GI Pathology: Gupta

Question 1

What is sialadenitis?
Etiologies?
Clinical manifestation?

Answer 1

inflammation of salivary glands
Infectious, Sjogren’s syndrome, sarcoidosis, irradiation
Staph. aureus- MCC (pathogen)
Typically involves parotid- swollen and painful. Duct drains pus.

Question 2

Hairy leukoplakia:
Cause-
Appearance-
Associations-
Malignant? Premalignant? Not premalignant?

Answer 2

Cause- EBV
Appearance- white plaque that cannot be scrapped off- unlike thrush
Association- AIDS, immunosuppression, old age
Considered premalignant until proven otherwise.

Question 3

Erythroplakia
Cause-
Appearance-
Male or female predominance?
Malignant? Premalignant? Not premalignant?

Answer 3

Cause- tobacco use
Appearance- erythematous, level or slightly depressed from surrounding mucosa
Found in men, predominately
90% are severely dysplastic, CIS, or minimally invasive carcinoma

Question 4

Approx 95% of cancers of the head and neck are adenocarcinomas, SCC, gangliomas…?
What is the etiology in 70% of cases?

Answer 4

SSC

70% are secondary to HPV-16

Question 5

Whereas SCC due to smoking is associated with mutated ____, HPV related SCC is due to mutations in ____.

Answer 5

p53 (smoking)

p16- cyclin-dependent kinase inhibitor (HPV)

Question 6

A pt with HPV negative or HPV pos. SCC has a better prognosis?

Answer 6

HPV positive

Question 7

What is a dentigerous cyst?
Cure?
Cancer association?

Answer 7

A cyst originating around the crown of an unerupted 3rd molar. Lined by SS epith.
Removal of lesion is curative.
Associated w/ ameloblastoma*- locally invasive tumors in mandible, radiolucent “soap bubble”

*Ameloblasts are cells present only during tooth development that deposit tooth enamel, which is the hard outermost layer of the tooth forming the surface of the crown. -Wiki

Question 8

What is an odontogenic karatocyst aka karatocystic odontogenic tumor?
How old/what sex are the pts?
What area of the mandible are they found in?
Radiographic and histo appearance?
Cure?

Answer 8

Rare and benign but locally aggressive developmental cystic neoplasm. It most often affects the posterior mandible.
Males 10-40yo
Posterior mandible
Rad- well-defined unilocular or multilocular radiolucencies
Histo- Cyst lined by thin layer of keratinized SS epith. w/ a prominent basal cell layer and corrugated epith.
Resect lesion for cure. Inadequate resection results in 60% recurrence.

Question 9

What is a cholesteatoma?

Answer 9

Non-neoplastic cystic lesions lined by karatinizing SS epith. or metaplastic mucus secreting epith. Filled with amorphous debris.
Kind of like an epidermal inclusion cyst of the ear. Can cause local destruction of middle/inner ear.

Question 10

Cyst on later aspect of neck along SCM. What is it?

What’s found in it, histologically?

Answer 10

Brachial cleft cyst.

Prominent lymphoid cells on histo (germinal centers)

Question 11

Cyst along midline of neck. What is it?

What is found in it on histo?

Answer 11

Thyroglossal duct cyst.

Find lymphoid aggregates or remnants of recognizable thyroid tissue on histo

Question 12

What combination of fistula/atresia/blind endedness is the most common presentation of esophageal malformation?

Answer 12

Blind ended proximal esophagus w/ distal esophageal fistula to trachea. Air down trachea—> into esophagus —> stomach

Question 13

A posterior outpouching of mucosa and submucosa of the esophagus through the cricoharyngeal muscle is called a:

Answer 13

Zenker (pharyngeal) diverticula

Question 14

longitudinal mucosal tears near the gastroesophageal junction are called:

Answer 14

Mallory-Weiss tears. Often present as blood in vomit.

Question 15

Difference between omphalocele and gastrochesis?

Answer 15

Omphalocele has serous parietal peritoneum surrounding it. Basically, guts in a bag protruding from abdomen. Due to abd. muscles not coming together appropriately.

Gastrochesis has no parietal peritoneum. Just guts protruding from abdomen.

