Gastrointestinal Pathology. Correlative Endoscopic and Histologic Assessment

375 Pages·2021·32.979 MB·English

by  Gregory Y. Lauwers, Michael B. Wallace, Till S. Clauditz

Gastrointestinal Pathology
Gastrointestinal Pathology
Correlative Endoscopic and
Histologic Assessment
Edited by
Gregory Y. Lauwers, MD, FAGPS
Senior Member and Director, Gastrointestinal Pathology Service
Department of Pathology, Moffitt Cancer Center
Professor, Departments of Pathology and Cell Biology and Oncologic Sciences
University of South Florida
Tampa, FL, USA
Michael B. Wallace, MD, MPH
Consultant – Gastroenterology and Hepatology
Fred C. Andersen Professor of Medicine, Mayo Clinic School of Medicine
Jacksonville, FL, USA
Associate Editor:
Till S. Clauditz, MD
Associate Professor, Head of Gastrointestinal Pathology Service
Department of Pathology with Section Molecular Pathology and Cytology
University Medical Center Hamburg-Eppendorf,
Hamburg, Germany
This edition first published 2021
© 2021 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material
from this title is available at http://www.wiley.com/go/permissions.
The right of Gregory Y. Lauwers and Michael B Wallace to be identified as the authors of the editorial material in this work has been asserted in
accordance with law.
Registered Offices
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Office
9600 Garsington Road, Oxford, OX4 2DQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print-on-demand. Some content that appears in standard print versions
of this book may not be available in other formats.
Limit of Liability/Disclaimer of Warranty
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and
should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient.
In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating
to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert
or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and
for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no
representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties,
including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or
extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or
product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors
endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with
the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be
suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this
work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be
liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging-in-Publication Data applied for
HB ISBN: 9780470658369
Cover Design: Wiley
Cover Images: © Gregory Y. Lauwers and Michael B. Wallace
Set in 9.5/12.5pt STIXTwoText by SPi Global, Pondicherry, India
10 9 8 7 6 5 4 3 2 1
v
Contents
List of Contributors vii
1 General Principles of Biopsy Diagnosis of GI Disorders 1
Herbert C. Wolfen, Michael B. Wallace, Naohisa Yahaghi and Yutaka Saito
2 Esophagus Inflammatory Conditions 11
Anthony R. Mattia, Gregory Y. Lauwers, Michael B. Wallace and Till S. Clauditz
3 Epithelial Metaplastic, Polypoid, and Neoplastic Conditions of the Esophagus 35
Till S. Clauditz, Gregory Y. Lauwers, Michael B. Wallace and Anthony R. Mattia
4 Inflammatory Disorders of the Stomach 73
Till S. Clauditz , Michael B. Wallace and Gregory Y. Lauwers
5 Polyps of the Stomach 99
K. Kim, Till S. Clauditz, Jun Haeng Lee and Gregory Y. Lauwers
6 Gastric Neoplastic Conditions: Precursor Lesions and Early Gastric Cancer 125
Till S. Clauditz and Gregory Y. Lauwers
Gastric Neoplastic Conditions: Lymphoid Lesions of the Stomach 142
Mounir Trimeche and Laurence de Leval
7 Inflammatory and Miscellaneous Conditions of the Small Intestine 161
Ian Brown and Michael B. Wallace
8 Polyps of the Small Intestine 195
Ian Brown and Michael B. Wallace
9 Epithelial and Nonepithelial Neoplasms of the Small Intestine 209
Ian Brown, Michael B. Wallace and Till S. Clauditz
10 Inflammatory Conditions of the Colon 235
Tze Sheng Khor, Till S. Claudtiz, Bence Kővári, Gregory Y. Lauwers, Michael B. Wallace and Priyanthi Kumarasinghe
11 Polyps of the Large Intestine 307
Christophe Rosty, Michael B. Wallace and Till S. Clauditz
vi Contents
12 Epithelial Neoplasms of the Large Bowel 321
Christophe Rosty, Michael B. Wallace and Till S. Clauditz
13 Inflammatory Conditions of the Anus 337
Thomas Arnason and Michael B. Wallace
14 Polyps and Neoplastic Lesions of the Anus 349
Thomas Arnason, Michael B. Wallace and Till S. Clauditz
Index 369
vii
List of Contributors
Thomas Arnason Gregory Y. Lauwers
Queen Elizabeth II Health Sciences Centre and Moffitt Cancer Center
Dalhousie University Tampa
Halifax Florida
Nova Scotia USA
Canada
Jun Haeng Lee
Ian Brown Samsung Medical Center
Envoi Specialist Pathologists Sungkyunkwan University School of Medicine
Brisbane Seoul
