MORPHOLOGICAL FEATURES AND DYNAMICS OF THE ULCER SUBSTRATE IN BLEEDING GASTRODUODENAL ULCER DEPENDING ON THE DEGREE OF BLEEDING ACTIVITY

Abstract

The aim of the work: to evaluate the morphological changes of the gastroduodenal ulcer defects with different stigmata of bleeding activity according to Forrest classification.

Materials and Methods. Biopsy material of postoperative patients (675 patients) of the pathology department of the Kyiv City Clinical Hospital No. 12 in the period 2000–2011 was evaluated. Morphological examination was carried out in accordance with the requirements of standardized methods with fixation with a 10 % solution of neutral buffered formalin, embedding in plastic paraffin and staining with hematoxylin and eosin. Separate histological sections with a thickness of no more than 7 μm were stained according to Masson. The preparations were photographed using an American Optical microscope.

Results and Discussion. During the histological examination of the wall and bottom of acute and chronic ulcers (among the group of patients F1A–F1C), we observed diffuse lymphohistiocytic infiltration of the stroma, structures of the mucous membrane. The bottom of the ulcer was covered by freshly formed fibrin and a large number of leukocytes and massive erythrocyte clusters, which was prognostically unfavorable in terms of possible bleeding from the ulcer. During the histological examination of the tissue of the operated stomach (among the group of FIIA – FIIC patients – bleeding stopped, unstable hemostasis), we found that the wall of the edge of the ulcer was diffusely infiltrated with lymphohistiocytic infiltrates, there was a pronounced focal accumulation of lymphocytes and the joining of these infiltrates with neutrophils. At the bottom of the ulcer, there was an accumulation of fibrin in the form of a loose mesh (signs of bleeding that had occurred). During histological examination of the wall of a chronic gastric ulcer, it was found that the surface layer was represented by fibrinous layers, which is characteristic of ulcer disease complicated by bleeding with bleeding stigmata (FIII – bleeding stopped, signs of stable hemostasis).

A swollen vessel is the cause of bleeding from an ulcer defect. These changes are due to signs of inflammatory infiltration of the mucous membrane of the stomach and gastric mucosa, spreading to the submucosa and muscle layers.