MORPHOLOGY OF PEPTIC ULCER

MORPHOLOGY OF PEPTIC ULCER

Gross

• Lesions less than 2 cm in diameter

• classic peptic ulcer is a round to oval, sharply punched-out with sharply defined margins

• The mucosal margin may overhang the base slightly, in contrast, heaped-up margins are more characteristic of cancers

• base of peptic ulcers is smooth and clean as a result of peptic digestion of exudate, and blood vessels may be evident

• Gastric mucosal folds appear radiating from the margin of ulcer

Microscopy

• In active ulcers the base-  thin layer of fibrinoid debris

• underlying stroma shows predominantly neutrophilic inflammatory infiltrate

•  Beneath this, active granulation tissue infiltrated and a fibrous or collagenous scar forms the ulcer base

• Vessel walls within the scarred area are typically thickened and are occasionally thrombosed

• Scarring may involve the entire thickness of the wall and pucker the surrounding mucosa into folds that radiate outward.