Endoscopic Biopsy Interpretation: A Practical Guide

340 Pages·2019·52.02 MB·English

by  M. Priyanthi Kumarasinghe

Endoscopic Biopsy
Interpretation
A Practical Guide
M. Priyanthi Kumarasinghe
Ian Brown
Editors
123
Endoscopic Biopsy Interpretation
M. Priyanthi Kumarasinghe • Ian Brown
Editors
Endoscopic Biopsy
Interpretation
A Practical Guide
Editors
M. Priyanthi Kumarasinghe Ian Brown
Department of Anatomical Pathology Envoi Pathology
PathWest Laboratory Medicine Kelvin Grove, QLD
QEII Medical Centre and University Australia
of Western Australia
Perth, WA
Australia
ISBN 978-3-319-79116-6 ISBN 978-3-319-79117-3 (eBook)
https://doi.org/10.1007/978-3-319-79117-3
Library of Congress Control Number: 2018951925
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Dedicated to my parents Christie Dias Perera and Winifred
Fernando who taught me the value of being educated and
educating others.
M. Priyanthi Kumarasinghe
In loving memory of mother, Kay, who showed me the benefit of
education and kindness.
Ian Brown
Preface
Biopsies and resection of the gastrointestinal tract are performed for a num-
ber of reasons. Firstly, for the investigation of a clinical symptom, common
examples of which include abdominal pain, diarrhoea, nausea, vomiting and
dyspepsia. Secondly, for the further investigation of an abnormal finding,
examples of which include the investigation of anaemia, abnormal imaging
of the gastrointestinal tract and investigation for a primary source of a malig-
nancy of unknown origin. Thirdly, endoscopic biopsies are performed as a
screening test for patients with known or potential inherited polyposis syn-
dromes, positive family history of gastrointestinal tract malignancy, or a find-
ing of positive faecal occult blood test. Fourthly, endoscopic biopsies are
performed as a follow-up to previously diagnosed disease either to ensure
adequate treatment, for example coeliac disease following gluten-free diet, or
to screen for development of neoplasia such as in Barrett’s oesophagus.
Lastly, for the management of known pre-malignant or early malignant
lesions of the upper and lower GI tracks including laterally spreading tumours
of the colon and early oesophageal cancer in Barrett’s oesophagus.
Over the past decade there have been numerous advances in endoscopic
equipment and techniques with a much better understanding of endoscopic
patterns for lesion characterisation and targeted biopsies. With these evolving
techniques, there has also been a strong shift away from invasive surgical
procedures towards minimally invasive endoscopic therapies. That being
said, there is still a definite role for surgical management; however this is now
mostly guided by the pathology reporting of resected specimens, which assist
the clinician in determining nodal metastatic rates that mandate surgical
resection so that now pathologists are not only integral in guiding diagnosis
but also serve as a gatekeeper to more invasive therapies for patients.
For histopathologists the endoscopic appearance is the equivalent of the
macroscopic assessment of the pathology. Hence a knowledge of the endo-
scopic finding provides important information useful to develop a final patho-
logical diagnosis. Endoscopic findings can be broadly characterised as (1)
normal appearance, (2) probable inflammation (mucosal hyperaemia, friabil-
ity and oedema), (3) erosion or ulceration and (4) polyp/mucosal ridge/mass
forming process. The clinical setting and site of occurrence and extent within
the gastrointestinal tract provide additional information which helps narrow
the potential differential diagnosis. Some conditions within the broad endo-
scopic patterns described above have additional characteristic endoscopic
features and these are discussed further throughout the book.
vii
viii Preface
An important aspect to the assessment of endoscopic biopsies is that ade-
quate sampling has been undertaken. Guidelines for this are available and are
continually being refined. The following table provides a summary of the
minimal biopsy requirements required for histological assessment.
Site Condition Biopsy requirements
Oesophagus Gastro-oesophageal Biopsies of irregular mucosa
reflux disease
Barrett’s oesophagus— Quadrant biopsies for every 2 cm length of
no dysplasia Barrett’s mucosa
Barrett’s Quadratic biopsies for every 1 cm length
oesophagus—dysplasia of Barrett’s mucosa. Targeted biopsies of
abnormal mucosa
Eosinophilic At least two biopsies from mid-oesophagus
oesophagitis and from lower oesophagus
Targeted biopsies of abnormal mucosa