Australia South Korea
Till S. Clauditz Laurence de Leval
Department of Pathology Institute of Pathology
University-Medical-Center University of Lausanne
Hamburg Lausanne
Germany Switzerland
Tze Sheng Khor Anthony R. Mattia
PathWest Laboratory Medicine Newton-Wellesley Hospital
Queen Elizabeth II Medical Centre Newton, MA
Nedlands USA
Western Australia
Christophe Rosty
Australia
Envoi Specialist Pathologists
K. Kim Brisbane
Queensland
Samsung Medical Center
Australia
Sungkyunkwan University School of Medicine
Seoul
Yutaka Saito
South Korea
National Cancer Center
Tokyo Japan
Bence Kővári
Department of Pathology
Mounir Trimeche
University of Szeged
Institute of Pathology
Szeged
University of Lausanne
Hungary
Lausanne
Switzerland
Priyanthi Kumarasinghe
Department of Anatomical Pathology Michael B. Wallace
PathWest, QE II Medical Centre Mayo Clinic
Univ. of Western Australia Jacksonville
Perth Florida
Australia USA
viii List of Contributors
Herbert C. Wolfen Naohisa Yahaghi
Mayo Clinic Keio University Cancer Center
Jacksonville Tokyo
Florida Japan
USA
1
1
General Principles of Biopsy Diagnosis of GI Disorders
Herbert C. Wolfen1, Michael B. Wallace1, Naohisa Yahaghi2 and Yutaka Saito3
1 Mayo Clinic, Jacksonville, Florida, USA
2 Keio University Cancer Center, Tokyo, Japan
3 National Cancer Center, Tokyo Japan
Tissue sampling of the gastrointestinal tract at the time of ­Endoscopic­Equipment­for Tissue­
endoscopy is the cornerstone of many gastrointestinal Sampling
diagnoses. The development of a flexible endoscope and
the subsequent ability to directly acquire tissue under
Modern endoscopic equipment can be divided in two gen-
optical guidance has been one of the most important
eral categories: the endoscope that allows access to the gas-
advancements in the field of gastroenterology throughout
trointestinal tract and accessory devices that are typically
its history. Although tissue sampling can be performed
passed through the working channel of the endoscope to
through nonendoscopic devices, the ability to directly cor-
directly acquire tissue, including biopsy forceps, snares,
relate precise locations and target biopsies to specific areas
fine-needle aspiration devices, and cytology brushes.
of disease is critical to our ability to diagnose and further
Recent developments in tissue sampling include devices
understand gastrointestinal pathology. Many of the
that are capable of wide-field, often definitive, endoscopic
advancements in our understanding of the basic pathol-
resection of early neoplasia and invasive carcinoma.
ogy and molecular biology of gastrointestinal disease can
A modern endoscope is a remarkably robust and versa-
be directly attributed to our ability to acquire tissue for
tile instrument including a light source, optical lenses with
histological, molecular, and genetic analyses. An excellent
a video capture device, image processing, and display
example is our deep understanding of the molecular
equipment, and importantly for the purposes of tissue
pathology of colorectal cancer development from normal
acquisition, an accessory channel ranging from 1 to 6 mm
colonic epithelium to adenoma to colorectal cancer, a dis-
(typically 3–4 mm), which allows passage of devices for
covery made possible because of colonoscopic access to
mechanical collection of tissue (Figures 1.1 and 1.2).
precursor lesions such as adenomatous polyps and early
There is a general trade-off between the diameter of the
cancers.
instrument and the ease and comfort with which it can be
In this chapter, we will review general principles of tissue
passed through the natural orifices of the body such as the
acquisition at the time of endoscopy including the following
mouth and anus. In general the larger the outer diameter,
topics:
the larger the accessory channel is to accommodate larger
● Endoscopic equipment for obtaining tissue including instruments for tissue acquisition. A fundamental limita-
endoscopic accessory channels, biopsy forceps, snare tion of most flexible endoscopes, as opposed to surgical
devices, needle aspiration and cytology brush. instruments, is that all accessories pass through a single
● General principles of optimal sampling technique. access point of the endoscope. As compared to surgical
● Methods of tissue preparation in the endoscopy labora- instruments with multiple access points, the endoscopic
tory to optimize diagnostic accuracy. devices do not typically allow triangulation to acquire a
● The role of endoscopic ultrasound (EUS)-guided fine- large bulk tissue or resect entire organs. For this reason,
needle aspiration cytology. most tissue is sampled through pinch forceps, needle
Gastrointestinal Pathology: Correlative Endoscopic and Histologic Assessment, First Edition. Edited by Gregory Y. Lauwers and Michael B. Wallace.
