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Upper git and salivary gland

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Upper git and salivary gland

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Upper git and salivary gland

  1. 1. UPPER GIT AND SALIVARY GLAND Part - 1 DR. SHAMEERA
  2. 2. ORAL CAVITY
  3. 3. •A white patch or plaque that cannot be scraped off • Cannot be characterized as any other disease, clinically or pathologically (WHO) •Aged 40-70 years, •male •tobacco use, alcohol, ill-fitting dentures, chronic exposure of persistent irritants, HPV-16 PRE MALIGNANT LESIONS OF ORAL CAVITY LEUKOPLAKIA
  4. 4. LEUCOPLAKIA All leucoplakias are considered premalignant, until proved otherwise MICROSCOPY: Characterized by hyperkeratosis Acanthosis Variable dysplasia & inflammation
  5. 5. ERYTHROPLAKIA • Red, velvety, eroded area, level or depressed; associated with highly atypical epithelial changes with thin and atrophic epithelium & prominent vasculature
  6. 6. SQUAMOUS CELL CARCINOMA OF ORAL CAVITY • Usually ages 50-70 years • 90% men • Risk factors • Alcohol, chewing tobacco, marijuana, betel quid and paan (India) • Poor oral hygiene, sunlight • Family history of head and neck cancer
  7. 7. SQUAMOUS CELL CARCINOMA OF ORAL CAVITY What are the viral infections associated with SCC of oral cavity? • HPV infection • EBV infection
  8. 8. FAVOURED SITES OF SQUAMOUS CELL CARCINOMA
  9. 9. Squamous cell carcinoma • Favoured sites: Ventral surface of tongue, floor of the mouth, lower lip, soft palate, gingiva • Initially resemble leukoplakia, then form masses with necrosis, ulcers and rolled borders; induration is relatively specific for invasion • M/E: can be verrucous or well differentiated or anaplastic or sarcomatoid
  10. 10. Squamous cell carcinoma
  11. 11. CLASSIFICATION OF SALIVARY GLAND TUMORS
  12. 12. PLEOMORPHIC ADENOMA •Also called mixed tumors because of histological diversity •All the neoplastic elements are of either epithelial or myopeithelial reserve cell origin •Radiation exposure increases the risk
  13. 13. PLEOMORPHIC ADENOMA
  14. 14. PLEOMORPHIC ADENOMA - GROSS •Rounded, well-circumscribed masse < 6 cm. •Glistening in appearance because of presence of mucoid material •Capsule in some areas is not fully developed with tongue like extension of tumour into surrounding area
  15. 15. This mixed tumor of the parotid gland contains epithelial cells forming ducts and myxoid stroma that resembles cartilage MICROSCOPY •The neoplasm is a mixed proliferation of both ductal epithelium & mesenchymal component with a hyaline or chondroid or myxomatous stroma.
  16. 16. WARTHIN TUMOR • Benign neoplasm • Arises exclusively in the parotid gland • Smokers • 10% bilateral • 10% becomes malignant
  17. 17. OESOPHAGUS
  18. 18. BARRETT OESOPHAGUS • Chronic GERD can lead to glandular metaplasia of the lower oesophagus, known as Barrett oesophagus • Consist of transformation of squamous epithelium into columnar epithelium with many goblet cells • Virtually all adenocarcinomas of the oesophagus arise from Barrett epithelium
  19. 19. BARRETT OESOPHAGUS
  20. 20. Oesophageal tumors (a) Squamous cell carcinoma (b) Adenocarcinoma in the lower end of the oesophagus from: Barrett’s esophagus Risk factors GERD Tobacco use Radiation exposure
  21. 21. Adenocarcinoma of oesophagus
  22. 22. Squamous cell carcinoma of oesophagus
  23. 23. PEPTIC ULCER DISEASE • Refers to chronic mucosal ulceration with areas of degeneration and necrosis affecting the duodenum or stomach Risk factors • H. pylori infection • Cigarette use • NSAIDS / corticosteroids • Cocaine • Alcohol • Psychological stress
  24. 24. PEPTIC ULCER - GROSS • Gastric ulcers – pyloric antrum, posterior wall • Duodenal ulcers – first part, anterior • Round to oval, sharply punched-out defect with relatively straight walls • Margins are in level with the surrounding mucosa • Depth of these ulcers varies, from superficial lesions involving only the mucosa and muscularis mucosa to deeply excavated
  25. 25. • Base of a peptic ulcer is smooth and clean as a result of peptic digestion of exudate • Thrombosed or even patent blood vessels are evident in the base of the ulcer • Scarring may involve the entire thickness of the stomach; puckering of the surrounding mucosa creates mucosal folds that radiate from the crater in spoke like fashion • The gastric mucosa surrounding a gastric ulcer is edematous and reddened, owing to invariable gastritis
  26. 26. MICROSCOPY
  27. 27. H.pylori – Warthin – Starry silver stain
  28. 28. GASTRIC ADENOCARCINOMA • Most common malignancy in the stomach • Japan and South Korea have the highest incidence (20 fold higher)
  29. 29. FACTORS ASSOCIATED WITH INCREASED INCIDENCE OF GASTRIC CARCINOMA
  30. 30. MORPHOLOGY • Location of gastric carcinomas within the stomach is ▫ Pylorus and antrum, 50% to 60%; ▫ Cardia, 25%; and the remainder in the body and fundus. ▫ Lesser curvature is involved in about 40% and the greater curvature in 12%. • Favored location is the lesser curvature of the antropyloric region. • Though less frequent, an ulcerative lesion on the greater curvature is more likely to be malignant than benign.
  31. 31. LAUREN CLASSIFICATION OF GASTRIC CA Intestinal type • Those exhibiting an intestinal morphology with the formation of bulky tumors composed of glandular structures • predominates in high-risk areas, and develops from precursor lesions- intestinal metasplasia from chronic gastritis • mean age 55 years and a male- to-female ratio of 2:1. • Amplification of HER-2/NEU and increased expression of β- catenin are present in 20% to 30% Diffuse type • Those with diffuse, infiltrative growth of poorly differentiated discohesive malignant cells. • Incidence of the diffuse type is relatively constant, and the tumors have no identifiable precursor lesions. • Mean age, 48, with an approximately equal male-to- female ratio. • Loss of E-cadherin
  32. 32. GROSS
  33. 33. Gastric adenocarcinoma – Intestinal type an ill-defined, excavated central ulcer surrounded by irregular, heaped-up borders
  34. 34. Diffuse infiltrative type LINITIS PLASTICA
  35. 35. A, Intestinal type demonstrating gland formation by malignant cells, which are invading the muscular wall of the stomach. B, Diffuse type demonstrating signet-ring carcinoma cells
  36. 36. Metastasis • Supraclavicular sentinel lymph node – Virchow node • Periumbilical lymph nodes – Sister Mary Joseph nodes • Left axillary lymph node – Irish node • Ovary - Krukenberg tumor • Pouch of Douglas – Blumer shelf

Editor's Notes

  • ducts, tubules, strands or sheets of cells ---loose myxoid tissue,islands of cartilage
  • several tongues or patches of red, velevety mucosa
  • nitroso compounds
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