PATHOLOGY FINDINGS ON PEPTIC ULCER - spesialis2.bd.fk ...spesialis2.bd.fk.unair.ac.id/wp-content/uploads/2017/11/Impacts-on... · S. MALIGNANT PERFORASI GASTER S. UNGI GASTRITIS KRONIK

PATHOLOGY FINDINGS ON PEPTIC ULCER

DYAH FAUZIAHDepartment of Anatomical Pathology

Faculty of Medicine, Universitas Airlangga / Dr. Soetomo Hospital

Surabaya

INTRODUCTION

• Gastric ulcer: loss of the entire mucosa, including muscularis mucosae. May extend deep into submucosa and muscularis propia.

• Erosion ≠ Ulcer

• Gastric Ulcers

– Peptic ulcers

– Acute stress ulcers

– Tumors (benign & malignant)

Erosion & Ulcer

Odze RD, Golblum JR, 2015

PEPTIC ULCERS• Etiologies

– Acid hypersecretion

– NSAIDs

– Helicobacter pylori (HP) infection

Fenoglio-Preiser, 2008

• Most common location: lesser curvature, in the anthrum

• Often solitary

• Sharply demarcated, slightly elevated, erythematous and edematous.

• Size: usually small (0.5 to 2 cm), but may be

> 3 cm (giant ulcer)

Odze RD, Golblum JR, 2015

Fenoglio-Preiser, 2008

• Microscopic feature of chronic peptic ulcers:

4 zones

– PMN leukocytes

– Coagulation necrosis

– Granulation tissue

– Fibrosis

Fenoglio-Preiser, 2008

Fenoglio-Preiser, 2008

Peptic Ulcer, HPA data 2014-2016 in Dr. Soetomo HospitalTotal case: 75

PRIA64%

WANITA36%

GENDER

0

5

10

15

20

25

<10 TH 10-19TH

20-29TH

30-39TH

40-49TH

50-59TH

60-69TH

70-79TH

≥ 80 TH

AGE

55

12

8

0

10

20

30

40

50

60

GASTER DUODENUM GASTER+DUODENUM

SITE OF INVOLVEMENT

46

14

1

5 5

21 1

GASTRITIS KRONIS GASTRITIS KRONISAKTIF

GASTRITIS KRONISEROSIVA

DUODENITISKRONIS

GASTRODUODENITIS

KRONIS

ULKUS PEPTIKUN ULKUSDUODENUM

SUSPECT CA

PATHOLOGY DIAGNOSIS

POSITIF19%

NEGATIF68%

UNKNOWN13%

H. PYLORI • HP is major cause of peptic ulcers not associated with NSAID

• Identification of HP

– Normally infects antral & corpus mucosa.

– HP can be identified in about 70% on biopsy specimen from HP(+) subjects by routine HE, 30% cases need more sensitive staining.

– Cheap and commonly used staining: Giemsa and Diff-Quik

– Immunohistochemistry for HP increase sensitivity, particularly after HP treatment.

Coccoid forms of Helicobacter pylori (which usually result from unsuccessful eradication therapy) are stained with the H. pylori blue

stain (A) and with an anti-H. pylori immunohistochemical stain (B)

Odze RD, Golblum JR, 2015

• Histology: provide information related to mucosa (severity of inflammation, intestinal metaplasia, atrophy, dysplasia, neoplasia)

• Sensitivity and specificity of histology for HP detection: 53% up to 90%.

• Depending on:– Density of colonization

– Number of biopsies

– Pathologist’s experience

Benign Ulcers vs Malignant Ulcers

• Benign vs malignant ulcers, problem in biopsy specimen: – Malignant cells vs degenerative atypia

– Tumor cells invasion vs distorted regenerating glands

- rebiopsy after inflammation subsides

- Clinically suspicious benign ulcer: treat and reevaluation

Architectural distortion of gastric glands due to inflammation, mimicking malignancy

• Complication of Peptic Ulcers

– Hemorrhage

– Perforation

– Obstruction

Gaster Perforation, HPA data in Dr. Soetomo Hospital2014-2016total case: 110

75%

25%

GENDER

LAKI

PEREMPUAN

0

5

10

15

20

25

30

35

40

45

50

<10 TH 10-19TH 20-29TH 30-39TH 40-49TH 50-59TH 60-69TH 70-79TH >80TH

AGE

0

20

40

60

80

100

120

GASTER DUODENUM GASTER+DUODENUM

SITE OF INVOLVEMENT

0

5

10

15

20

25

30

35

40

45

SESUAI ULKUSPEPTIKUM

GASTRIC ULCER JAR GRANULASIDENGAN RADANG

ULKUSDUODENUM

S. MALIGNANT PERFORASIGASTER

S. UNGI GASTRITIS KRONIK

PATHOLOGY DIAGNOSIS

CASE

• 64 y.o man

• Clinical diagnosis:

Gaster perforation

• Macroscopic:

4 pieces of tissue,

7 mm – 17 mm

• ConclusionMALIGNANT ROUND BLUE CELLS TUMOR

DD.

- Lymphoma

- Neuroendocrine tumor

Required IHC

conclusion

• Gastric Ulcers: Peptic ulcers, Acute stress ulcers, Tumors (benign & malignant).

• Pathology examination has role in:

• determining benign and malifgnant ulcer

• etiology

THANK YOU