3.03 Patho: Upper GI Cancers 36/49*

Question 1

Barrett’s esophagus is metaplasia of LES mucosa from stratified squamous epithelium to what?

Answer 1

non-ciliated columnar epithelium + goblet cells

Question 2

Is Barrett’s esophagus a malignant condition?

Answer 2

no, pre-malignant (it in itself does not have metastatic potential)

Question 3

What leads to Barrett’s esophagus?

Answer 3

chronic irritation usually from GERD

Question 4

Risk factors of Barrett’s esophagus?

Answer 4

male, white, 50s

Question 5

Where does the normal squamocolumnar junction of the esophagus and stomach meet?

Answer 5

tips of the rugal folds

Question 6

What can help you indicate that a biopsy is of the tubular esophagus?

Answer 6

esophageal submucosal glands*, ducts, or multilayered muscosa

Question 7

What do you need to establish a Barrett esophagus from the biopsy?

Answer 7

biopsy is from the lower esophagus via “tongue”/landmarks
columnar metaplasia WITH goblet cells
must designate a dysplasia category (+/-)

Question 8

Patients with high-grade dysplasia Barrett’s esophagus have at 30% chance of progressing to invasive what?

Answer 8

adenocarcinoma

Question 9

What are Barrett’s esophagus gross endoscopy findings?

Answer 9

salmon “tongue” above GEJ that extend out
velvety mucosa

Question 10

What are some clinical features of Barrett’s esophagus?

Answer 10

asymptomatic or GERD related (heartburn, chest pain, dysphagia)

Question 11

90% of Barrett’s esophagus involves what genetic abnormality?

Answer 11

p16 (INK4/CDKNA)

(TP53 mutations are also frequent)

Question 12

What is the most rapidly increasing cancer in the USA and thought to be related to increasing obesity, GERD, and declining H/pylori infections?

Answer 12

Adenocarcinoma

Question 13

Malignant epithelial tumor of the esophagus with glandular differentiation?

Answer 13

Esophageal Adenocarcinoma (EAC)

Question 14

Alcohol is strongly associated with what cancer?

Answer 14

esophageal squamous cell cancer

Question 15

What are EAC risk factors?

Answer 15

obesity, smoking, alcohol, 7% familial

Question 16

Virtually all EAC develop in the setting of what?

Answer 16

intestinal metaplasia (ex. Barrett’s Esophagus)

Question 17

What are some microscopic features that indicate EAC?

Answer 17

gland crowding, cribriform glands, dirty necrosis

Question 18

Where does EAC usually take place?

Answer 18

Distal 1/3 esophagus (from Barrett’s and extensive)

Question 19

What are some characteristics of EAC late gross lesion?

Answer 19

fungating or annular mass, ulcer

Question 20

Advanced EAC tumors that were not detected can lead to what clinical symptoms?

Answer 20

progressive dysphagia to solids –> liquids, weight loss, retrosternal/epigastric pain

Question 21

Malignant epithelial neoplasm with squamous cell differentiation?

Answer 21

squamous cell carcinoma (SCC)

Question 22

Keratinocyte-like cells with intracellular bridges +/- keratinization

Answer 22

SCC

Question 23

What are SCC risk factors? Western? Strong? Overall?

Answer 23

West - Tobacco
STRONG - alcohol
Overall - vitamin deficiency or nitrosamines in moldy/pickled food, Plummer Vinson Syndrome, achalasia, tylosis, celiacs, corrosive ingestion

Question 24

AD skin disorder with Ch 17 RHBDF2 mutations?

Answer 24

Tylosis aka focal nonepidermolytic palmoplantar keratoderma

Question 25

sever long-term iron deficiency anemia with dysphagia due to esophageal webs?

Answer 25

Plummer Vinson Syndrome

Question 26

Most SCCs are found where in the esophagus? Where does it have the worst outcomes?

Answer 26

middle 1/3 (worst at upper 1/3)

Question 27

malignant epithelial cell tumor of gastric origin?

Answer 27

gastric adenocarcinoma

Question 28

What is the difference between adenocarcinomas of early vs. late stage?

Answer 28

early limited to mucosa + submucosa while late can invade muscularis propria or deeper

Question 29

What is the pathogenesis of gastric adenocarcinomas?

Answer 29

multifactorial + strong environment & chronic mucosal injury

Question 30

People with what are up to x5 times greater risk of developing gastric adenocarcinoma?

Answer 30

H. pylori infection (cagA)

Question 31

What are the risk factors of gastric adenocarcinoma?

Answer 31

H. pylori, GERD, bile reflux gastropathy (gastric surgery), autoimmune gastritis, diet, smoking

Question 32

What will you find in the intestinal gland forming gastric adenocarcinoma?

Answer 32

bulky tumors with infiltrating glands and tubules with enlarged hyperchromatic nuclei

Question 33

What will you find in diffuse infiltrative gastric adenocarcinoma?

Answer 33

singlet rings growing in nests, cords, or singlets, with plasmacytoid or epitheliod cells aligning with inflammatory damage, stomach may look like a leather bottle

Question 34

What are signs that the gastrocarcinoma went metaplastic?

Answer 34

Virchow (left supraclavicular) Krukenberg (ovaries) Sister Mary Joseph (periumbilical) Leser-Trelat Hemategnous = Liver + Lung Ascites + Intraabdominal