Pattern-Based Interpretation of Gastrointestinal Mucosal Biopsies: Surgical Pathology with Diagnostic Criteria, Pitfalls, IHC Panels, and Structured Reporting
A gastrointestinal biopsy almost never announces its diagnosis. It presents a pattern, and the pathologist's task is to read that pattern and reason toward its cause. This book teaches GI biopsy interpretation the way it is actually performed at the microscope: pattern first, differential next, diagnosis last. Each chapter ends with review questions that reinforce the reasoning.
The book is organized in two connected parts. It builds a pattern-based framework, then applies that framework site by site through the gastrointestinal tract, and closes with the ancillary testing and reporting that complete the diagnosis.
The pattern-based foundation covers:
- The logic of pattern-based interpretation and the deceptively normal biopsy.
- Acute mucosal injury, chronic architectural distortion, and reactive, regenerative, and reparative patterns.
- Eosinophilic infiltration, granulomatous inflammation, and intraepithelial lymphocytosis.
- Villous atrophy and malabsorptive patterns, atrophic and metaplastic patterns.
- Subepithelial and stromal deposition, and vascular, ischemic, and radiation-induced patterns.
- Infectious organism recognition, dysplastic patterns, and malignant patterns on mucosal biopsy.
The site-based chapters apply the framework to:
- The esophagus: non-neoplastic disease, and neoplastic and pre-malignant pathology.
- The stomach: the gastritis spectrum and reactive gastropathy, autoimmune and drug-induced injury, and gastric dysplasia, neoplasia, and lymphoproliferative lesions.
- The small intestine: non-neoplastic and neoplastic pathology.
- The colon and rectum: non-neoplastic and drug-induced disease, inflammatory bowel disease and its mimics, polyps and serrated and pre-malignant lesions, and colorectal neoplasia, lymphoma, and mesenchymal tumors.
- The anal canal and anorectum.
The diagnostic toolkit chapters cover:
- Immunohistochemistry, special stains, and molecular testing, organized by how they confirm or refute a pattern-based differential.
- Structured pathology reporting, CAP protocols, and clear diagnostic communication.
Who it is for:
- Pathology residents learning to interpret GI biopsies systematically.
- Gastrointestinal pathology fellows refining judgment on difficult cases.
- Practicing pathologists seeking a pattern-based bench reference.
The book emphasizes diagnostic criteria, the pitfalls that lead to error, and the IHC panels that settle hard cases, with classification aligned to the WHO Classification of Digestive System Tumours. Quick-reference appendices include a pattern-to-diagnosis navigator, a master IHC panel reference by diagnostic scenario, diagnostic criteria and grading tables, CAP synoptic reporting templates, and normal histological values with intraepithelial lymphocyte counts by site.
By starting from what the tissue shows rather than from a fixed list of diseases, this book gives residents, fellows, and practicing pathologists a structured, repeatable approach that holds up on the cases where the diagnosis is not obvious. It is written to be read straight through as a method and then kept at the scope as a daily reference.