Question 16

Meckel diverticulum is a failed involution of the:
Explain the “rule of 2s” as it relates to MD.
They often become symptomatic because of:

Answer 16

Vitelline duct

2% of population
present within 2 ft of iliocecal valve
2 inches long
x2 more common in males
symptomatic by age 2, if ever. only 4% ever symptomatic

Often symptomatic due to presence of ectopic pancreas, secreting enzymes that cause damage–> inflammation

Question 17

Pyloric stenosis:
Cause?
Presentation?
males/females?
Physical exam findings?

Answer 17

Hypertrophic pyloric circular muscle
Projectile vomiting.
Males
Firm, ovoid 1-2cm abdominal mass

Question 18

Esophageal mucosal webs.
Syndrome name?
Men or women?
Associations?

Answer 18

Patterson-Brown-Kelly or Plummer-Vinson syndrome
Women.
Assoc. w/ Fe deficiency anemia, dysphagia from incompletely chewed food.
Fe def—> angular cheilitis, glossitis.

Question 19

What are Schatzki rings?

Answer 19

Like an esophageal web but circumferential as opposed to sectional.

Question 20

Viral esophagitis:
Viral etiologies?
Histo appearance?
Gross appearance?

Answer 20

HSV, CMV
Multinucleated giant cells with viral inclusions
Overlapping herpetic ulcers in distal esophagus.

Question 21

Fungal infxn of the esophagus. What is causing it?

Answer 21

Candida- big sign: parakeratosis

Question 22

What will you see histologically in graft-versus-host dz?

Answer 22

Dyskeratotic/dying keratinocytes in mucosal epithelium +/- lymphocytic inflammation

Question 23

Ulcers occurring in the proximal duodenum associated with severe burns or trauma (skin burns/trauma, not to GI tract, necessarily) are called:

Answer 23

Curling ulcers (think curling iron burn)

Question 24

Gastric, duodenal and esophageal ulcers in pts with intracranial dz are called:
These carry a high incidence of:

Answer 24

Cushing ulcers

High incidence of perforation

Question 25

Gastric antral vascular ectasia aka watermelon stomach:
Cause?
Gross appearance on endoscopy?
Histo appearance?
Dz associations?
Presentation?

Answer 25

Cause: ectatic mucosal vessels

Longitudinal stripes of edematous, erythematous mucosa that alternate with less severely injured, paler mucosa (hence, watermelon stripes)

Histo: reactive gastropathy w/ dilated capillaries containing fibrin thrombi

Dz assoc: cirrhosis and systemic sclerosis

Presentation: occult fecal blood or Fe def. anemia

Question 26

MCC of small bowel obstruction:
MCC of intestinal obstruction worldwide:
MCC of intestinal obstruction in children younger than 2yo:

Answer 26

Peritoneal adhesions in US
Herniation worldwide
Intussusception

Question 27

Clinical presentation of intestinal obstruction:

Answer 27

abd pain, distension, vomiting, constipation

Question 28

Graft-vs-host dz:
Cause?
Histo appearance?

Answer 28

Cause- hematopoietic stem cell transplantation. Secondary to donor T-cells targeting antigens on host's GI epithelial cells. 
Small bowel/colon involved in most cases. 
Mucosal apoptosis (not necrosis, bc cell mediated!)

Question 29

Pure SCC of the anal canal is most freq assoc. w/:

Answer 29

HPV-16

Question 30

MCC of acute appendicitis:

Dx requires:

Answer 30

Overt lumenal obstruction by poop stone aka fecalith.

Dx req’s neutrophilic infiltration of the muscularis propria

Question 31

Most common tumor of appendix?
Benign or malignant?
proximal or distal tip assoc?
Gross appearance on cross section?

Answer 31

Carcinoid tumor
Almost always benign
Distal tip swelling
Well-circumscribed, golden-yellow color.

Question 32

Mucinous neoplasms of the appendix:
Types?
Clinical course?
Prognosis?

Answer 32

Can be mucocele- a dilated appendix filled with mucin (indolent)
Can be a mucinous cystadenoma or cystadenocarcinoma.
Cystadenocarcinoma can invade through wall of appendix and spread intraperitonealy (pseudomyxoma peritonei).
Can be held in check for yrs by debulking but in most instances, is fatal.