290
UNIT 3
Organ Systems
CLINICAL CORRELATIONS
Figure 15-8B.
Gastric Ulcer (Peptic Ulcer).
H&E,
3
19
Peptic ulcers
are
chronic mucosal lesions
that occur in the gastro-
intestinal tract. The
duodenum
and
stomach
are the most common
sites for
ulcers
. Causes of these ulcers include
Helicobacter pylori
infection, long-term use of nonsteroidal anti-infl
ammatory drugs
and corticosteroids, and cigarette smoking. Epigastric burning or
pain, bleeding, and even perforation are the common signs and
symptoms of the peptic ulcers. Morphologically, peptic ulcers are
usually small, round to oval in shape, less than 4 cm in diameter with
well-deF
ned margins without elevation, and have a clean, smooth
base. Histologically, a thin layer of
necrotic f
brinoid debris
with
neutrophil inf ltration
is seen, beneath which lies
granulation tis-
sue
. Treatments include using H
2
receptor antagonists; antibiotics;
proton pump inhibitors; and surgery for severe, refractory cases.
Care must be taken to differentiate benign ulcers from malignant
adenocarcinomas, which may appear ulcerated. This image shows
the transition from gastric mucosa to ulcer, showing a
f brinopuru-
lent
surface with underlying
granulation
tissue. The gastric mucosa
shows
chronic gastritis
with plasma cells within the lamina propria
and
intestinal metaplasia
(note the goblet cells).
Figure 15-8C.
Gastrinoma (Zollinger-Ellison Syndrome).
H&E,
3
97
Gastrinomas
, also called
Zollinger-Ellison syndrome
, are neoplasms
producing the hormone
gastrin
, which commonly arise in the
duo-
denum
and
pancreas
.
Hypersecretion
of
gastrin
by the tumor leads
to
hypergastrinemia
, resulting in excess production of
gastric acid
.
Patients have symptoms of peptic ulcers, with clinical F ndings, such
as
epigastric tenderness
, bleeding, and perforation. Pathologic F nd-
ings include
hyperplasia
of the
parietal cells
that produce gastric
acid within the mucosa of the
stomach
. Tumor cells resemble pan-
creatic endocrine cells, are well differentiated, and contain gastrin
peptides within the secretory granules. Proton pump inhibitors and
surgical removal of the tumor are the F rst treatment choice for this
syndrome. This image shows
normal pancreatic parenchyma
(
upper
portion
) and a well-circumscribed
gastrinoma
(
lower portion
). Note
the relatively uniform
neoplastic cells
within the gastrinoma.
Gastric mucosa
(with intestinal
metaplasia)
Chronic gastritis
Granulation
tissue
Fibrinopurulent
exudate (ulcer)
B
Normal
pancreatic
parenchyma
Gastrinoma
C
Figure 15-8A.
Pyloric region o± the stomach.
H&E,
3
68;
insets
3
283
The
pylorus
is the last region of the stomach and connects to the
duodenum. The mucosa of the pylorus has deep
gastric pits
.
Pyloric
glands
, composed primarily of
mucus-secreting cells
, empty their
secretory products into the base of the gastric pits. These mucus-
secreting cells are pale staining and have basally located nuclei, as
do the cells of the cardiac glands. They produce mucus to protect the
epithelium of the pylorus from acidic gastric secretions. Two types
of
enteroendocrine cells
are found at the base of the pyloric glands.
G cells
release
gastrin
, which stimulates parietal cells to secrete
HCl
.
Another type of enteroendocrine cell, called the
D cell
, releases
somatostatin
, which inhibits the release of
gastrin
by G cells. These
two types of enteroendocrine cells are also found in the mucosa of
the duodenum (see ±ig. 15-13B). The
upper inset
shows a
gastric
pit
and
sur±ace mucous cells
in the superior portion of the mucosa.
The
lower inset
shows
pyloric glands
and
mucus-secreting cells
in
an inferior portion of the mucosa. Both cell types have basally posi-
tioned nuclei and clear cytoplasm containing secretory granules.
Pyloric
Pyloric
glnads
glnads
Pyloric
glands
Muscularis
Muscularis
mucosae
mucosae
Muscularis
mucosae
Submucosa
Submucosa
Submucosa
Pyloric
Pyloric
glnads
glnads
Pyloric
glands
Surface
Surface
mucous cells
mucous cells
Surface
mucous cells
Mucus-secreting
Mucus-secreting
cells
cells
Mucus-secreting
cells
Gastric pits
Gastric pits
Gastric pits
Mucosa
Mucosa
Mucosa
Gastric pits
Gastric pits
Gastric pits
A
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