Infectious oesophagitis Targeted biopsies of abnormal mucosa or
the edge of an ulcer
Stomach Gastritis—standard Updated Sydney Protocol:
five biopsies: one from the antrum 2–3 cm
from the pylorus lesser curvature, one from
the antrum 2–3 cm from the pylorus
greater curvature, one from the corpus
8 cm from the cardia lesser curvature, one
from the corpus 8 cm from the cardia
greater curvature, one from the angularis
Targeted biopsies of any erosion, polyps,
possible intestinal metaplasia, mass lesions
Ulceration Biopsies of base and edge
Small intestine Possible coeliac disease Five to six biopsies throughout the
duodenum. Should include the duodenal
bulb
Large intestine Microscopic colitis ≥2 biopsies from right colon
≥2 biopsies from left colon
Inflammatory bowel Pancolitis: four-quadrant biopsies every
disease—screening for 10 cm from the cecum to the rectum, for a
dysplasia minimum total 33 biopsy samples
OR
Targeted biopsies performed with the aid
of methylene blue chromoendoscopy
Table adapted from the Standards of Practice Committee of the American
Society for Gastrointestinal Endoscopy (GASTROINTESTINAL ENDOSCOPY
Vol. 78, No. 2: 2013)
Perth, Australia M. Priyanthi Kumarasinghe, MBBS, MD, FRCPA
Kelvin Grove, Australia Ian Brown, MBBS, BGEN, FRCPA
Contents
Part I Introduction
1 Pathological Reaction Pattern Approach to Biopsies
of the Gastrointestinal Tract: Oesophagus/Stomach/Small
Intestine/Large Intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Ian Brown and M. Priyanthi Kumarasinghe
Part II Oesophagus
2 Oesophagus: Inflammatory Patterns . . . . . . . . . . . . . . . . . . . . . 25
Mahsa S. Ahadi, Anthony J. Gill, John R. Turchini,
Spiro C. Raftopoulos, and M. Priyanthi Kumarasinghe
3 Oesophagus: Neoplastic Patterns and Mimics . . . . . . . . . . . . . . 69
M. Priyanthi Kumarasinghe, Benjamin M. Allanson,
Spiro C. Raftopoulos, and Gregory Y. Lauwers
Part III Stomach
4 Stomach: Inflammatory Patterns . . . . . . . . . . . . . . . . . . . . . . . . 115
M. Priyanthi Kumarasinghe, Spiro C. Raftopoulos,
and Gregory Y. Lauwers
5 Stomach: Neoplastic Patterns and Mimics . . . . . . . . . . . . . . . . . 157
Tetsuo Ushiku, Spiro C. Raftopoulos, Gregory Y. Lauwers,
and M. Priyanthi Kumarasinghe
Part IV S mall Intestine
6 Proximal Small Intestine: Inflammatory Patterns. . . . . . . . . . . 191
Ian Brown
7 Proximal Small Intestine: Neoplastic Patterns and Mimics . . . 215
Ian Brown
ix
x Contents
8 Terminal Ileum: Inflammatory Patterns . . . . . . . . . . . . . . . . . . 241
Ian Brown
9 Terminal Ileum: Neoplastic Pattern and Mimics . . . . . . . . . . . . 249
Ian Brown
Part V L arge Intestine
10 Large Intestine: Inflammatory Patterns . . . . . . . . . . . . . . . . . . . 259
Ian Brown and Gregory C. Miller
11 Large Intestine: Neoplastic Patterns and Mimics . . . . . . . . . . . 283
Ian Brown and Gregory C. Miller
12 Molecular Testing in Colorectal Carcinoma . . . . . . . . . . . . . . . . 299
Connull Leslie, M. Priyanthi Kumarasinghe, and Ian Brown
13 Overview of Endoscopic Features of Gastrointestinal
Pathology (Colon) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Ammar O. Kheir, Nicholas J. Tutticci, and David G. Hewett
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Editors and Contributors
Editors
M.  Priyanthi  Kumarasinghe, MBBS, MD, FRCPA Department of
Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre
and University of Western Australia, Perth, WA, Australia
Ian Brown, MBBS, BGEN, FRCPA Envoi Pathology, Kelvin Grove, QLD,
Australia
Contributors
Mahsa S. Ahadi, MD, FRCPA Department of Anatomical Pathology, Royal
North Shore Hospital, University of Sydney, St. Leonards, NSW, Australia
Benjamin M. Allanson, MBBS Department of Tissue Pathology and
Diagnostic Oncology, Royal Prince Alfred Hospital and School of Pathology
and Laboratory Medicine, Sydney, NSW, Australia
University of Western Australia, Perth, Australia
Anthony J. Gill, MD, FRCPA Cancer Diagnosis and Pathology Group,
Kolling Institute of Medical Research, Royal North Shore Hospital, University
of Sydney, St. Leonards, NSW, Australia
David  G.  Hewett, MBBS, MSc, PhD, FRACP Faculty of Medicine,
University of Queensland, Brisbane, QLD, Australia
Department of Endoscopy, Queen Elizabeth II Jubilee Hospital, Brisbane,
QLD, Australia
Ammar O. Kheir, MBBS, MRCP, FRACP Faculty of Medicine, University
of Queensland, Brisbane, QLD, Australia
Department of Endoscopy, Queen Elizabeth II Jubilee Hospital, Brisbane,
QLD, Australia
Gregory Y. Lauwers, MD Gastrointestinal Pathology Service, Department
of Pathology, Moffitt Cancer Center, Tampa, FL, USA
xi