ON
B
Cytology of Other Body Sites
chapter
1 4
Alimentary Tract (Esophagus, Stomach, Small
Intestine, Colon, Rectum, Anus, Biliary Tract)
Simon Bergman and Kim R. Geisinger
Contents
In tro d u c tio n
D u o d e n u m
S p e c im e n C o lle c tio n a n d P re p a ra tio n
N o r m a l H is t o lo g y a n d C y t o lo g y
O v e rv ie w o f G a s tro in te s tin a l E p ith e lia l R e p a ra tiv e A ty p ia
I n f e c tio n s
p e p tic U lc e r
E s o p h a g u s
A d e n o c a r c in o m a
N o r m a l H is t o lo g y a n d C y t o lo g y
M a lig n a n t L y m p h o m a
I n fe c tio u s E s o p h a g itis
M e ta s ta tic T u m o r s
R a d ia tio n a n d C h e m o th e r a p y - A s s o c ia t e d E s o p h a g itis
L a r g e In te stin e
G a s tr o e s o p h a g e a l R e flu x D is e a s e
N o r m a l H is t o lo g y a n d C y t o lo g y
B a rre tt's E s o p h a g u s
C h r o n ic I n f la m m a t o t
y
B o w e l D is e a s e
S q u a m o u s C e ll C a r c in o m a
A d e n o m a s a n d A d e n o c a r c in o m a
S m a ll- C e ll C a r c in o m a
A n u s
M is c e lla n e o u s M a lig n a n t N e o p la s m s
N o r m a l H is t o lo g y a n d C y t o lo g y
S t o m a c h
S q u a m o u s C e ll L e s io n s
N o r m a l H is t o lo g y a n d C y t o lo g y
B ilia ry T r a c t
O v e r v ie w o f G a s t r it is
N o r m a l H is t o lo g y a n d C y t o lo g y
H e lico b a cte r-A sso cia te d
G a s t r it is
p e p tic U lc e r D is e a s e
C o n c lu d in g R e m a rk s
A tr o p h ic G a s t r it is
C h e m o th e r a p y - A s s o c ia t e d A t y p ia
p o ly p s
A d e n o c a r c in o m a
M a lig n a n t L y m p h o m a
S t r o m a l N e o p la s m s
C a rc in o id T u m o r ( E n d o c r in e T u m o r s )
M is c e lla n e o u s L e s io n s
Introduction
by the brush is intrinsically more thorough. Most submucosal
The digestive system is an integrated collection of anatomically
and physiologically distinct organs and structures. They may
be involved by a large number of important inflammatory and
neoplastic diseases, most of which have been well characterized
histologically. Yet, the key features of many of these entities is
less widely recognized, despite the fact that the majority of
clinically significant disorders originate in or are concentrated
within the mucosa. With the development and widespread
usage of the flexible fiberoptic endoscope, the diagnostic value
of GI cytology has had a rebirth.1,2 This is even truer with the
advent of endoscopic ultrasound-directed aspirates of sub-
mucosally based mass lesions, which are readily sampled by
brushings.
Exfoliative and aspiration cytology enjoy several advantages
not equally possessed by tissue biopsies.1-5 One of the more
important of these is that the endoscopic brush may retrieve
epithelial cells from a much larger surface area of the mucosa.
Even when a large number of biopsies are obtained, sampling
lesions cannot be sampled well by biopsy forceps, whereas they
are quite accessible by aspiration biopsy.
A basic tenet of exfoliative cytology is that malignant cells
possess a lower level of intercellular cohesion than do normal
cells. Thus, brushing should selectively sample these dyshesive
elements.2 This property is not shared by biopsies. Another
advantage is in the evaluation of stenotic lesions, as the brush
has much greater accessibility to the neoplasm than do biopsy
forceps, especially true in the region of the gastroesophageal
junction.
Another advantage is the relatively lower expense of cytol-
ogy. This is especially important in surveillance programs in
which numerous endoscopic biopsies may be procured.6,7 In a
much more common situation of evaluating patients with GI
symptoms or signs, cytologic sampling may also significantly
reduce the overall costs. As is emphasized later, the procure-
ment of both biopsies and cytologic samples during the same
endoscopic session significantly improves the overall diagnostic
yield. If only biopsies are obtained and a diagnosis sufficient
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