Gastric ulcer
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Gastric ulcer, also stomach ulcer, is pathology of the stomach that is evident grossly. It can be benign or malignant.
General
- May be benign or malignant.
Causes:
- Gastric carcinoma.
- Peptic ulcer disease.
- Syphilis.[1]
- Other causes.
Gross
- Heaped (raised) edges - suggestive of cancer.
- Punched-out appearance with flat edges - suggestive of benign.
Notes:
- The classical teaching is to biopsy the ulcer edge, as the dictum is: the cancer is there; this dictum may not be true.[2]
- Ulcer with clean base refers to nothing "in" the ulcer (depression); these may be benign or malignant.[3]
Images
Malignant ulcer of the stomach. (WC)
Microscopic
Features:
- Loss of the (gastric) epithelium.
- Vital reaction.
- Marked (acute) inflammation.
- Fibrin.
Images
SU - low mag. (WC)
SU - intermed. mag. (WC)
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Compatible with benign
A. STOMACH, BIOPSY: - GASTRIC ANTRAL-TYPE MUCOSA WITH EDEMA, FOCALLY PROMINENT SMOOTH MUSCLE, ACTIVATED FIBROBLASTS, A MILD INCREASE OF EOSINOPHILS, AND FIBRIN -- COMPATIBLE WITH NEARBY ULCER. - NEGATIVE FOR HELICOBACTOR-LIKE ORGANISMS. - NEGATIVE FOR INTESTINAL METAPLASIA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
See also
References
- ↑ Fyfe, B.; Poppiti, RJ.; Lubin, J.; Robinson, MJ. (Aug 1993). "Gastric syphilis. Primary diagnosis by gastric biopsy: report of four cases.". Arch Pathol Lab Med 117 (8): 820-3. PMID 8343046.
- ↑ Lv, SX.; Gan, JH.; Ma, XG.; Wang, CC.; Chen, HM.; Luo, EP.; Huang, XP.; Wu, SH. et al. (May 2012). "Biopsy from the base and edge of gastric ulcer healing or complete healing may lead to detection of gastric cancer earlier: an 8 years endoscopic follow-up study.". Hepatogastroenterology 59 (115): 947-50. doi:10.5754/hge10692. PMID 22469743.
- ↑ "Follow-up endoscopy for benign-appearing gastric ulcers has no additive value in detecting malignancy: It is time to individualise surveillance endoscopy". Gastric Cancer 18 (4): 803–9. October 2015. doi:10.1007/s10120-014-0433-4. PMID 25312052.