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Upper ALIMENTARY tract

Pathology of the ALIMENTARY TRACT Department of Pathology Gadjah Mada University School of Medicine. Upper ALIMENTARY tract. I. Diseases of the Mouth & Jaw A. Congenital Disorders B. Inflammatory disorders C. Tumors and tumor-like conditions II. Diseases of the Salivary Glands

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Upper ALIMENTARY tract

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  1. Pathology of theALIMENTARY TRACTDepartment of PathologyGadjah Mada University School of Medicine

  2. Upper ALIMENTARY tract I. Diseases of the Mouth & Jaw A. Congenital Disorders B. Inflammatory disorders C. Tumors and tumor-like conditions II. Diseases of the Salivary Glands A. Sialadenitis B. Acute parotitis C. Sjogren syndrome D. Mucocele E. Ranula F. Tumors of the salivary gland III. Diseases of the Esophagus A.Tracheoesophageal fistula B. Esophageal diverticula C. Achalasia D. Esophageal varices E. Hiatus hernia F. Inflammatory and related disorders of the esophagus G. Carcinoma of the esophagus

  3. I.A. CONGENITAL DISORDERS • SCHISIS / CLEFT MICROGNATHIA • * Failure of mesodermal penetrance between • the maxillary, median nasal, and lateral nasal. • - Unilateral/ Bilateral • - Simplex/ complex: Labioschisis • Labiognatoschisis • Labiognatopalatoschisis • Oblique facial clef • - Sporadic/ congenital • - May be it is associated with other anomalies

  4. TONGUE CONGENITAL DISORDER OF THE TONGUE MICROGLOSSI MACROGLOSSI MEDIAN RHOMBOID GLOSSITIS TIE TONGUE BIFID TONGUE

  5. I.B. INFLAMMATORY DISORDERS 1. Herpes Labialis - most common lesion caused by HSV (HSV-1) - tends to recur, with activation by febrile illness, trauma, sunshine, menstruation 2. Aphthous stomatitis - characterized by painful, recurrent, erosive oral ulceration 3. Oral candidiasis (thrush, moniliasis) - local lesion, white, membranous, caused by Candida albicans - occurs most commonly in debilitated infants and children, immunocompromized patient, and diabetics 4. Acute necrotizing ulcerative gingivitis (trench mouth, Vincent infection, fusospirochetosis) - severe gingival inflammation occuring in patient with decresed resistance to infection - due to concurrent infection with symbiotic bacteria (Fusobacterium species and Borrelia vincentii)

  6. INFALAMMATORY DISORDERS Aphthous stomatitis

  7. GLOSSITIS Geographic tongue Hairry tongue Glositis tuberculosa Glositis luetica

  8. I.C. TUMORS & TUMOR-LIKE CONDITIONS 1. Benign tumors of the oral mucosa a. Papilloma:the most common benign epithelial oral mucosal tumor  tongue, lips, gingivae, buccal b. Fibroma:it is often a non-neoplastic hyperplastic lesion due to chronic irritation c. Hemangioma:tongue, lips, buccal mucosa d. Epulis: any abnormal swelling of the gingiva, as a reparative growth rather than a true neoplasm 2. Leukoplakia: - clinical term describing irregular white mucosal patches - pre-cancer

  9. Reparative lesion: EPULIS • Excessive reparative process • Granulomatous epulis • Fibromatous epulis • Giant cell epulis • Haemangioform epulis • Pregnancy epulis

  10. I.C. TUMORS & TUMOR-LIKE CONDITIONS 3. Odontogenic tumors a. Odontoma:hamartoma derived from odontoblastic epithelium b. Ameloblastoma: - epithelial tumor arising from precursor cells of the enamel organ - usually before age 35, and most fequently in mandible - irregular local extension 4. Oral cancer - mostly squamous cell carcinoma - often associated with abuse of tobacco and alcohol - may be associated with irritants: pipe smoking, chewing tobacco or betel nuts

  11. LEUKOPLAKIA - white patches of keratosis - premalignant lesion - hyperkeratosis, hyperplasia of the squamous epithelium - dysplastic changes SQUAMOUS CELL CARCINOMA

