Dr. Jesse Paul Babwah, MD, FRCPC
115 Midair Court Brampton, ON, Canada

This is a esophageal biopsy of a patient with a few esophageal ulcers and a history of multiple myeloma. Diagnosis? Tag a friend if you don't know. Find me on Twitter for GI pathology tweets #GIPath #Pathology #Histology #GI #Medicine #MD #esophagus

Whipple's disease is a rare systemic infection due to Tropheryma whippelii, a gram positive intracellular actinomycete. Patients experience malabsorption with diarrhea, weight loss, abdominal pain, occasionally polyarthritis, CNS complaints, and lymphadenopathy. Histologically, distended macrophages are present expanding the lamina propria. They contain PAS+ granules and rod shaped bacilli by EM. http://www.babwah.com/whipples-disease/

This is an example of Cryptosporidium parvum infection in the colon. The organisms appear as tiny basophilic spherical structures that attach themselves to the surface of the columnar epithelium. Cryptosporidium is an acid fast protozoa which causes self-limited disease in those who are immunocompetent but may cause severe watery diarrhea in patients who are immunocompromised http://www.babwah.com/cryptosporidium-parvum/

In this gastric body biopsy there is intestinal metaplasia arising on the background of chronic glandular atrophy. No Helicobacter is present. This is an example of autoimmune gastritis (or type A gastritis). This is typically associated with hypochlorhydria (due to parietal cell loss) and high serum gastrin levels. 90% of patients have anti-parietal cell antibodies (to the protein pump K/hydrogen ATPase) and 60% have anti-intrinsic factor antibodies. http://www.babwah.com/type-a-gastritis/

This pancreatic tumour is comprised of loosely cohesive monomorphic epithelial cells forming solid and pseudopapillary structures. The microscopic appearance is basically the diagnosis. This is a solid pseudopapillary tumour of pancreas. Here we can see the pseudopapillae with hyalinized fibrovascular cores lined by bland epithelial cells with clear and pale eosinophilic cytoplasm. The reason these are not true papillae is that the epithelial cells that are away from the blood vessels degenerate; leaving behind structure that resemble papillae and rosettes in cross section. In terms of immunophenotype, this tumour is positive for beta-catenin, CD10, CD56, Vimentin, ER, PR, and CD99 (paranuclear dot pattern). http://www.babwah.com/solid-pseudopapillary-tumour/