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A Retrospective and Single Centric Histopathological Study of Gastrointestinal Tumors from 2011 to 2015

1,2 Department of Pathology, Government Medical College, Bhavnagar, INDIA *Corresponding Author Dr Dhara H. Dadhania 3 rd year Resident, Department of Pathology, Govt. Medical College, Bhavnagar-364001 Email: dr.dharadadhania@gmail.com ABSTRACT Background: This study was carried out to evaluate and to correlate the various histopathologic types of tumors at different sites of gastrointestinal tract in relation to age and sex of the patients. Materials and Methods: A cross-sectional histopathological study of gastrointestinal tumors of 117 cases was carried out retrospectively; on biopsies and surgical specimens received from department of Surgery of a teaching institute, from January-2011 to December-2015. Specimens were sent in 10% formalin, ten times that of the specimen’s volume; and kept for 24 hours in 10% formalin for proper fixation, subsequently dehydration, clearing, embedding in paraffin wax were carried out. Blocks were made, sections of 3-4μm thicknesses were cut and stained with Harris Haematoxylin and Eosin stain and observed microscopically. Results: From the total 117 cases of gastrointestinal tumors: 72 were males and 45 were females with peak occurrence in sixth decade and anatomical distribution was in esophagus 50(42.74%), stomach 11(9.40%), small intestine 09(7.69%), appendix 00(0%), colon and rectum 40(34.19%), anal canal 07(5.98%) with histological typesepithelial 95(81.20%), mesenchymal 09(7.69%), lymphoma 03(2.57%), poorly differentiated carcinoma 07(5.98%), metastatic 02(1.71%) and others 01(0.85%). Conclusion: Gastrointestinal tumors show a wide variation in the morphology. So, histopathological examination is must for the diagnosis and typing of these tumors. The peak age distribution was in the sixth decade. Male to female ratio was 1.6:1. The occurrence of gastrointestinal tumors was highest in the esophagus accounted for 42.74% of all cases. Most common type of malignancy was adenocarcinoma.


INTRODUCTION
Gastrointestinal tumors account for a large proportion of all neoplasms. [1] Colorectal cancer ranks second and stomach cancer ranks fourth among the most common tumors of the world, according to the World Cancer Report of 2000. [2] Curiously the small intestine is an uncommon site for tumor despite its great length and vast pool of dividing cells. There is worldwide variation in the distribution of these neoplasms, which appear largely due to exogenous factors rather than genetic. [3] The various histologic types of tumors at different gastrointestinal sites also differ in their incidence and prognosis. Tumors arising from the mucosa of stomach and intestines predominate over mesenchymal and stromal tumors. Adenocarinomas constitute 70% of all malignancies arising in the gastrointestinal tract. Without exception, all tumors are incurable when metastasis exists. However effective treatment in case of lymphoma and stromal tumors is likely to result in cure. [1] This study is undertaken to determine the relative frequency of various histopathologic types of gastrointestinal tumors, knowledge about their prognosisand to correlate the different types of these tumors in relation to age and sex of the patients.

MATERIALS AND METHODS
A cross-sectional histopathological study of gastrointestinal tumors of 117 cases was carried out retrospectively; on biopsies and surgical specimens received from department of Surgery of a teaching institute, from January-2011 to December-2015. All the data were collected from the reporting register of Histopathology department of the same institute and all the data were analysed by the software (Microsoft Excel). Specimens were sent in 10% formalin, ten times that of the specimen's volume. Specimens were kept for 24 hours in 10% formalin for proper fixation, subsequently dehydration, clearing and embedding in paraffin wax were carried out. Blocks were made, sections of 3-4µm thicknesses were cut and stained with Harris Haematoxylin and Eosin stain and observed microscopically. Procedure of staining Dewax sections in Xylene giving two changes for 20 minutes then hydrate sections in descending grade of alcohol, bringing them to water. Place sections in Haematoxylin for 5-10 minutes and wash in running water for 5 minutes then differentiate in 1% Acid alcohol (1 dip) and wash with water immediately, place in running water for 5 minutes and place in Eosin for 10 Seconds. Give 5 dips in running water then dehydrate through alcohols, clear and mount with DPX.

RESULTS
The total of 117 cases: 72 were males and 45 were females with peak occurrence in sixth decade. The most common malignancy in the present study was esophageal malignancy accounted for 42.74% of all cases and second most common carcinoma was colorectal carcinoma followed by carcinoma of stomach and small intestine (anatomical distribution is shown in Table 1).The distribution of Gastrointestinal Tumors age and gender wise are shown in Fig. 1 and Fig. 2 respectively. The histological types were epithelial 95(81.20%), mesenchymal 09 (07.69%), lymphoma 03 (02.57%), poorly differentiated carcinoma 07 (05.98%), metastatic 02(01.71%) and others 01 (00.85%) ( Table 2). Most common type of malignancy was adenocarcinoma and the most common site was colon.

Fig. 3 Anatomical distribution of colorectal carcinomas
According to anatomical distribution shown in Fig.3; Recto-sigmoid colon 28 (70%) was the most common site among total 40 (100%) cases of colorectal carcinomas. In Table 3; the histological variants of colorectal carcinomas are tabulated that Adenocarcinomas were majority accounted for 65% of all colorectal tumors.   Fig. 4, Fig.  5 and Fig. 6 respectively.

DISCUSSION
Gastrointestinal Tumors were seen over a wide range of age (03 years to 88 years). The highest distribution was found in the 6th decade, which was consistent with the study by Assem O. et al, 2000 [4] and Patel Mandakini et al, 2012 [5] . However the peak distribution was 7th decade in study done by Mohammad et al, 2005 [3] . A male predominance was observed in this study with a male to female ratio of 1.6:1 which is consistent with study by Assem O. et al, 2000 [4] . While male to female ratio was1.39:1 and 2.28:1 in studies by Patel Mandakini et al, 2012 [5] and Shahid Jamal et al, 2005 [6] respectively. The histological types of Gastrointestinal Tumors showed immense variation. However, adenocarc-inomas were the commonest tumors all over the gastrointestinal tract. The present study also showed similar findings. The anatomical site commonly involved was esophagus, constituting 42.74% of all gastrointestinal cancers which was consistent with study by Patel Mandakini et al, 2012 [5] . However in study by Leena Devi et al, 1980 [7] and Abdul Kareem et al, 2011 [8] ; majority cases were of recto-sigmoid colon and transverse colon respectively.

CONCLUSION
Gastrointestinal tumors show a wide variation in the morphology. So, histopathological examination is must for the diagnosis and typing of these tumors. The peak age distribution was in the sixth decade. Males outnumbered females with a male to female ratio of 1.6:1. The occurrence of gastrointestinal tumors was highest in the esophagus accounted for 42.74% of cases. Adenocarcinomas were common all over the gastrointestinal tract, accounted for 41.03%; majority were well differentiated. 17 cases were presented with Lymph node Metastasis and 2 cases were presented with Distant Metastasis.