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    Can't understand the pathology report of gastroscopic biopsy?

    • Last Update: 2022-05-10
    • Source: Internet
    • Author: User
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    Gastroscopy biopsy reports often include these bewildering descriptions: "chronic inflammation (++), intestinal metaplasia (+++), dysplasia (+), active (++)"; or reported as "chronic superficial Epigastric gastritis, moderately active, with focal intestinal metaplasia, mild dysplasia" or reported as "chronic atrophic gastritis, severe, moderate intestinal metaplasia, severe dysplasia in some areas",


    etc.
    Today, I will briefly introduce some pathological knowledge about chronic gastritis
    .
    Generally speaking, gastroscopy is the change of gastric mucosa seen by the naked eye, and the diagnosis given is relatively rough
    .
    For example, "chronic superficial gastritis with bleeding" and "chronic atrophic gastritis with bile reflux" are broken
    .

    The pathological examination of diagnostic
    biopsy is based on the diagnosis of cytology, which is the change of gastric mucosa observed under the light microscope
    .
    1.
    The contents of the pathological report include: 1.
    The contents of the pathological report include: 1.
    The contents of the pathological report include: 1.
    The basic information of the patient, the appearance of the biopsy tissue, the findings under the microscope, the pathological diagnosis and remarks
    .
    1.
    Basic information of the patient, appearance of biopsy tissue, microscopic findings, pathological diagnosis and remarks
    .
    2.
    The patient's basic information includes: 2.
    The patient's basic information includes: name, medical record number and other identity verification information
    .
    3.
    The appearance of the biopsy tissue, that is, what the naked eye can see includes: 3.
    The appearance of the biopsy tissue, that is, what the naked eye can see includes: the whole picture of the tissue submitted for inspection, the biopsy site, size, shape, and the distance between the lesion and the edge of the tissue, etc.

