by
KLAUS J. LEWIN, M.D. FRCPath
Department of Pathology
UCLA School of Medicine
Los Angeles, California 90024
HENRY D. APPELMAN, M.D.
Department of Pathology
The University of Michigan Hospitals
Ann Arbor, Michigan 48109
With the Editorial Collaboration of
Patricia Lewin, M.D.
1 Introduction and Handling of Esophageal and Gastric Biopsy Resection
Specimens
1.1 Biopsies
1.2 Surgical (Resection) Specimens
1.3 The TNM Classification and Carcinoma Staging
2 Normal Anatomy, Embryology, and Histology of the Esophagus
2.1 Embryology
2.2 Anatomy
2.2.1 Topographic Relationships and Normal Constrictions of the
Esophagus
2.2.2 Esophagus Musculature and Sphincters
2.3 Blood Supply
2.3.1 Arterial
2.3.2 Venous
2.3.3 Lymphatic Drainage
2.4 Innervation of the Esophagus
2.5 Histology
2.5.1 Mucosa
2.5.2 Submucosa
3 Benign Epithelial Neoplasms, Salivary Gland-like Tumors, Non-Neoplastic
Epithelial Proliferations and Other Non-Neoplastic Epithelial
Tumor-like Conditions
3.1 Squamous papilloma and Condyloma-like Proliferations
3.2 Glycogen Acanthosis (Glycogenic Acanthosis)
3.3 Pseudoepitheliomatous Hyperplasia at the Edges and Bases of Ulcers
3.4 Cysts
3.4.1 Development of Cysts and Duplications
3.4.2 Pseudodiverticulosis (Intramural Diverticulosis)
3.5 Intramural Epithelial Tumors, Including Salivary Gland-like Tumors
and Other Epithelial Tumors and Tumor-like Lesions
4 Squamous Cell Carcinoma
4.1 Usual (Typical) Squamous Cell Carcinoma
4.2 Squamous Epithelial Dysplasia Including Squamous Cell Carcinoma
In Situ
4.3 Superficial Squamous Cell Carcinoma
4.4 Deeply Invasive Squamous Cell Carcinoma
4.5 Special Variants of Squamous Cell Carcinoma
4.5.1 Pseudosarcomatous Squamous Cell Carcinoma (Spindle Cell
Carcinoma, Polypoid Carcinoma, Carcinosarcoma, Polypoid Tumor)
4.5.2 Basaloid Squamous Carcinoma (The Commonly Misnamed Adenoid
Cystic Carcinoma)
4.5.3 Verrucous Squamous Cell Carcinoma
5 Barrett's Esophagus, Columnar Dysplasia, and Adenocarcinoma of the
Esophagus
5.1 Barrett's Esophagus
5.2 Barrett's Dysplasia
5.3 Adenocarcinoma of the Esophagus
5.4 Adenosquamous Carcinoma of the Esophagus and Adenoacanthoma
5.5 Adenocarcinoma of the Esophagus Unassociated with Barrett's
Esophagus
5.5.1 Adenocarcinoma Arising from Heterotopic Gastric Mucosa of
the Esophagus (the Inlet Patch)
5.5.2 Adenocarcinoma of Submucosal Glands
5.5.3 Choriocarcinoma of the Esophagus
6 Mesenchymal Tumors and Tumor-like Proliferations of the Esophagus
6.1 Leiomyoma
6.2 Leiomyomatosis
6.3 Malignant Mesenchymal Tumors: Sarcomas
6.4 Granular Cell Tumor
6.5 Fibrovascular Polyps (Giant Fibrovascular Polyps, Fibrolipomas)
and Lipomas
6.6 Inflammatory Fibroid Polyps (Inflammatory Pseudotumors)
6.7 Vascular Tumors
7 Miscellaneous Tumors of the Esophagus
7.1 Endocrine Tumors
7.1.1 Carcinoid Tumors
7.1.2 Small Cell Carcinoma (Small Cell Undifferentiated Carcinoma,
Oat Cell Carcinoma)
7.2 Malignant Lymphoma and Plasmacytoma
7.3 Malignant Melanoma
7.4 Neoplasms Metastatic to the Esophagus
7.4.1 Metastatic Carcinoma of the Lung
7.4.2 Metastatic Melanoma
8 The Stomach: Embryology, Normal Anatomy, and Tumor Derivation
8.1 Embryology
8.2 Normal Anatomy
8.2.1 Gross Anatomy
8.2.2 Microscopic Anatomy
8.2.3 Blood Supply
8.2.4 Lymphatic Supply
8.2.5 Nerves
8.3 Classification of Gastric Tumors
9 Non-Neoplastic Tumor-like Lesions, Predominantly Epithelial
9.1 Gastric Mucosal Polyps
9.2 Specific Types of Gastric Polyps
9.2.1 Fundic Gland Polyps and Fundic Gland Polyposis
9.2.2 Hamartomatous Polyps of the Peutz-Jeghers Type
9.2.3 Juvenile Polyps
9.2.4 Gastric Polyps of Cowden's Disease
9.2.5 Heterotopic or Ectopic Pancreas, Including Adenomyomatous or
Myoglandular Hamartoma
9.2.6 Gastric Gland Heterotopia
9.2.7 Focal Foveolar Hyperplasia (Foveolar Hyperplasia)
9.2.8 Hyperplastic Polyps
9.2.9 Polyposis of the Cronkhite-Canada Syndrome
9.2.10 Other Polyps
9.3 Giant Rugal Hypertrophies (Giant Folds Diseases, Hyperplastic
Gastropathies)
9.3.1 Classification of Giant Folds with or without Associated
Syndromes
9.3.2 Normal Variant Giant Folds
9.3.3 Menetrier's Disease
