Pathology of the

ALIMENTARY TRACT
Department of Pathology
Gadjah Mada University School of Medicine
 Upper ALIMENTARY tract
I. Diseases of the Mouth & Jaw
A. Congenital Disorders
B. Inflammatory disorders
C. Tumors and tumor-like conditions
II. Diseases of the Salivary Glands
A. Sialadenitis
B. Acute parotitis
C. Sjogren syndrome
D. Mucocele
E. Ranula
F. Tumors of the salivary gland
III. Diseases of the Esophagus
A.Tracheoesophageal fistula
B. Esophageal diverticula
C. Achalasia
D. Esophageal varices
E. Hiatus hernia
F. Inflammatory and related disorders
of the esophagus
G. Carcinoma of the esophagus
I.A. CONGENITAL DISORDERS

SCHISIS / CLEFT MICROGNATHIA

* Failure of mesodermal penetrance between
the maxillary, median nasal, and lateral nasal.
- Unilateral/ Bilateral
- Simplex/ complex: Labioschisis
Labiognatoschisis
Labiognatopalatoschisis
Oblique facial clef
- Sporadic/ congenital
- May be it is associated with other anomalies
 TONGUE

CONGENITAL DISORDER OF THE TONGUE

MICROGLOSSI MACROGLOSSI MEDIAN RHOMBOID GLOSSITIS

TIE TONGUE BIFID TONGUE

 I.B. INFLAMMATORY DISORDERS
1. Herpes Labialis
- most common lesion caused by HSV (HSV-1)
- tends to recur, with activation by febrile illness, trauma, sunshine,
menstruation
2. Aphthous stomatitis
- characterized by painful, recurrent, erosive oral ulceration
3. Oral candidiasis (thrush, moniliasis)
- local lesion, white, membranous, caused by Candida albicans
- occurs most commonly in debilitated infants and children,
immunocompromized patient, and diabetics
4. Acute necrotizing ulcerative gingivitis (trench mouth, Vincent infection,
fusospirochetosis)
- severe gingival inflammation occuring in patient with decresed
resistance to infection
- due to concurrent infection with symbiotic bacteria (Fusobacterium
species and Borrelia vincentii)
INFALAMMATORY DISORDERS

Aphthous stomatitis
 GLOSSITIS
Geographic tongue Hairry tongue

Glositis tuberculosa Glositis luetica

 I.C. TUMORS & TUMOR-LIKE CONDITIONS

1. Benign tumors of the oral mucosa

a. Papilloma: the most common benign epithelial oral mucosal
tumor tongue, lips, gingivae, buccal
b. Fibroma: it is often a non-neoplastic hyperplastic lesion due to
chronic irritation
c. Hemangioma: tongue, lips, buccal mucosa
d. Epulis: any abnormal swelling of the gingiva, as a reparative
growth rather than a true neoplasm
2. Leukoplakia:
- clinical term describing irregular white mucosal patches
- pre-cancer
 Reparative lesion:
EPULIS

Excessive reparative process

- Granulomatous epulis
- Fibromatous epulis
- Giant cell epulis
- Haemangioform epulis
- Pregnancy epulis
 I.C. TUMORS & TUMOR-LIKE CONDITIONS

3. Odontogenic tumors
a. Odontoma: hamartoma derived from odontoblastic epithelium
b. Ameloblastoma:
- epithelial tumor arising from precursor cells of the enamel organ
- usually before age 35, and most fequently in mandible
- irregular local extension
4. Oral cancer
- mostly squamous cell carcinoma
- often associated with abuse of tobacco and alcohol
- may be associated with irritants: pipe smoking, chewing tobacco
or betel nuts
LEUKOPLAKIA
- white patches of keratosis
- premalignant lesion
- hyperkeratosis, hyperplasia of the squamous epithelium
- dysplastic changes