    .
    What is seen under the microscope is the manifestation of the lesion observed by the pathologist under the microscope.
    The biopsy tissue is professionally described at the cellular level, and the pathological diagnosis is made based on the nature of the disease
    .
    4.
    "Remarks" or "Notes" on the pathology report 4.
    The "Notes" or "Notes" on the pathology report are the pathologist's advice to the physician or patient who sent the biopsy, including: what kind of biopsy should be done, or What special pathological examinations need to be done, or it is recommended that patients borrow pathological sections from previous operations for comparison and observation
    .
    2.
    Pathological diagnosis should answer two basic questions: 2.
    Pathological diagnosis should answer two basic questions: 2.
    Pathological diagnosis should answer two basic questions: First, what is the lesion?
    First, what is the disease? Second, what is the nature of the lesion, whether it is a tumor, benign or malignant? Second, what is the nature of the lesion, whether it is a tumor, benign or malignant? In the case of malignant tumors, the grade of malignancy, the depth and extent of invasion, the number of lymph node metastases, the cleanness of the margins, and the degree of sensitivity to radiotherapy and chemotherapy should be explained in detail in the pathological diagnosis
    .
    3.
    Common pathological changes under gastroscope are as follows: 3.
    Common pathological changes under gastroscope are as follows: 3.
    Common pathological changes under gastroscope are as follows: 1.
    Chronic superficial (non-atrophic) gastritis 1.
    The pathological changes of chronic superficial (non-atrophic) gastritis are mainly confined to the mucosa, rarely involving the submucosa
    .
    In the superficial layer of the gastric mucosa, inflammatory cells dominated by lymphocytes or plasma cells are infiltrated, while the glands in the deep layer are normal
    .
    According to the degree of inflammatory cell infiltration, superficial gastritis can be divided into mild, moderate, severe and acute activity
    .
    Such asAcute inflammation is associated with neutrophil infiltration
    .
    This is the most common and mildest type of report, and the vast majority recover completely with targeted treatment
    .
    The long-term existence of chronic inflammation causes the destruction of gastric glands and intestinal metaplasia, which gradually develops superficial gastritis into atrophic gastritis
    .
    2.
    Atrophic gastritis 2.
    Atrophic gastritis It refers to not only the infiltration of inflammatory cells in the mucosa, but also the partial or complete disappearance of gastric glands
    .
    The gastric mucosal glands atrophy to varying degrees, reduce or even disappear completely, and only the gastric pits remain
    .
    According to the degree of reduction, it is divided into light, medium and heavy
    .
    Can be represented by +
    .
    At the same time as gastric gland atrophy, the epithelium in the deep gastric pits proliferates to form glands and can undergo intestinal metaplasia, or form polyps, or even cancer
    .
    Since atrophy occurs in the pyloric part of the stomach (gastric antrum), while the gastric body and fundus mucosa are less involved and retain the secretory function, some patients with atrophic gastritis still have symptoms of acid regurgitation and heartburn in clinical practice.
    Reasonable explanation
    .
    3.
    Inflammatory cell infiltration 3.
    Inflammatory cell infiltration There are more chronic inflammatory cell infiltration in gastric mucosa lamina propria, mainly plasma cells and lymphocytes
    .
    Inflammatory cell infiltration is mostly diffuse, often located in the fovea, gradually infiltrating deep, and reaching the muscularis mucosa
    .
    According to the degree of infiltration of inflammatory cells, chronic gastritis can be divided into mild, moderate and severe
    .
    (1) In mild cases, there are fewer chronic inflammatory cells, limited to the superficial mucosa, not exceeding 1/3 of the mucosa; (2) In moderate cases, the inflammatory cells are denser, exceeding 1/3 of the mucosa, reaching 2/3 of the mucosa.
    3;(3) Severe inflammatory cells are dense and occupy the full thickness of the mucosa
    .
    Active inflammation refers to neutrophil infiltration on a background of chronic inflammation
    .
    According to the degree of neutrophil infiltration, it can be divided into mild, moderate and severe
    .
    (1) A small amount of neutrophil infiltration was seen in the mucosal lamina propria in mild cases; (2) more neutrophil infiltration was seen in the mucosal layer in moderate cases; (3) neutrophils in the mucosal layer were denser in severe cases , and a pit abscess can be seen
    .
    4.
    Intrinsic gland atrophy 4.
    Intrinsic gland atrophy is manifested as a decrease in the number of intrinsic glands and thinning of the mucosal layer
    .
    However, fibrous tissue, muscularis mucosa and lymphoid follicles often proliferate in the lamina propria
    .
    Atrophy can be focal or diffuse
    .
    According to the degree of intrinsic gland reduction, atrophy can be divided into mild, moderate, and severe
    .
    (1) Mild reduction in the number of intrinsic glands, not more than 1/3 of the original glands; (2) Moderate reduction in the number of intrinsic glands, more than 1/3, but not more than 2/3; (3) Severe intrinsic glands The number of glands decreased by more than 2/3, only a few glands remained, or even disappeared completely
    .
    5.
    Intestinal metaplasia 5.
    Intestinal metaplasia Intestinal metaplasia (intestinal metaplasia, referred to as intestinal metaplasia) refers to the replacement of the epithelium and glandular epithelium of the gastric mucosa by goblet cells and absorptive cells
    .
    Atrophic gastritis is associated with intestinal metaplasia, but the two can also exist independently
    .
    Atrophic gastritis with very significant intestinal metaplasia is also called metaplastic gastritis
    .
    Intestinal metaplasia can be divided into mild, moderate and severe according to the number of gastric mucosal gland ducts.

