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Gastrointestinal > Large intestines II > Flashcards

Large intestines II Flashcards

1
Q

What is the most common type of adenomatous polyps?

A

Tubular adenoma

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2
Q

What percent of polyps are villous adenomas? Who are these found in?

A

1% Older people

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3
Q

How big can villous adenomas get before they’re considered CA?

A

4 cm

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4
Q

Is there a stalk with villous adenomas?

A

no

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5
Q

What are the histological characteristics of villous adenomas?

A

Finger like projections

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6
Q

What are tubulovillous adenomas? The risk of CA with these is proportional to what?

A

Adenomas with partial stalk and part villous architecture. CA risk correlates with villous proportion

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7
Q

What are the three factors that predict whether or not a polyp will develop into CA?

A

Size (max diameter is chief determinant)
Proportion of villous component
Degree of dysplastic change

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8
Q

What are the clinical ssx of adenomas?

A

asymptomatic to bleeding

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9
Q

When can adenomas metastasize?

A

if they cross the muscularis mucosa

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10
Q

What are the three histological considerations for excising an adenoma?

A
  1. Adenocarcinoma is superficial
  2. No vascular or lymphatic invasion
    3 CA is not poorly differentiated
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11
Q

What is the only treatment for adenomas?

A

Complete resection

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12
Q

Why are villous adenomas more worrisome for CA?

A

closer to BM

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13
Q

What is the adenoma-carcinoma sequence?

A

Theory that CA develops from adenomatous lesions based on observations and evidence of genetic alterations

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14
Q

How does the distribution of adenomas and adenocarcinomas relate?

A

Very similar distribution

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15
Q

True or false: cancer risk is directly related to the number of adenomas?

A

True

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16
Q

True or false: the incidence of colorectal CA decreases if adenomas are removed?

A

True

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17
Q

True or false: most GI cancers arise sporadically

A

True

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18
Q

What is the age range for the development of rectal CA?

A

60-70

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19
Q

True or false: ASA and other NSAID use may increase the risk of developing GI CA

A

False–protective

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20
Q

Fe deficiency anemia in an older male means it is what until proven otherwise?

A

GI tract CA

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21
Q

Where does most of the GI tract drain lymph to?

A

Liver

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22
Q

What is the pattern of inheritance for familial adenomatous polyposis?

A

AD

23
Q

What is familial adenomatous polyposis?

A

mutation of the APD gene, a tumor suppressor gene, which regulates the WNT pathway

24
Q

Describe the role of FAP in the WNT pathway.

A

Absence of the APC gene in the WNT pathway inhibits the destruction of beta-catenin. This can then go into the nucleus of a cell, and transcribe myc and Cyclin D

25
Q

What is the cause of HNPCC (lynch syndrome)?

A

Defects in the pathway of DNA mismatch repair, specifically MSH2 or MLH1.

MSH2 identifies mismatched DNA
MLH1 repairs them

26
Q

Why is the APC gene mutation so concerning?

A

WILL cause carcinoma of the GI tract

27
Q

What is the attenuated FAP?

A

APC and MUTYH mutations cause a less severe type of polyposis

28
Q

What is Gardener’s syndrome?

A

Polyposis syndrome that can result in tumors outside the GI tract. Caused by a mutation in the APC gene.

29
Q

What is Turcot syndrome?

A

APC gene mutation that causes polyposis with medulloblastomas

30
Q

What is the model of the genetic alterations needed for HNPCC to develop?

A

APC or MSH2 are mutated on BOTH alleles (two hit phenomenon), causing a loss of DNA mismatch repair and more mutations, leading to CA

31
Q

Why are right sided polypoid masses rarely obstructive?

A

stool is still watery at this pint

32
Q

Pencil thin stool are suspicious for what?

A

Annular, encircling lesions in the left colon

33
Q

Mucin production is a good or bad sign of colorectal CA?

A

Bad

34
Q

What are carcinoid tumors?

A

Carcinoid tumors are a type of neuroendocrine tumor, which means they come from cells of the nervous and endocrine system, and can produce hormones. When they secrete excess hormones such as histamine and serotonin, they can cause symptoms such as flushing, stomach cramps, and diarrhea.

35
Q

Which location of carcinoid tumor rarely metastasizes? Which often does?

A

Appendix = rare

Ileal, gastric, colonic - frequent

36
Q

What is the cause of carcinoid syndrome?

A

Mets of carcinoid tumors to the liver. These release 5HT and cause flushing/diarrhea/wheezing

37
Q

What are the gross characteristics of carcinoid tumors? Histological?

A

Yellow, firm tumors

Minimal atypia, monotonous, uniform cells

38
Q

Who gets carcinoid tumors?

A

60 yo

39
Q

What types of lymphoma are common in the GI tract (what cell origin)?

A

B cell origin

40
Q

What percent of gastrointestinal lymphomas are extranodal?

A

40%

41
Q

What are the three main types of gastric lymphomas?

A

MALT
SPru-associated
Mediterranean lymphomas

42
Q

True or false: GI lymphomas are usually inherited

A

False– sporadic

43
Q

When are GI lymphomas treated with surgery?

A

If large enough to cause an obstruction

44
Q

MALT lymphomas have what cellular origin, usually?

A

B cell

45
Q

MALTomas are usually associated with what infection?

A

H.Pylori

46
Q

Why are MALTomas different from nodal lymphomas?

A

Behave as a focal tumor

47
Q

What is the cellular origin of Mediterranean lymphoma? What does this cause?

A

B cells that produce abnormal IgA heavy chain.

48
Q

WHo gets intestinal T-cell lymphomas?

A

Pts with celiac sprue

49
Q

True or false: GI lymphomas have a worse prognosis that those arising in other sites

A

False–better prognosis

50
Q

What are mesenchymal tumors of the GI tract? What is the cause of them?

A

GISTs that are caused by a somatic mutation in c-KIT gene–a tyrosine kinase receptor

51
Q

What are the histological characteristics of appendicitis?

A

PMN infiltration

52
Q

What are the three types of appendix tumors?

A

Mucocele
Mucinous cystadenoma
Mucinous cystadenocarcinoma

53
Q

What is a mucocele?

A

Mucinous production–benign

54
Q

What is a mucinous cystadenomas? Mucinous cystadenocarcinoma?

A

Both are mucin filled spaces and glands. the CA produces pseudomyxoma peritonei (mucus secreting malignant cells in the abdo)

Gastrointestinal (42 decks)

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