Kontham Praveen, Farida Begum, Kandukuri Mahesh Kumar. Study of histopathological types of gastro-intestinal lesions by endoscopic biopsy. IAIM, 2016; 3(11): 46-53. Original Research Article Study of histopathological types of gastro- intestinal lesions by endoscopic biopsy Kontham Praveen1, Farida Begum2, Kandukuri Mahesh Kumar3* 1Senior Resident, Department of Pathology, Government Medical College, Nizamabad, Telangana State, India 2Assistant Professor, Department of Pathology, Government Medical College, Nizamabad, Telangana State, India 3Assistant Professor, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana State, India *Corresponding author email: [email protected] International Archives of Integrated Medicine, Vol. 3, Issue 11, November, 2016. Copy right © 2016, IAIM, All Rights Reserved. Available online at http://iaimjournal.com/ ISSN: 2394-0026 (P) ISSN: 2394-0034 (O) Received on: 18-10-2016 Accepted on: 01-11-2016 Source of support: Nil Conflict of interest: None declared. How to cite this article: Kontham Praveen, Farida Begum, Kandukuri Mahesh Kumar. Study of histopathological types of gastro-intestinal lesions by endoscopic biopsy. IAIM, 2016; 3(11): 46-53. Abstract Introduction: Gastro Intestinal Tract (GIT) is an important site for wide variety of lesions which include congenital, inflammatory, neoplastic conditions. The invention of flexible fiber-optic endoscope is a very good achievement towards the diagnostic field. With the use of this facility direct vision of diseased mucosa and biopsy of mucosal lesions, therapeutic induction and photographic visualization of the lesions are made possible. Aim: Aim of this study was to know the incidence of Gastro intestinal lesions with reference to age, sex and site and to study the histopathological types of Gastro Intestinal lesions. Materials and methods: The present study included 180 GIT biopsies (gastro intestinal biopsies) between the period August 2013 to August 2015 .Clinical details and case histories were obtained from the patients presented to the gastroenterology department. Biopsies were obtained by the gastroenterologist with fiber optic forward viewing endoscope. Results: Among all the GIT biopsies, esophageal biopsies were 11 (6.11%), gastric biopsies were 31 (17.22%), gastro esophageal junction 4 (2.22%), and small Intestinal 67 (37.22%) and 67 (37.22%) was from large intestine. Conclusion: Endoscopy and subsequent biopsy for histopathology can detect early malignant lesions. In the absence of endoscopic screening, detection of these lesions may be missed. Such patients may present with advanced stage of disease in later life. In endoscopic biopsy only mucosa is seen, the level of invasion cannot be ascertained. Page 46 Kontham Praveen, Farida Begum, Kandukuri Mahesh Kumar. Study of histopathological types of gastro-intestinal lesions by endoscopic biopsy. IAIM, 2016; 3(11): 46-53. Key words Gastro Intestinal Tract Lesions, Endoscopy, Biopsy, Carcinoma, Polyp, Histopathology. Introduction transferring the tissue to the laboratory. After Gastro Intestinal Tract (GIT) is an important site usual time fixation of the biopsy specimen, it was for wide variety of lesions which include wrapped in a piece of filter paper after adding congenital, inflammatory, neoplastic conditions. eosin and processed accordingly .It is then In present era, gastroenterology is one of the unwrapped and embedded in paraffin with most important and expanding branch of mucosal surface uppermost .Four micron sections medicine. The invention of flexible fiber-optic were cut perpendicular to this surface and 3 to 4 endoscope is a very good achievement towards sections were taken on each slide .One slide was the diagnostic field. With the use of this facility stained with Hematoxylin and Eosin stain and direct vision of diseased mucosa and biopsy of studied. Apart from the routine Hematoxylin and mucosal lesions, therapeutic induction and Eosin stain, the sections were studied with the photographic visualization of the lesions are following special stains wherever it was made possible. The endoscopic biopsy in many necessary. instances has replaced, rather than being used as an adjunct procedure. Lesions of the GIT range Results from inflammatory lesions to carcinomas. The Among all the GIT biopsies, esophageal biopsies symptoms of GIT lesions include nausea, were 11 (6.11%), gastric biopsies were 31 vomiting, dyspepsia, pain abdomen, malaena etc. (17.22%), gastro esophageal junction 4 (2.22%), Thus, the following study is undertaken to study and small Intestinal 67 (37.22%) and 67 the histopathology of these lesions. These (37.22%) was from large intestine (Table - 1). biopsies will help a large group of patients who come or suffer with symptoms of abdominal Table - 1: site wise distribution of GIT lesions. diseases. After accurate diagnosis, treatment modalities can be applied. LESION TOTAL % Esophageal lesion 11 6.11 Aim Gastric lesion 31 17.22 Aim of this study was to know the incidence of Gastro esophageal junction 