Pathology and histology of the oesophagus and stomach

The presenting symptoms of dysphagia and dyspepsia can be caused by gastro-oesophageal reflux disease, malignancy or, less commonly, disorders of dysfunctional motility, such as achalasia. Most neoplasms of the oesophagus and stomach are epithelial in nature. Benign epithelial neoplasms usually take the form of polypoid lesions, such as oesophageal squamous papillomas, gastric adenomas, hyperplastic and fundic gland polyps. Malignant epithelial neoplasms of the oesophagus are divided into squamous cell carcinoma and adenocarcinoma, whereas malignant gastric neoplasms are predominantly adenocarcinomas. Each tends to develop in the context of dysplastic epithelial changes. Gastric carcinomas and lymphomas are associated with Helicobacter pylori infection. Stromal tumours of the stomach are important in that they have a distinctive molecular pathology and linked targeted therapy. This educational article provides an overview of the incidences, aetiologies and histological features of some of the most common mechanical, inflammatory and neoplastic pathologies encountered in the oesophagus and stomach. The emphasis is on clinical application.