Gastric mesenchymal lesions other than gastrointestinal stromal tumor

Interpretation of gastrointestinal mesenchymal lesions involving the stomach and the remainder of the gastrointestinal tract is daunting but can be simplified somewhat merely by knowing in which layer they are usually found. For example, gastric Kaposi sarcoma is detected in mucosal biopsies whereas inflammatory fibroid polyp is nearly always in the submucosa. Gastrointestinal stromal tumors (discussed elsewhere in this issue) are generally centered in the muscularis propria. Gastric schwannomas are essentially always in the muscularis propria. Mesenteric lesions are usually found in the small bowel mesentery but the gastric mesentery is not immune. Knowledge of the favored layer is even more important in interpreting colon biopsies, since many mesenschymal polyps are encountered in the colon, but the same principle applies in the stomach. Herein we discuss several gastric mesenchymal lesions

Mesenchymal polyps

Most mesenchymal polyps are encountered in the colorectum but some characteristically arise in the oesophagus and stomach. Small bowel polyps are not often sampled but many of the types found in the other locations can be found in the small intestine and are covered elsewhere in this volume. Generally mesenchymal lesions of the tubular gastrointestinal tract that present as polyps are centred in the mucosa or submucosa. However, some lesions that are typically centreed in the muscularis propria are included since they are often confused with superficial lesions. Often the issues in interpreting such lesions revolve around whether the tumour is a gastrointestinal stromal tumour and whether it is a syndromic or sporadic, which has been addressed particularly for neural lesions

Diagnosis and Management of Barrett-Related Neoplasia in the Modern Era

Whereas in the past, pathologists were hesitant to diagnose high-grade dysplasia in patients with Barrett esophagus, because this diagnosis prompted esophagectomy, current international consensus is that endoscopic treatment is the management for high-grade dysplasia and intramucosal carcinoma. Furthermore, many centers advocate endoscopic ablation for low-grade dysplasia. As such, establishing a diagnosis of dysplasia has become the key step; separation between the grades of dysplasia is less critical. This article offers some criteria for separating dysplasia from reactive changes, discusses pitfalls in interpreting endoscopic mucosal resection specimens, and outlines management strategies

Histopathology of Barrett esophagus

Barrett esophagus (BE) is a metaplastic, premalignant lesion of the tubular esophagus that carries significant implications and is associated with approximately 0.5% annual cancer incidence. Although gastroesophageal reflux disease is a recognized risk factor, no clear guidelines exist as to who should undergo endoscopic screening for the condition. Histologic requirements for the diagnosis vary by geographic region with some but not all countries requiring the presence of goblet cells. In spite of interobserver variability, histologic assessment of dysplasia is currently the accepted method of surveillance and subsequent patient management is dictated by this evaluation. Though not universal, endoscopic therapy is rapidly replacing esophagectomy in patients with high-grade dysplasia/early carcinoma. This review aims to provide the reader with an overview on this subject with special emphases on the histopathologic features of BE and BE-associated dysplasia as well as evolution and new developments related to therapeutic modalities in patients diagnosed with dysplasia

Metastatic urachal carcinoma in bronchial brush cytology

Urachal carcinoma is rare comprising less than 1% of all bladder carcinomas. Metastases of urachal carcinoma have been reported to meninges, brain, ovary, lung, and maxilla. Cytologic features of metastatic urachal carcinoma have not been previously reported. We present a case of metastatic urachal adenocarcinoma in bronchial brushings and review the use of immunohistochemistry in its diagnosis. A 47-year-old female was seen initially in 2007 with adenocarcinoma of the bladder dome for which she underwent partial cystectomy. She presented in 2011 with a left lung mass and mediastinal adenopathy. Bronchoscopy showed an endobronchial lesion from which brushings were obtained. These showed numerous groups of columnar cells with medium sized nuclei and abundant cytoplasm. The cells were positive for CK20 and CDX2 and negative for CK7. The cytomorphological findings were similar to those in the previous resection specimen and concurrent biopsy. This is the first case report of bronchial brushings containing metastatic urachal carcinoma. No specific immunohistochemical profile is available for its diagnosis. The consideration of a second primary was a distinct possibility in this case due to the lapse of time from primary resection, absence of local disease, and lack of regional metastases