  12. Pharynx & Tonsil • Pharyngitis • Viral pharyngitis: common feature of the CC, influenza, measles, etc • -Streptococcal pharyngitis: less common but more important than viral • pharyngitis because the complication  rheumatic fever, acute • proliferative glomerulonephritis, Henoch Schonlein purpura • -Ulcerative pharyngitis & tonsillitis diphtheria • Tonsilitis: • -Follicular tonsilitis, streptococcus/ Borrelia / virus • -Parenkhimal tonsilitis: quincy, Peritonsiler abses • -Angina agranulositic netropenic • -Tonsilitis morbili: Warthin Finkeldey giant cells Malignant tumors: NPC, squamous cell ca, lymphoma

  13. II. Diseases of the SALIVARY GLAND • Sialadenitis • Mucocele • Ranula • Tumors Pleomorphic adenoma (Mixed tumor) Warthin tumor / adenolymphoma / Papillary cystadenoma lymphomatosum Oncocytoma Adenoid cystic carcinoma Mucoepidermoid tumor

  14. II. A. Sialadenitis Acute - Suppurative parotitis - Non-suppurative parotitis - Parotitis epidemica / Mumps: paramyxovirus  Orchitis/ Oophoritis - Cytomegalic inclusion disease Chronic 1. SJOGREN’S SYNDROME : - Autoimmune disease - Keratoconjungtivitis sicca - Xerostomia - Parotitis hyperplasia 2. MIKULICZ SYNDROME : - Idiophatic - Keratoconjungtivitis sicca - Xerostomia - Unilateral parotitis hyperplasia

  15. Mucocele • A cyst-like pool of mucus, lined by granulation tissue, near a minor salivary gland • Results from mucus leakage caused by rupture of obstructed or traumatized ducts Ranula • Is a large mucocele, of salivary gland of origin, characteristically localized to the floor of the mouth

  16. Tumors of the Salivary Glands 1. Pleomorphic adenoma (Mixed tumor) 2. Warthin tumor / adenolymphoma / Papillary cystadenoma lymphomatosum 3. Oncocytoma 4. Adenoid cystic carcinoma 5. Mucoepidermoid tumor

  17. Anatomy of parotid gland

  18. Anatomy of parotid gland

  19. Pleomorphic adenoma (parotid)

  20. Pleomorphic adenoma (gross)

  21. Pleomorphic adenoma

  22. Pleomorphic adenoma

  23. Warthin tumor Benign tumor mostly occur in parotid gland

  24. Warthin tumor Cystic spaces lined by double-layered eosinophilic epithelium, and all embedded in lymphoid stroma

  25. Oncocytoma Mostly in parotid gland

  26. Oncocytoma Large granular appearing, eosinophilic-staining epithelial cells

  27. Adenoid cystic carcinoma Minor salivary gland

  28. Adenoid cystic carcinoma

  29. Adenoid cystic carcinoma Most characteristic appearance consists of cribriform pattern with masses of small, dark-staining cells arrayed arround cystic spaces

  30. Adenoid cystic carcinoma

  31. Mucoepidermoid tumor(Palatal gland) Mostly in parotid gland

  32. Mucoepidermoid tumor(Low grade) Comprised of mucus-producing and epidermoid omponents and cells intermediate between the two

  33. Mucoepidermoid tumor(moderate grade)

  34. Mucoepidermoid tumor(High grade)

  35. III. Diseases of the EsophagusA.1. Tracheoesophageal fistula Congenital disorder, is suggested in a newborn by copious salivation associated with choking, coughing, and cyanosis on attempts at food intake The most common variant (90%),the lower portion of the esophagus communicates With the trachea near the tracheal bifurcation, the upper esophagus ends in a blind pouch Associated abnormality: maternal polyhydramnion The second most common variant, fistulous connection between the upper esophagus and the trachea; the lower esophageal segment is not connected to the upper esophagus The third variant, fistulous connection between the tachea and a completely patent esophagus

  36. III. Diseases of the EsophagusA.2. Heterotopic tissue • patches of fundic-type gastric mucosa are occasionally found above the distal sphincter separated from the columnar lining of the distal esophagus • congenitally misplaced gastric tissue (heterotopic)  can lead to ulceration and stricturing due to local acid/pepsin secretion

