presentation

1. Presented by: Ikram Ullah

2. Contents
 Introduction of esophagus
 Normal Cytology
 Abnormal Cytology
 Introduction of stomach
 Normal Cytology
 Abnormal Cytology
 References

3. Introduction to Esophagus
 It is a muscular tube which extends from pharynx
(C6) to the esophageal gastric junction
 It is about 18-25 cm long
 Two sphincters
 Upper sphincter
 Lower sphincter

4. Normal cytology of esophagus
 Mucosa:
 Epithelium: the mucosa that lines the length of
esophagous has a non keratinized stratified squamous
epithelium.
 Lamina propria: is a connective tissue present beneath
the mucosal layer
 Muscularis mucosae: It is a deeper layer of mucosa and is
composed of longitudinally organised smooth muscle.
 The cells are polygonal with abundant esinophilic
cytoplasm and a single pyknotic nucleus, cytoplasm
contain keratohylin granules.

5. Cont…..
 Sub mucosa: The sub mucosa consist of dense
irregular connective tissues, consist of collagenous
fibres with some elastic fibres
 The cells are polygonal, abundant cytoplasm but with a
green or greenish blue staining reaction.
 Nucleus is larger than that of a superficial cell, round
or more commonly with a vesicular pattern.

6. Con…

7. Cont….
 Muscularis propria: Consist of two muscular layer
an inner circular layer and an outer longitudinal layer
 Upper one third is composed of striated muscle
 Striated and smooth muscle bundles are mixed and
interwoven in the middle third of esophagous, the
distal third consist of only smooth muscle

8. Con….
 Cells from deeper layer the Para basal cells are seen in
normal brushing and also in inflammation, more
probably in ulceration of the mucosa with exposure of
the deeper layers
 The cells are round or oval in shape, have narrow ring
cytoplasm which stains blue or blue gray and a round
or oval hyper chromatic nucleus with a vesicular
chromatin pattern
 Adventitia: loose connective tissue, no consistence
serosa

9. Con…

10. Abnormal cytology of esophagus
 1. Barrett esophagus: Is the replacement of
normal distal stratified squamous mucosa by
metaplastic columnar epithelium containing goblet
cells
 It is a complication of long standing gastroesophageal
reflux (GER)
 Prolonged and recurrent GER is thought to produce
inflammation and eventually ulceration of squamous
epithelial lining

11. Cont….

12. Cont…..
 Sample method: The current diagnostic method is endoscopy
or brushing biopsy
 Cytological Examination: Cytology smear of BE shows
cohesive sheets of epithelial cells with monomorphic nuclei
 The outlines of clusters is regular
 Identification of goblet cell is essential for the diagnosis of BE
 The cells have abundant vacuolated cytoplasm, the size of
vacuole is three times more than the nucleus

13. Cont…

14. Abnormal cytology of esophagus
 3. Esophagitis: Injury to the esophageal mucosa
with subsequent inflammation is a common condition
worldwide
 The anatomical changes depend on the causative agent
and on the duration and severity of the exposure

15. Cont….
 Sampling method: Endoscopy with brushing sample
 Cytological examination:
 Cytology smear from the brush sample shows cohesive
cluster of cells with streaming pattern
 Squamous cell shows nuclear enlargement , and
prominent nucleoli
 Nuclear margin is regular and nuclear chromatin is
fine
 Smear shows inflammatory cells

16. Cont….

17. Stomach
 Description of stomach: The stomach is an
expanded J-shaped organ in the upper left region of
the abdominal cavity
 It is continuous with
esophagus superiorly and
duodenum inferiorly

18. Normal cytology of stomach
 The gastric mucosa is lined by simple columnar epithelium.
 The surface and neck of the glands are lined by mucus-
secreting columnar cells.
 The fundus and body of the stomach contain parietal and
chief cells

19. Cont…..
 Chief Cells: These are cuboidal cells with numerous
coarse basophilic cytoplasmic granules. Nuclei are
central in position and round in shape.
 Parietal Cells: These are round cells with marked
vacuolization of the cytoplasm. Cytoplasmic
eosinophilic granules are seen. Nuclei are centrally
placed having coarse chromatin.
 Cardiac gland: cells are cuboidal and nuclei is basal in
position

20. Cytology of mucus secreting cells
 The mucus cells are usually present in small clusters and in
flat sheets.
 The cells are usually in monolayer .
 Dispersed single cells are infrequent in brush cytology.
 The individual cells are tall, columnar in appearance with
abundant vacuolated cytoplasm .
 The nuclei are central in position, round and
monomorphic with fine nuclear
 chromatin and inconspicuous nucleoli. Occasionally,
nuclear protrusion may be noted.

23. Abnormal cytology of stomach
 1.Acute gastritis: Is sudden inflammation of the
lining of the stomach
 Sampling method: Endoscopy with brush biopsy
 Cytological examination:
 The cytology smear of acute gastritis shows cohesive
sheet of glandular cells
 Nuclei of the cells may be enlarged
 Smear shows abundant polymorphs

25. Cont….
 2. Chronic gastritis: Is the chronic inflammation of
the gastric mucosa
 Sampling method: Gastric crush, brush cytology
 Histological examination: multiple cohesive sheets
of glandular cells
 Nuclei may show a mild increase of the N/C ratio with
relatively enlarge nuclei, nuclear polymorphism and
hyperchromasia , prominent nucleoli
 In case of gastric ulcer there may be necrotic debris
and inflammatory cells