9.3.4 Zollinger-Ellison Syndrome
9.3.5 Lymphocytic Gastritis
9.3.6 Extensive or Diffuse Neoplastic Infiltrates
9.3.7 Other Causes of Giant Folds
9.4 Cysts of the Stomach
9.4.1 Development Cysts
9.4.2 Intramucosal Cysts
9.4.3 Misplaced Gastric Pits in the Submucosa and Muscularis Mucosae:
Gastritis Cystica Profunda and Gastritis Cystica Polyposa
10 Adenomas
11 Carcinoma of the Stomach
11.1 Adenocarcinoma of the Stomach
11.1.1 Prevalence and Incidence
11.1.2 Pathogenesis
11.2 Gastric Dysplasia
11.3 Gastric Carcinoma
11.4 Morphologic Variants of Gastric Adenocarcinoma
11.4.1 Undifferentiated Carcinoma with Lymphoid Stroma (Medullary
Carcinoma Gastric Lymphoepithelioma-like Carcinoma)
11.4.2 Diffuse Gastric Carcinoma with Gastric Endocrine Cells
11.4.3 Parietal Cell Carcinoma
11.4.4 Hepatoid Adenocarcinoma
11.4.5 Composite Gastric Carcinoma
11.4.6 Paneth Cell Carcinoma
11.4.7 Gastric Carcinoma with Rhabdoid Features
11.4.8 Collision Tumors
11.5 Adenocarcinoma of the Gastric Cardia and Proximal Stomach
11.6 Adenocarcinoma in Heterotopic Pancreas
11.7 Carcinomas with Interspersed Endocrine Differentiation
(Adenoendocrine Cell Carcinoma, Scirrhous Argyrophil Cell
Carcinoma)
11.8 Small Cell (Oat Cell) Carcinoma
11.9 Adenosquamous and Squamous Cell Carcinoma of the Stomach
11.10 Adenocarcinoma and Choriocarcinoma
12 Endocrine Cell Proliferations of the Stomach
12.1 Normal Anatomy of the Gastric Endocrine Cells
12.2 Endocrine Cell Hyperplasia
12.2.1 Primary G-Cell Hyperplasia
12.2.2 Endocrine Cell Hyperplasia Secondary to Gastric Disease
12.3 Gastric Carcinoid Tumors
12.4 Small Cell (Oat Cell) Carcinoma
12.5 Mixed Endocrine and Non-Endocrine Epithelial Tumors
12.5.1 Carcinoid Tumors with Interspersed Nonendocrine Cells
12.5.2 Adenocarcinoma with Interspersed Endocrine Cells
12.5.3 Composite Glandular-Endocrine Cell Carcinomas and Gastric
Collision Tumors
12.5.4 Poorly Differentiated (Signet-Ring Cell) Carcinoma with
Interspersed Endocrine Cells
13 Lymphoproliferative Disorders of the Stomach
13.1 Lymphoma
13.2 Secondary Malignant Lymphomas
13.3 Gastric Lymphoid Hyperplasia (Pseudolymphoma)
13.4 Gastric Involvement in Leukemia
13.5 Solitary Plasmacytomas
13.6 Angiocentric Lymphoproliferative Lesion (Lymphomatoid
Granulomatosis) Involving the Stomach
13.7 Mycosis Fungoides Involving the Stomach
14 Mesenchymal Tumors and Tumor-like Proliferations
14.1 Common Stromal Tumors Composed of Undifferentiated, Minimally
Differentiated, or Peculiarly Differentiated Cells/Leiomyomas
and Leiomyosarcomas
14.1.1 Use of Intraoperative Consultation, Including Frozen Section,
in the Management of Gastric Stromal Tumors
14.1.2 Procedure for Pathologic Examination
14.2 Tumors Composed of Mature Smooth Muscle Cells (Typical Leiomyomas)
14.3 Tumors of Adipose Tissue
14.3.1 Lipomas
14.3.2 Liposarcomas
14.4 Neural Tumors
14.4.1 Common Gastric Stromal Tumors That May Be Neural Neoplasms,
Including Gastric Autonomic Nerve (GAN) Tumors
14.4.2 Neuroma/Ganglioneuroma and Neurofibroma with and without Von
Recklinghausen's Multiple Neurofibromatosis and Multiple
Endocrine Neoplasia Type II
14.4.3 Schwannoma
14.4.4 Granular Cell Tumor
14.4.5 Gangliocytic Paraganglioma
14.5 Tumors of Blood and Lymphatic Vessels
14.5.1 Glomus Tumors
14.5.2 Hemangioma, Lymphangioma, and Vascular Malformations
14.5.3 Angiosarcoma and Hemangioendothelioma
14.5.4 Kaposi's Sarcoma
14.5.5 Hemangiopericytoma
14.6 Other Tumors
14.7 Tumor-like Lesions
14.7.1 Inflammatory Fibroid Polyp (Eosinophilic Granuloma, Vanek's
Tumor, Granuloblastoma, Fibroma with Eosinophilic
Infiltration, Submucosal Granuloma with Eosinophilic
Infiltration)
14.7.2 Xanthelasma (Xanthoma, Lipid Island)
15 Miscellaneous Tumors
15.1 Germ Cell Tumors
15.1.1 Teratoma
15.1.2 Choriocarcinoma and Yolk Sac (Embryonal) Carcinoma
15.2 Carcinosarcoma (Sarcomatoid Carcinoma, Pseudosarcomatous
Carcinoma)
15.3 Metastatic Neoplasms
15.3.1 Metastatic Melanoma
15.3.2 Metastatic Carcinoma of the Breast
15.3.3 Metastatic Carcinoma of the Lung
15.4 Other Tumors and Tumor-like Lesions
16 Index