    .
    (1) Mild intestinal metaplasia or glands does not exceed 1/3 of the intrinsic glands; (2) Moderately accounts for 1/3~2/3 of the intrinsic membranous glands; (3) Severely accounts for 2 of the intrinsic glands /3 or more
    .
    Intestinal metaplasia can be divided into three types according to histological morphology and mucosal histochemical staining: (1) Type I is complete type , which is composed of absorbing cells, goblet cells, and Panth cells.
    Goblet cells contain sialic acid mucosa.
    Absorbing cells do not contain mucus; (2)  Types II and III are incomplete metaplasia , consisting of goblet cells and columnar cells without Panth cells
    .
    The difference between type II and type III incomplete intestinal metaplasia is that the former column cells secrete neutrophils and sialic acid mucus, while the latter column cells secrete sulfate mucus
    .
    Most believe that type III intestinal metaplasia is associated withGastric cancer is closely related and has certain value in estimating the risk of gastric cancer
    .
    Gastric cancer6, dysplasia6 , dysplasia , also known as dysplasia (dysplasia), also known as intraepithelial neoplasia, is a hyperproliferative state in which the structure of gastric mucosa and epithelial cells deviate from normal, and its basic characteristics include cell atypia, differentiation Abnormalities and disorders of mucosal structure
    .
    Intestinal and non-intestinal mucosal dysplasia can occur, and there are intrinsic intestinal type and gastric type dysplasia
    .
    It can also be divided into two types: adenomatous dysplasia - thought to develop into well-differentiated intestinal-type gastric adenocarcinoma; hyperplastic dysplasia - closely related to incomplete intestinal metaplasia and thought to develop It is a poorly differentiated intestinal-type gastric adenocarcinoma
    .
    Dysplasia is a precancerous lesion of gastric cancer and can be divided into three grades: mild, moderate and severe according to the degree of dysplasia
    .
    The new classification refers to dysplasia as intraepithelial neoplasia, with mild to moderate dysplasia as low-grade intraepithelial neoplasia, and severe dysplasia as high-grade intraepithelial neoplasia
    .
    High-grade intraepithelial neoplasia becomes a true precancerous lesion, which some doctors call carcinoma in situ
    .
    The morphological manifestations of mild dysplasia are mildly irregular glandular duct structure, disordered or unevenly arranged, mainly distributed in the superficial mucosa, reduced goblet cells, hyperchromatic nuclei, slightly enlarged in size, and densely arranged in the nucleus.
    basal layer of cells
    .
    Moderately, the glandular ducts are irregular in structure, branch-like, with different shapes and sizes, and are closely arranged in foci, but with clear boundaries
    .
    Cells with obvious atypia, hyperchromatic nuclei, oval or rod-shaped, densely arranged, located on the basal side of the cells, but slightly disordered
    .
    Severely manifested as structural disorder of glandular ducts, varying in shape and size, commonly seen in budding, branching, papilla, co-mural, and back-to-back phenomena
    .
    The cell atypia was more obvious.
    Epithelial cells were columnar or cuboid.
    The nuclear ratio was significantly increased.
    The nuclei were hyperchromatic.
    They were round or rod-shaped
    .
    Severe dysplasia is sometimes indistinguishable from well-differentiated adenocarcinoma and should be closely observed
    .
    7.
    Other pathological changes 7.
    Other pathological changes Epithelial degeneration, pit hyperplasia, edema, erosion, fibrosis, pseudopyloric gland metaplasia and pancreatic metaplasia may appear in chronic gastritis
    .
    (1) Pseudopyloric gland metaplasia: refers to the increase and expansion of the mucous neck cells of the gland after the atrophy of the gastric glands, replacing the parietal cells and chief cells
    .
    Pseudopyloric gland metaplasia is an indicator of fundic gland atrophy, which is difficult to distinguish from pyloric glands
    .
    (2) Pancreatic metaplasia: It is nested or lobular, distributed in the body of gastric glands, pancreatic-like cells, with abundant cytoplasm, eosinophilic granules at the top and middle of the cells, and basophilic at the base.
    The significance is not clear
    .
    (3) Lymphoid follicular hyperplasia: refers to a reactive hyperplasia of lymphoid tissue that occurs in the long-term chronic inflammation of the gastric mucosa
    .
    Normally, there is no lymphoid tissue in the gastric mucosa
    .
    Repeated hyperplasia of lymphoid tissue can develop into lymphoma , so lymphoid follicles in gastric mucosal biopsy should be noticed by clinicians, especially in middle-aged and elderly people
    .
    Lymphoma (4) such as showing HP positive: to standardize eradication treatment
    .
    It is closely related to the occurrence of most gastritis, ulcers and even gastric cancer
    .
    (5) Polyps: Hyperplasia and inflammation are generally benign, and adenomas, especially those with dysplasia, may become cancerous, and they need to be removed in time and reviewed regularly
    .
    (6) Cancer (Ca): Generally, gastroscopic biopsy is only to determine the nature of the lesion, and the extent to which the lesion develops depends on the gross specimen resection.
    Comprehensive assessment is made by the depth of infiltration of the cancer tissue, the degree of differentiation, and the metastasis of lymph nodes.
    Determine the most appropriate treatment plan
    .
    There are often descriptions of well-differentiated, moderately-differentiated, and poorly-differentiated; the higher the differentiation, the better the maturity and the relatively good prognosis; on the contrary, the lower the differentiation, the worse the maturity and the worse the prognosis
    .
    If the malignant nature of the report is pending, further pathological analysis is required
    .
    4.
    Suggestion: 4.
    Suggestion: If immunohistochemistry is required , there may generally be the following reasons: Immunization first, it is impossible to confirm whether it belongs to cancer at present, and needs to be further clarified; second, it has been determined to belong to cancer, in order to determine the source of cancer cells , type, degree of differentiation, tumor stage, etc.
    ; third, it is easy to find micrometastases, find out the cause, and guide medication
    .


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