Virtual Microscopy > Gastrointestinal > GI Histology (ORAL CAVITY, ESOPHAGUS, STOMACH)
Case 1: Squamous Cell Carcinoma of Tongue
A 67-year-old male with a 40 pack-year smoking history presents with a 2 cm nodule on his lateral tongue, detected at a recent dental visit. Biopsy was followed by surgical resection. A histologic section through his tumor and a section of normal tongue are provided for your study.
Slides: [patient's tumor] [normal tongue]
- Identify mucosa, submucosa and smooth muscle. Which of these areas does the pathologic process involve?
- What cell types and structures normally reside in the involved area? Be able to identify squamous epithelial cells, submucosal collagen, vessels and nerves, and smooth muscle. [compare and review normal histology slide]
- What cellular alterations have occurred in the squamous cell carcinoma in the tumor? How do the tumor cells compare to the normal squamous cells of the tongue mucosa? How deeply does the tumor invade? Are there other cells in addition to the squamous cancer cells that do not normally reside in this area?
- What might be the role or consequence of these cellular alterations in terms of cell function/dysfunction?
Case 2: Acinic Cell Carcinoma of the Parotid Gland
A 49-year-old woman present with a swelling of her left cheek. CT scan of her head identifies a 4 cm tumor in her left parotid gland. Surgical resection was performed and a section of the tumor and of her normal uninvolved parotid gland are provided for your study.
Slides: [patient's tumor] [normal parotid gland]
- Identify parotid gland acinar cells, ducts and stroma. [compare and review normal histology slide]
- Which of these areas does the pathologic process involve?
- What cellular alterations have occurred in the tumor? What cell type(s) of the normal parotid are the tumor cells most similar to?
- What might be the role or consequence of these cellular alterations in terms of cell function/dysfunction?
Case 3: Herpes Esophagitis
A 23-year-old woman presents with odynophagia (painful swallowing). She had recently had a cold sore on her lip. Esophageal endoscopy reveals a reddened mucosa with punched out ulcers. A biopsy was obtained and is submitted for your review along with a section of normal esophagus.
Slides: [patient's biopsy] [normal esophagus]
- Review the slide of normal esophagus. Be able to identify the following normal structures: squamous epithelium, lamina propria, muscularis mucosae, submucosa, muscularis propria (inner and outer layers), neural plexi, blood vessels and nerves.
- Review the biopsy. What cells are present that are not normally seen in the esophagus? What has happened to the normal structure of the mucosa? Are cellular changes seen in the squamous cells that vary from the normal squamous cells?
- How might these changes result in painful swallowing?
Case 4: Gastroesophageal Reflux Disease
A 56-year-old male presents with heartburn. He is placed on an antacid regimen by his family practitioner, but he continues to have break-through heartburn at least twice a week. He is referred to a gastroenterologist who performs esophagoscopy, showing the distal 3 cm of the esophagus to be lined by pink mucosa. Focal ulcers are also present in the distal esophagus. Biopsies from the distal esophagus are obtained.
Slides: [patient's esophagus]
- What cell types are present in the mucosa of the biopsies? Identify the different epithelial cell types and inflammatory cells and stromal cells.
- Be able to state which cell types are abnormal and not present in the normal squamous-lined esophagus.
- What might have produced the ulceration and inflammation of the mucosa?
Case 5: Helicobacter Pylori Gastritis
A 62-year-old woman presents with upper abdominal pain and occult blood in her stool. She has had no change in her bowel habits. Upper endoscopy discloses an pyloric channel ulcer and biopsies were obtained from her ulcer, and non-ulcerated antrum and gastric body. The non-ulcerated biopsies are provided for your study.
Slides: [patient's stomach] [normal gastric antrum] [normal gastric fundus]
- Review the slide of normal stomach. Be able to identify the following normal structures: antral and fundic epithelium, lamina propria, muscularis mucosae, submucosa, muscularis propria (inner and outer layers), neural plexi, blood vessels and nerves.
- Be able to identify the gastric parietal cells, mucous neck cells, chief cells, and antral glands.
- Note the degree of inflammation in the normal gastric lamina propria. Contrast this to the cell content of the lamina propria of the patient's biopsy. What new types of cells are present?
- How might the ulcer have lead to blood in the stool and abdominal pain?
