GI Pathology Slides

GI - 1

Normal esophagus emphasizing the surface epithelium which is stratified squamous having a relatively thin basal layer.  The papillae extend to the lower one-third of the epithelium.  These features are important when considering changes that can be regarded as due to reflux esophagitis.

GI - 6

These show columnar epithelium interposed between stratified squamous epithelium with associated inflammation in the submucosa and basal cell hyperplasia of the adjacent squamous epithelium.

GI - 9

Carcinoma-in-situ.  There is a small amount of normal squamous epithelium in the right upper corner.  The remainder shows cell crowding, hyperchromasia, increased N:C ratio and loss of maturation.  The changes remain confined above the basement membrane.

GI - 14

Gross appearance of squamous cell carcinoma of esophagus.

GI - 15

Normal body-type mucosa of the stomach.  Parietal cells (acid-secreting) are seen.

GI - 18

These two slides illustrate the changes of chronic gastritis,

GI - 19

principally as infiltration of the lamina propria by a dense aggregate of lymphocytes and plasma cells.  This is non-specific and does not indicate the etiology.  Intestinal metaplasia with goblet cells and villous pattern can be seen in 18.

GI - 22

Typical deep penetrating peptic gastric ulcer.   Note the sharp edges and punched out appearance of the ulcer.

GI - 23

Multiple gastric ulcers with one perforated (accentuated by a piece of white paper under the perforation).

GI - 25

Chronic gastric ulcer showing histologic appearance of ulcer - zone of necrosis, zone of  inflammation, granulation tissue and cicatrix.

GI - 27

This photograph is to show an adenomatous polyp of the stomach, sometimes seen in persons with the familial adenomatous polyposis syndrome (especially in the Japanese.

GI - 28

Large fungating and ulcerative gastric carcinoma with necrotic and hemorrhagic (black) areas on the surface.

GI - 29

Large ulcerative and penetrating type of gastric cancer.  This gross pattern may be difficult to distinguish from a benign peptic ulcer therefore biopsies are required.

GI - 30

Massive polypoid type of gastric cancer.

GI - 31

Diffuse infiltrating and sclerosing type of gastric carcinoma- linitis plastica, seen as thickening of the gastric wall minimal mucosal changes.

GI - 41

Gross photograph of the stomach in a case of diffuse carcinoma of the stomach (linitis plastica type); notice the thickened walls, which are due to tumor cell infiltrates.

GI - 43

This lymph node shows sinusoidal infiltration by tumor cells in a case of carcinoma of the stomach.  Finding of the lymph node metastases reduces the already poor survival rate in these patients.

GI - 44

Normal ileal mucosa, resting on muscularis mucosae.  Note the height of villi and the regularity.  Distinguish the villi from the underlying crypts.

GI - 45

A PAS stain for glycoprotein (mucus)on normal intestinal epithelium.  Note the thick glycocalyx on the surface, and presence of interepithelial lymphocytes. Which class of immunoglobulin may be seen on the surface of the epithelial cells?

GI - 46

Typical histologic features of subtotal villous atrophy

GI - 47

seen in celiac disease.  There is an increase in the height of crypts due to hyperplasia and pseudostratification of crypt cells and presence of heavy  lymphocyte  infiltration. Ultrastructurally, loss and blunting of microvilli and epithelial degeneration may be seen.

GI - 49

Three slides illustrating Whipples disease.  The small bowel shows expanded

GI - 50

lamina propria containing histiocytes with a granular foamy cytoplasm which stained intensely with PAS (Periodic Acid Schiff.

GI - 51

The electron micrograph shows bacilliform structures.  These structures disappear when treatment with appropriate antibiotics is initiated.

GI - 52

A button-like mucosal lesion with umbilication typical of a carcinoid tumor of ileum.  The cut surface is often yellow in colour.

GI - 53

Microscopic appearance of the carcinoid tumor with a submucosal location.

GI – 54

The monotonous cells of the carcinoid are arranged in nests with a vascular stroma.

GI - 55

Normal colonic mucosa.  Note the regular array of the tubular glands and the amount of goblet cells.

GI - 56

Gross appearance of chronic ulcerative colitis showing

GI- 57

contiguous mucosal ulceration, haemorrhage, and small multiple inflammatory polyps. The musclular wall is minimally affected.

GI - 58

Radiologic features of chronic ulcerative colitis.  Try to relate to the gross morphology for the spikes, irregularity of mucosal contour.

GI - 59

Early crypt abscess in two distended crypts.  Mucosal hyperemia is marked.

GI - 61

Disarray of glands with hyperplasia of mucosal glands accompanied by active acute and chronic inflammation, and marked mucosal congestion.   Compare to the normal in slide 55.

GI - 62

Persistent acute and chronic inflammation, glandular hypertrophy and hyperplasia with disarray in a regenerative attempt.

