Histopathological spectrum of lesions in upper Gastrointestinal Endoscopic Biopsies: A single centre experience with review of literature

Dr Spoorthy Rekha YC; Dr Gale Kathleen.

Volume : IX, Issue : VIII, August - 2020

Histopathological spectrum of lesions in upper Gastrointestinal Endoscopic Biopsies: A single centre experience with review of literature

Dr Spoorthy Rekha Yc, Dr Gale Kathleen.

Abstract :

BACKGROUND: Upper gastrointestinal disorders are the most commonly encountered disorders in day to day clinical practice especially in general medical and gastrointestinal outpatient departments of developing countries. AIM: To evaluate the histopathological spectrum of lesions in upper GI endoscopic biopsies. MATERIALS AND METHODS: This retrospective study was conducted in the Department of histopathology at our referral laboratory in Bangalore. Endoscopic biopsies done for various upper gastrointestinal symptoms, received between August 2016 – August 2019 were included in the study. Sections of each case stained with Hematoxylin & Eosin(H&E)stain and Geimsa stain were examined. RESULTS: A total of 105 upper GI endoscopic histopathology samples were included in the study with the age range of patients being 20–85yrs with the mean age of presentation being 55.7yrs and the male to female ratio is 1.05:1. There were 13 (12.4%) oesophageal biopsies, of 6(46%) were histologically neoplastic comprising squamous cell carcinoma (SCC) and 02 (15.3%) were suspicious for carcinoma and the rest 01(7.6%) was a residual treated case of adenocarcinoma. There were 02(15.3%)cases of barrettes esophagus and 02(15.3%)cases of acute erosive esophagitis. 90 (85.7%) endoscopic biopsies from stomach were received, among them 71(78.1%) were benign non–neoplastic lesions and 19(20.9%) were malignant lesions. Of the benign non–neoplastic lesions 41(45.5%) comprised H.Pylori positive inflammatory lesions including chronic active gastritis 24(26.4%), acute active gastritis 04(4.4%), acute ulcerative gastritis 02(2.2%) and a hyperplastic polyp 01(1.1%). H.Pylori associated chronic active gastritis with mild dysplasia was seen in 05(5.5%)cases, moderate dysplasia 01(1.1%), severe dysplasia in 03(3.3%). Acute gastritis with associated mild dysplasia and H.Pylori had 01(1.1%) case. H.Pylori negative cases included 30(33%) cases comprising hyperplastic polyp 08(8.8%), chronic active gastritis 15(16.5%), acute active gastritis 02(2.2%) ,acute ulcer 03(3.3%)and suspicious for malignancy included 03(3.3%)cases. Malignant lesions of stomach comprised adenocarcinoma in 07(7.7%)cases, poorly differentiated carcinoma 08(8.8%), squamous cell carcinoma 01(1.1%), GIST 01(1.1%) and In–situ squamous cell carcinoma with associated H.Pylori in 01(1.1%) case. Duodenal mucosal biopsies included in the study were 02(1.9%) only, of which one case was chronic duodenitis with associated H.Pylori and the other being a benign hyperplastic polyp. CONCLUSION: In our study, the most common site for upper GI endoscopic biopsy was from the stomach comprising 85.8% cases followed by oesophagus and duodenum which is in concordance to many studies existing in literature from developing countries, possibly due to more stress related lifestyles and low socio–economic status contributing to more dyspeptic symptoms and gastric ulcers among patients attending routine out–patient departments. Endoscopy is incomplete without biopsy as histopathological evaluation is the gold standard for the diagnosis of endoscopically detected lesions.