Slide 1
Gross: Chronic peptic ulcers are typically small (less than 4 cm in diameter), round, sharply punched-out lesions with perpendicular walls and a clean base. Fibrous contracture of the base of the ulcer may cause puckering of the surrounding mucosal folds such that they radiate away from the ulcer in spoke-like fashion.

Slide 2
Is a low power view of the gastric ulcer in your class set. The ulcer (U) lies between the arrows. The intact, but chronically inflamed, gastric mucosa (M) is on either side. Note that the base of the ulcer extends all the way to the serosa of the stomach. Large arteries (A) are present at the base of the ulcer. Erosion into one of these large arteries could result in massive hematemesis.

Slide 3
Is a low power view of the full thickness of the gastric wall in the region of the ulcer. This ulcer shows ongoing necrosis and inflammation as well as fibrous repair and the classic zones of Askenazy are readily apparent. "A" represents the superficial layer of necrotic debris and acute inflammation. Just below this superficial layer is a zone of active granulation tissue (B) which in the deeper layers matures into a fibrous scar (C). The entire ulcer extends to the serosa of the stomach and the subserosal fat layer is noted by the letter "D". Again, notice the large artery at the base of the ulcer.