  37. III. Diseases of the EsophagusB. Esophageal diverticula • - Outpouchings of the wall of hollow viscus • - herniation of the mucosa or full thickness • - effects: dysphagia, diverticulitis • - pharyngoesophageal diverticula • Traction: external forces pulling on the wall • (true divericula) • Pulsion: forcible distention (false diverticula): • result from periesophageal inflammation and • scarring

  38. III. Diseases of the EsophagusC. Achalasia • Contractility of the lower esophagus is lost and • there is failure of relaxation at the sphincter • (cardiospasm) • -Mechanism: fibrosis and atrophy of smooth muscle • (reduced number number of ganglion cells in the • myenteric plexus: Chagas’ disease & other • unknown etiology). • -Clinically:slowing / retention of the food  • dilatation  dysphagia

  39. III. Diseases of the Esophagus D. Esophageal varices • Localized dilatation of veins • Portal hypertension • cirrhosis hepatis • - Haematemesis

  40. III. Diseases of the esophagus E. HIATUS HERNIA The presence of part of the stomach above the diaphragmatic orifice, mostly acquired Increased intra-abdominal pressure and loss of diaphragmatic muscular tone with aging  herniation of the stomach and subsequent retraction of the esophagus.

  41. III. Diseases of the EsophagusF. Inflammatory and related disorders of the esophagus 1. Gastroesophageal reflux 2. Barret’s esophagus 3. Candida esophagitis 4. Viral esophagitis 5. Esophageal stricture

  42. III. Diseases of the EsophagusF. 1. Gastroesophageal reflux • Reflux of gastric acid contents into the esophagus  esophagitis, stricture, ulceation, or columnar metaplasia (Barret’s esophagus) • Usually characterized by burning pain (often manifests by substernal pain or heartburn) relieved by antacids • Often precipitated by assuming recumbent position • Associated: - most commonly with hiatal hernia and incompetent lower esophageal sphincter - with excessive use of alcohol & tobacco, and with increased gastric volume - with pregnancy and scleroderma

  43. III. Diseases of the Esophagus F.2. BARRET’S ESOPHAGUS Columnar metaplasia (often of intestinal type with prominent goblet cells) of esophageal squamous epithelium. Complication of long-standing gastroesophageal reflux, to be a well-known precursor of esophageal adenocarcinoma

  44. III. Diseases of the EsophagusF. 3. Candida esophagitis • Etiology: Candida (Monilia) albicans • Manifest clinically by white adherent mucosal patches and painful, difficult swallowing • Often assciated with: - antibiotic therapy - diabetes mellitus - malignancy - immunodeficiency

  45. III. Diseases of the EsophagusF. 4.a. Viral esophagitis Herpetic esophagitis • Characterized by painful and difficult swallowing • Tends to occur in immunosuppressed patient, caused by HSV-1 infection Cytomegalovirus (CMV) infection • Less common

  46. III. Diseases of the EsophagusF. 4.b. Other esophagitis Less common form of esophagitis Caused by: uremia, radiation therapy, graft-versus-host (GVH) disease

  47. III. Diseases of the EsophagusF. 5. Esophageal stricture Most often results from prolonged esophageal gastric acid reflux May also be caused by suicidal or accidental ingestion of corrosive agent (acid or alkaline)

  48. III. Diseases of the EsophagusG. Carcinoma of the esophagus Aggressive tumor manifest clinically by dysphagia, weight loss, and anorexia, and occasionally by pain or hematemesis In the USA the incidence of SC and adenocarcinoma are equal May be manifest pathologically by protrusion into the esophageal lumen Spread by local extension to adjacent structure: trachea, bronchi, aorta, or diffuse infiltration into esohageal wall

  49. III. Diseases of the EsophagusG.1. Squamous Cell Carcinoma Arises most frequently in the upper and middle thirds of the esophagus

  50. III. Diseases of the EsophagusG2. Adenocarcinoma Arises most frequently in the lower third, and mostly from aberrant gastric mucosa or Barret’s esophagus

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