, or interstitial cells of Cajal. GISTs occur within the GI tract from the oesophagus to the anorectum, with the majority of cases developing within the stomach (50–60%), small intestine and less commonly the colorectum. GISTs are exceptionally rare in the oesophagus. Unlike GI epithelial carcinomas, GISTs originate within the deeper wall of the

References (0)

View full text