SQUAMOUS CELL CARCINOMA

 Pharynx & Tonsil
Pharyngitis
- Viral pharyngitis: common feature of the CC, influenza, measles, etc
-Streptococcal pharyngitis: less common but more important than viral
pharyngitis because the complication rheumatic fever, acute
proliferative glomerulonephritis, Henoch Schonlein purpura
-Ulcerative pharyngitis & tonsillitis diphtheria
Tonsilitis:
-Follicular tonsilitis, streptococcus/ Borrelia / virus
-Parenkhimal tonsilitis: quincy, Peritonsiler abses
-Angina agranulositic netropenic
-Tonsilitis morbili: Warthin Finkeldey giant cells

Malignant tumors: NPC, squamous cell ca, lymphoma

II. Diseases of the SALIVARY GLAND

A. Sialadenitis
B. Mucocele
C. Ranula
D. Tumors
Pleomorphic adenoma (Mixed tumor)
Warthin tumor / adenolymphoma / Papillary cystadenoma
lymphomatosum
Oncocytoma
Adenoid cystic carcinoma
Mucoepidermoid tumor
 II. A. Sialadenitis
Acute
- Suppurative parotitis
- Non-suppurative parotitis
- Parotitis epidemica / Mumps: paramyxovirus
Orchitis/ Oophoritis
- Cytomegalic inclusion disease
Chronic
1. SJOGRENS SYNDROME :
- Autoimmune disease
- Keratoconjungtivitis sicca
- Xerostomia
- Parotitis hyperplasia
2. MIKULICZ SYNDROME :
- Idiophatic
- Keratoconjungtivitis sicca
- Xerostomia
- Unilateral parotitis hyperplasia
 Mucocele
A cyst-like pool of mucus, lined by granulation tissue,
near a minor salivary gland
Results from mucus leakage caused by rupture of
obstructed or traumatized ducts

Ranula
Is a large mucocele, of salivary gland of origin,
characteristically localized to the floor of the mouth
Tumors of the Salivary Glands
1. Pleomorphic adenoma (Mixed tumor)
2. Warthin tumor / adenolymphoma / Papillary
cystadenoma lymphomatosum
3. Oncocytoma
4. Adenoid cystic carcinoma
5. Mucoepidermoid tumor
Anatomy of parotid gland
Anatomy of parotid gland
Pleomorphic adenoma (parotid)
Pleomorphic adenoma (gross)
Pleomorphic adenoma
Pleomorphic adenoma
 Warthin tumor

Benign tumor mostly occur in parotid gland

 Warthin tumor

Cystic spaces lined by double-layered eosinophilic epithelium,

and all embedded in lymphoid stroma
 Oncocytoma

Mostly in parotid gland

 Oncocytoma

Large granular appearing, eosinophilic-staining epithelial cells

Adenoid cystic carcinoma

Minor salivary gland

Adenoid cystic carcinoma
 Adenoid cystic carcinoma

Most characteristic appearance consists of cribriform pattern

with masses of small, dark-staining cells arrayed arround
cystic spaces
Adenoid cystic carcinoma
Mucoepidermoid tumor
(Palatal gland)

Mostly in parotid gland

 Mucoepidermoid tumor
(Low grade)

Comprised of mucus-producing and epidermoid omponents

and cells intermediate between the two
Mucoepidermoid tumor
(moderate grade)
Mucoepidermoid tumor
(High grade)
 III. Diseases of the Esophagus
A.1. Tracheoesophageal fistula
Congenital disorder, is suggested in a newborn by copious salivation associated with
choking, coughing, and cyanosis on attempts at food intake

The most common variant (90%), the lower portion of the esophagus communicates
With the trachea near the tracheal bifurcation, the upper esophagus ends in a blind
pouch
Associated abnormality: maternal polyhydramnion

The second most common variant, fistulous connection

between the upper esophagus and the trachea; the lower
esophageal segment is not connected to the upper esophagus

The third variant, fistulous connection between

the tachea and a completely patent esophagus
 III. Diseases of the Esophagus
A.2. Heterotopic tissue

patches of fundic-type gastric mucosa are

occasionally found above the distal sphincter
separated from the columnar lining of the distal
esophagus
congenitally misplaced gastric tissue (heterotopic)
can lead to ulceration and stricturing due to
local acid/pepsin secretion
 III. Diseases of the Esophagus
B. Esophageal diverticula
- Outpouchings of the wall of hollow viscus
- herniation of the mucosa or full thickness
- effects: dysphagia, diverticulitis

