Endoscopic Biopsy Interpretation: A Practical Guide PDF
Preview Endoscopic Biopsy Interpretation: A Practical Guide
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 © Springer International Publishing AG, part of Springer Nature 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer Nature Switzerland AG. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland 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
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