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PATHOLOGY FINDINGS ON PEPTIC ULCER - ... · PDF fileS. MALIGNANT PERFORASI GASTER S. UNGI GASTRITIS KRONIK PATHOLOGY DIAGNOSIS . CASE •64 y.o man •Clinical diagnosis: Gaster perforation

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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

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

Pathologists 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

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