- pharyngoesophageal diverticula

- Traction: external forces pulling on the wall

(true divericula)
- Pulsion: forcible distention (false diverticula):
result from periesophageal inflammation and
scarring
III. Diseases of the Esophagus
C. Achalasia

- Contractility of the lower esophagus is lost and

there is failure of relaxation at the sphincter
(cardiospasm)

-Mechanism: fibrosis and atrophy of smooth muscle

(reduced number number of ganglion cells in the
myenteric plexus: Chagas disease & other
unknown etiology).

-Clinically: slowing / retention of the food

dilatation dysphagia
 III. Diseases of the Esophagus
D. Esophageal varices
- Localized dilatation of veins

- Portal hypertension

- cirrhosis hepatis

- Haematemesis
 III. Diseases of the esophagus
E. HIATUS HERNIA

The presence of part of the stomach above the diaphragmatic orifice, mostly acquired
Increased intra-abdominal pressure and loss of diaphragmatic muscular tone with aging
herniation of the stomach and subsequent retraction of the esophagus.
 III. Diseases of the Esophagus
F. Inflammatory and related disorders
of the esophagus

1. Gastroesophageal reflux
2. Barrets esophagus
3. Candida esophagitis
4. Viral esophagitis
5. Esophageal stricture
 III. Diseases of the Esophagus
F. 1. Gastroesophageal reflux
Reflux of gastric acid contents into the esophagus esophagitis,
stricture, ulceation, or columnar metaplasia (Barrets esophagus)
Usually characterized by burning pain (often manifests by substernal
pain or heartburn) relieved by antacids
Often precipitated by assuming recumbent position
Associated:
- most commonly with hiatal hernia and incompetent lower
esophageal sphincter
- with excessive use of alcohol & tobacco, and with increased gastric
volume
- with pregnancy and scleroderma
 III. Diseases of the Esophagus
F.2. BARRETS ESOPHAGUS

Columnar metaplasia (often of intestinal type with prominent goblet cells) of

esophageal squamous epithelium.
Complication of long-standing gastroesophageal reflux, to be a well-known
precursor of esophageal adenocarcinoma
 III. Diseases of the Esophagus
F. 3. Candida esophagitis
Etiology: Candida (Monilia) albicans
Manifest clinically by white adherent mucosal patches and
painful, difficult swallowing
Often assciated with:
- antibiotic therapy
- diabetes mellitus
- malignancy
- immunodeficiency
 III. Diseases of the Esophagus
F. 4.a. Viral esophagitis

Herpetic esophagitis
Characterized by painful and difficult swallowing
Tends to occur in immunosuppressed patient, caused
by HSV-1 infection

Cytomegalovirus (CMV) infection

Less common
 III. Diseases of the Esophagus
F. 4.b. Other esophagitis

Less common form of esophagitis

Caused by: uremia, radiation therapy, graft-versus-host
(GVH) disease
 III. Diseases of the Esophagus
F. 5. Esophageal stricture

Most often results from prolonged esophageal

gastric acid reflux
May also be caused by suicidal or accidental
ingestion of corrosive agent (acid or alkaline)
 III. Diseases of the Esophagus
G. Carcinoma of the esophagus
Aggressive tumor manifest clinically by dysphagia, weight loss,
and anorexia, and occasionally by pain or hematemesis

In the USA the incidence of SC and adenocarcinoma are equal

May be manifest pathologically by protrusion into the

esophageal lumen

Spread by local extension to adjacent structure: trachea,

bronchi, aorta, or diffuse infiltration into esohageal wall
 III. Diseases of the Esophagus
G.1. Squamous Cell Carcinoma

Arises most frequently in the upper and middle thirds

of the esophagus
 III. Diseases of the Esophagus
G2. Adenocarcinoma

Arises most frequently in the lower third, and mostly from

aberrant gastric mucosa or Barrets esophagus