4 2.22 Gastro intestinal lesions with reference to age, Small intestine lesion 67 37.22 sex and site and to study the histopathological Large intestine lesion 67 37.22 types of Gastro Intestinal lesions. Maximum numbers of cases were seen in the 3th Materials and methods decade of life (23.88%) and only one case was found in 8th decade (1.21%) (Table - 2). Majority The present study included 180 GIT biopsies of the cases were seen in the age group of 21-40 (gastro intestinal biopsies) between the period years (42.21%). The oldest patient was 86 years August 2013 to August 2015 .Clinical details and and the youngest patient was 11 years. The sex case histories were obtained from the patients ratio was 1.2:1. Males were 99, females were presented to the gastroenterology department. 81. Biopsies were obtained by the gastroenterologist with fiber optic forward viewing endoscope. The lesions encountered were divided as Rapid fixation was done to prevent shrinkage by esophageal, Gastric lesions, gastresophageal placing the specimen in 10% neutral normal junction lesions, and Small intestine and large saline. Care was taken not to shake rigorously the intestine lesions. Commonest esophageal lesions bottle containing the specimen and also while were esophagitis and esophageal carcinoma Page 47 Kontham Praveen, Farida Begum, Kandukuri Mahesh Kumar. Study of histopathological types of gastro-intestinal lesions by endoscopic biopsy. IAIM, 2016; 3(11): 46-53. (2.8%) whereas commonest gastric lesion The commonest symptom overall was pain in encountered was chronic gastritis (10%). Other abdomen (31.7%) and diarrhoea 13.9%, esophageal lesions were esophagitis, Barret’s dysphagia 13.9%. The commonest sign and esophagus, ulcer, dysplasia, gastric carcinoma symptom in esophageal lesions were dysphagia (Table - 3). and loss of weight whereas pain in abdomen and diarrhoea was the commonest sign and symptom Table - 2: Age distribution of various lesions. in gastric lesion. Bleeding per rectum and constipation were the commonest signs in Age interval (Years) No. of cases % intestinal lesions. Dysphagia (100%) was the 11-20 8 4.4 commonest symptom of esophageal carcinoma. 21-30 33 18.33 Dysphagia 42.8%, Loss of weight 28.5%, 31-40 43 23.88 vomiting 14.2%, were the most common features 41-50 23 12.77 of Gastric Carcinoma.Bleeding per Rectum 51-60 30 16.66 (33.5%), Flatulence (33.3%), and pain abdomen 61-70 33 18.33 (33.3%) are associated with colon 71-80 9 5 Carcinoma.Occasionally cases of esophagitis also 81-90 1 0.55 showed patients suffering from hematemesis. TOTAL 180 100.0 Gastritis cases presented with pain in abdomen i.e. epigastric pain and vomiting with loss of Table - 3: Distribution of individual lesions. appetite.In patients with gastric polyp the most commonly encountered symptom was pain in Lesion Cases % abdomen. Esophageal lesions In this study, total malignancies reported were 17 Esophagitis 5 2.8 which included 5 cases of esophageal Barret’s esophagitis 1 0.5 malignancy; Gastric malignancy comprised 7 Esophageal carcinoma 5 2.8 cases, colon and rectum comprised 3 and 2 cases Gastric lesions respectively. The age wise and sex wise Chronic gastritis 18 10 distribution has been tabulated (Table - 4). Polyp 04 2.2 01 0.6 Ulcer Eighty percent (4 cases) of the total esophageal Dyspepsia 01 0.60 carcinoma (5) were squamous cell carcinoma Gastric carcinoma 07 3.8 were whereas adenocarcinoma were 20% (1 Gastresophageal junction 04 2.2 case). Histological typing with endoscopic Small intestinal lesions 67 findings is tabulated in Table - 5. Crohn’s disease 23 12.8 Inflammatory bowel disease 15 18.7 Gastric carcinoma was seen in 7 cases. All were Non specific colitis 21 11.6 adenocarcinomas .Endoscopically out of 7 cases, Hyperplasic polyp 8 4.4 4 cases showed ulcero-proliferative growth, 1 Large intestinal lesions 67 showed papillary folds in fundus and 2 were Chronic non specific 38 21.1 undifferentiated. Histological grading of the infection stomach carcinoma is tabulated in Table - 6. Inflammatory bowel disease 22 12.2 Colon cancer 3 1.7 The upper and lower esophagus were the Carcinoma rectum 2 1.1 commonest sites for esophageal carcinoma i.e. 4 Solitary rectal ulcer 2 1.1 out of 5 cases (80%) whereas antrum was the common site for gastric carcinoma, 4 cases out of 7 cases (57.14%). Page 48 Kontham Praveen, Farida Begum, Kandukuri Mahesh Kumar. Study of histopathological types of gastro-intestinal lesions by endoscopic biopsy. IAIM, 2016; 3(11): 46-53. Table - 4: Age distribution of malignancy. Age interval (Years) Esophagus cancer Gastric cancer Colon cancer Rectal cancer 21-30 1 1 0 1 31-40 1 1 0 0 41-50 2 1 0 0 51-60 1 2 1 0 61-70 0 2 2 1 71-80 0 0 0 0 TOTAL 5 7 3 2 Table - 5: Esophageal carcinoma-endoscopic and histopathlogical findings. Lesion Squamous cell carcinoma (%) Adenocarcinoma (%) Total cases Ulcerated 2 1 3 (60%) Proliferative 2 0 2 (40%) Total 4 (80%) 1 (20%) 5 (100%) Table - 6: Histological grading of stomach Endoscopically and clinically 8 lesions of the carcinoma.