© 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd.
2 General Principles of Biopsy Diagnosis of GI Disorders
aspiration, or wire loop snare devices. More recently, elec-
trosurgical needles and other cutting tools have been
developed, which have allowed wide-field resection of tis-
sues of virtually any diameter (Figure 1.3).
Pinch Biopsy Forceps
The flexible pinch biopsy forceps have been one of the
most versatile of all instruments for tissue acquisition.
These typically involve a flexible steel cable and lever
device with two sharp-edged cups, which can be opened
and closed to acquire tissue (Figure 1.4).
Standard endoscopic sampling typically acquires tissue
from the mucosa and occasionally a submucosal depth of
Figure 1.1 Endoscope with control handle and tip. The tip
contains a light source, imaging window, and accessory channel the intestinal wall; however, large-capacity forceps as
through which various tissue acquisition devices can be passed. well as multiple sampling including “bite on bite” allow
sampling of the deeper layers. Pinch biopsy forceps come
in multiple sizes from very small instruments such as a
pediatric forceps, which can be passed through very
small working channels. Recent development of very
tiny forceps makes it possible to pass them through spe-
cial endoscopes into the bile or pancreas duct and to
pinch biopsy outside of the traditional gastrointestinal
lumen (Figure 1.5).
Studies comparing jumbo forceps to standard forceps
have generally not shown significant advantages of larger
capacity forceps. A limitation of most forceps is the ina-
bility to sample tissue in the submucosa routinely. This is
highlighted in studies looking for Barrett’s esophagus
after the surface epithelium has been ablated. Biopsy for-
ceps can remove tissue with mechanical closure alone or
with electrocautery (“hot biopsy”) although the use of
hot biopsy has diminished significantly due to increased
Figure 1.2 Endoscopic processor, which converts the light
captured from the endoscope tip into a visible image for display. risks of complication and tissue damage in the biopsy
Source: Olympus America, Inc. With permission. specimen.
(a) (b) (c) (d) (e)
Jet B knife IT knife nano CO2 insufflator ST hood short type MucoUp
Zeon medical Olympus medical Olympus Medical Fujifilm medical Johnson and Johnson
Figure 1.3 (a) Tools for performing endoscopic resection including endoscopic submucosal dissection (ESD). Source: Zeon Medical.
(b) Standard and insulated tip electrocautery knives for incision and dissection. Source: © 2017 Korean Society of Gastrointestinal
Endoscopy. (c) CO insufflator for luminal distension, which is preferred to air given rapid reabsorption. Source: Olympus. (d) Distal
2
attachment hood to facilitate maintaining view within the submucosal space. Source: Fujifilm medical. (e) Injection fluid (hyaluronic
acid; Mucoup [Johnson and Johnson]) for submucosal lifting. Source: Gut and Liver.
­ndoscopicBrushCytology 3
Figure 1.4 Endoscopic biopsy forceps in the open position. The
needle-like pin in the center holds the tissue in place so one to
two samples can be obtained per pass.
Figure 1.6 Endoscopic snare for polypectomy. The wire loop is
extended in the open position outside the plastic sheath. When
closed, the wire loop is strangulated and resects the polyp
tissue.
Figure 1.7 Endoscopic cytology brush. Note the abrasive brush
Figure 1.5 Micro biopsy forceps <1 mm in diameter, which can
extended beyond the protective plastic sheath.
be passed through specialized endoscopes into the bile duct,
pancreas duct, or via 19-gauge needles for extraluminal tissue
sampling. Source: Boston Scientific Corporation with permission. oval, hexagonal, and asymmetric “duck bill.” Snares also
come in various degrees of stiffness, which allow resection
Endoscopic Snare Devices of lesions of many shapes and sizes. Tissue can be resected
with mechanical closure alone (so-called “cold snare”) or
Endoscopic snare devices have also been widely used for with mechanical plus electrosurgical cutting (“hot snare”).
resection of polypoid as well as flat lesions throughout the Recent studies suggest that cold snare is associated with
gastrointestinal tract. They have been remarkably versatile lower risk of bleeding and bowel wall injury.
and effective over the past four decades. Endoscopic snares
typically involve a metallic wire, which may braided or
E ndoscopic Brush Cytology
monofilament (Figure 1.6).
A wire loop is generally constrained within a small caliber
plastic catheter. At the distal end of the catheter, the wire Abrasive brush cytology has been used in many different
loop can be opened to various sizes to grasp and resect pol- fields of tissue sampling. Typical endoscopic brush is con-
yps of different sizes. Typical sizes include loops 5–30 mm strained within a plastic catheter similar to endoscopic
in diameter. There are numerous different shapes including snares (Figure 1.7).