1. GI Pathology I, Case 3
37-year-old man presents with epigastric pain relieved by eating.
Stool is positive for occult blood

2. Identify the organ(s) and labeled structures
Describe the gross morphologic changes
Diagnosis?

3. A Pylorus
B Pyloric Ring
C Ulcer
Peptic Ulcer (Duodenum)
The surgical specimen (opened) of the
distal stomach and proximal duodenum
reveals an irregular ulcer of the duodenal mucosa.
The ulcer is filled with clotted blood.
The duodenal mucosa is stained with blood.

4. Identify the structures

5. Peptic Ulcer (Duodenum)
A Artery
B Ulcer Bed
Peptic Ulcer (Duodenum)
A close up view of the duodenal mucosa reveals a sharply
demarcated peptic ulcer. The ulcer bed contains a ruptured small artery.

6. Identify the organ. Describe the histologic findings

7. Duodenal
mucosa
Brunner’s Glands
Ulcer

9. Floor of ulcer with
granulation tissue
fibrosis
Superficial surface
of ulcer with debris,
acute inflammatory
cells

11. Ulcer surface
neutrophils

12. Identify the organs and structures
Diagnosis?

13. Peptic Ulcer (Duodenum)
A Esophagus
B Liver
C Gallbladder
D Spleen
E Stomach
Peptic Ulcer (Duodenum)
Description: This autopsy specimen of the upper gastrointestinal tract, liver,
and spleen, reveals a perforated (probe) peptic ulcer of the proximal duodenum.
The probe passes from the gastric lumen to the exterior of the duodenum.
The liver is folded back to reveal the gall bladder and ulcer.

14. Identify the abnormality

15. Free air in the abdomen (air under the right diaphragm) Associated with a perforated viscus (example: perforated peptic ulcer)

16. What is the most probable diagnosis?

17. The specimen consists of a black tarry stool passed per anus.
Melena
The specimen consists of a black tarry stool passed per anus.
Note the mahogany color at the edge of the specimen (filter paper).