GI - 63

Ulceration limited to mucosa with loss of most of the mucosa and a flat layer of epithelium regenerated over the base.  Chronic persistent inflammation and haemorrhage are noted.

GI - 64

Microscopic appearance of an inflammatory polyp, representing residual relatively intact, though abnormal, mucosa protruding above the neighbouring ulcerative surface.

GI - 65

Close-up of large inflammatory polyp.  The granular and ridge-like areas are denuded muscle coat which is somewhat hypertrophied.

GI - 66

Filiform polyps with undermined passages, an unusual sequela of chronic inflammatory bowel diseases.

GI - 68

Glandular atypia of mucosa in rectal biopsy in a patient with longstanding history of chronic ulcerative colitis. The glandular features resemble an adenoma.  This is regarded as a dysplastic lesion.

GI - 69

Gross appearance of regional enteritis, showing mucosal ulceration, fibrosis with stricture and epiploic fat creeping along the anti-mesenteric aspect..

GI - 70

Crohn’s disease of the ileum (regional enteritis) with cobblestone mucosal change due to criss-cross transmural fissuring.

GI - 71

Regional enteritis in terminal ileum (above) with relative sparing of the cecum (below).

GI - 72

Close-up of deep fissuring and ulceration of mucosa resulting in cobblestone appearance in Crohn disease.

GI - 73

Crohn colon with transmural chronic inflammation, fibrosis, and necrotizing fissure.

GI - 74

Noncaseating granuloma with epithelial and giant cell in a lymphoid aggregate ofCrohn disease.

GI - 75

Transmural chronic inflammation with granulomatous inflammation in subserosal lymphoid aggregate in Crohn disease.

GI - 76

Pseudomembranous colitis with yellow-green patches of fibrinopurulent membranous exudate.  The lesion is associated with use of antibiotics (clindamycin).

GI - 77

Fibrinopurulent exudation, mucosal erosion, microvascular fibrin thrombi,  mucosal edema and epithelial hyperplasia in pseudomembranous colitis.  Overgrowth of clostridium difficile has been incriminated.

GI - 78

A benign pedunculated adenomatous polyp with a long stalk and lobated growth at the tip.  Normally, it looks pink and fleshy.  This one has been twisted at the stalk resulting in impending necrosis.

GI - 79

Multiple polyps, all benign microscopically.  How can one distinguish benign from malignant polyps?

GI - 80

Familial polyposis of colon.  An area of 2 cm² contains more than 50 small sessile polyps.  The entire colon is uniformly affected in this 30-year-old man with family history of the disease.

GI - 81

A Peutz-Jegher's polyp of colon characteristically showing presence of a muscular stalk devised from muscularis.  The mucosal glands of the polyp are those of disorganized and papillary epithelial linings.

GI - 82

Metaplastic or hyperplastic polyp showing elongated and hyperplastic tubular glands with serration and cystic dilatation with decrease of goblet cells.  There is no cytologic atypia.  An increase of inflammatory cells is noted in the mucosa.

GI - 83

Tubular adenoma - pedunculated.  The stalk is that of normal colonic mucosa. The adenoma is composed of tubular and branching glands.  Note the staining is darker in adenoma as compared with colonic mucosa because of hypercellularity.  A small incipient lesion is seen adjacent to the larger one with intervening normal mucosa.

GI - 85

Villous adenoma showing typical papillary frond-like surface.  Generally, this type of adenoma tends to be larger in size than the tubular one.

GI - 86

Sessile villous adenoma showing typical delicate frond-like epithelial growth.

GI - 87

High magnification of villous adenoma showing hyperchromatic pseudostratified tall columnar epithelial cells lining along the delicate connective tissue stalk.

GI - 88

Admixture of tubular and villous components.  The proportion of the two elements are about 3:1 but this can be variable.

GI - 89

Note the "apple core" deformity at the sigmoid colon.

GI - 90

Constricting type, "napkin-ring" appearance of cancerous infiltration.

GI - 91

A large ulcerating polypoid adenocarcinoma within the reach of index finger on palpation.

GI - 92

Whole tissue mount of the cross section of a sigmoid constructing carcinoma. Notice the semicircumferential infiltration limited in the submucosa.

GI - 93

A large infiltrating mass in the cecum.

GI - 94

Microscopy of infiltrating, well differentiated adenocarcinoma of colon.  It has penetrated the muscularis propria.

GI - 95

Typical adenocarcinoma showing cellular atypia of neoplastic glands, cellular necrosis and inflammatory infiltration.

GI - 96

An immunoperoxidase cytochemical staining for carcinoembryonic antigen of colonic adenocarcinoma, showing glycocalyx staining for CEA, spillage of CEA into the tissues, and high CEA in the lumen of neoplastic glands.

GI - 97a

Endoscopic view of esophageal varices