8. GI Pathology - BP

Question 1

What are the types of a gastric polyp?

Answer 1

1. Hyperplastic (90%)
2. Fundic gland (rare)
3. Adenomatous (10%)

Question 2

What is the epidemiology of intestinal type gastric adenocarcinoma?

Answer 2

Predominance in males; older than 50 years of age.

Question 3

What is the mechanism of formation of intestinal type adenocarcinoma?

Answer 3

Tumors arise from a precursor lesion - intestinal metaplasia occuring in the background of chronic gastritis.

Question 4

What are the main risk factors for intestinal-type gastric adenocarcinoma?

Answer 4

1. Nitrites, smoked and salted food.
2. Cigarette smoke
3. Chronic gastritis with intestinal metaplasia

Question 5

What is vital for staging intestinal-type gastric adenocarcinoma?

Answer 5

Depth of invasion into the wall of the stomach.

Question 6

What is the gross morphology of intestinal-type gastric adenocarcinoma?

Answer 6

1. Ulcer with heaped up margins.
2. Polypoid projection.
3. Flat or depressed.

Question 7

What is the microscopic morphology of intestinal-type gastric adenocarcinoma?

Answer 7

Neoplastic and invasive intestinal-type epithelium

Question 8

What is the epidemiology of diffuse (signet-ring cell) type gastric adenocarcinoma?

Answer 8

No male-female predominance; patients usually present younger than 50yrs of age.

Question 9

What is the mechanism of formation of diffuse (signet-ring cell) type of gastric adenocarcinoma?

Answer 9

No precursor lesion; signet ring cell tumors do not arise from intestinal metaplasia.

Question 10

What is the gross morphology of diffuse-type gastric adenocarcinoma?

Answer 10

Diffuse thickening of mucosa with no well-defined mass.

Question 11

What is linitis plastica?

Answer 11

Thickening of the stomach wall.

Question 12

What is the microscopic morphology of diffuse-type of gastric adenocarcinoma?

Answer 12

Signet-ring cells (eccentric nucleus with vacuole).

Question 13

What are the three components used to categorize gastric carcinomas?

Answer 13

1. Depth of invasion
2. Microscopic appearance
3. Histology

Question 14

What is the Virchow node?

Answer 14

Metastasis of gastric carcinoma to supraclavicular node.

Question 15

What is Sister Mary Joseph nodule?

Answer 15

Metastatic periumblical nodule.

Question 16

What is the clinical presentation of gastric carcinoma?

Answer 16

1. Abdominal discomfort
2. Early satiety
3. Nausea and vomiting
4. GI hemorrhage

Question 17

What are the cells of origin of GI stromal tumors (sarcoma of the stomach)?

Answer 17

The intestitial cells of Cajal.

Question 18

What is the marker commonly associated with GI stromal tumor?

Answer 18

CD117+ (c-kit).

Question 19

What are the two main non neoplastic polyps of the GI?

Answer 19

1. Hyperplastic polyps

2. Peutz-Jeghers polyps

Question 20

Give a basic description of hyperplastic polyps.

Answer 20

Common polyp of the large intestine, composed of hyperplastic colonic mucosa.

Question 21

Give a basic description of Peutz-Jeghers polyps.

Answer 21

Hamartomatous polyps, which include muscularis mucosa.

Question 22

What are the features of Peutz-Jeghers syndrome?

Answer 22

1. Autosomal dominant
2. Many GI polyps
3. Increased pigmentation of the lips and oral mucosa.
4. Patients have increased risk for developing pancreatic, breast, lung, and ovarian cancer.

Question 23

What are the main types of adenomas in the GI?

Answer 23

1. Tubular
2. Villous
3. Tubulovillous

Question 24

What is the importance of an adenoma in the GI?

Answer 24

Can be precursor of malignancy. Villous > tubular.

Question 25

What is the epidemiology of colonic adenocarcinoma?

Answer 25

Older adults (>50).

Question 26

What is the pathogenesis of colonic adenocarcinoma?

Answer 26

Small polyps (adenomas) are dysplastic, and dysplasia can progress to neoplasia.

Question 27

Mention some risk factors for colonic adenocarcinoma.

Answer 27

1. High fat, high refined carbohydrate diet. 2. Familial adenomatous polyposis. 3. Hereditary non polyposis colon cancer.

Question 28

What is the mutation associated with familial adenomatous polyposis?

Answer 28

APC gene in 5q21.

Question 29

What is the importance of familial adenomatous polyposis?

Answer 29

High risk for progression to invasive adenocarcinoma (100% of patients by age 50).

Question 30

Do we see increased numbers of polyps in hereditary non polyposis colon cancer?

Answer 30

No. (Compared to familial adenomatous polyposis)

Question 31

What colon adenocarcinomas present sooner?

Answer 31

Left-sided tumors by causing more of an obstruction.

Question 32

Is adenocarcinoma common in the small intestine?

Answer 32

No.

Question 33

What is the clinical presentation of colonic adenocarcinoma?

Answer 33

Right-sided lesions --> pain and change in stool caliber. | Left-sided lesions --> iron deficiency anemia due to hemorrhage.

Question 34

What do we suspect when we see iron deficiency anemia in patients over 50?

Answer 34

Colon cancer until proven otherwise.

Question 35

What is the usual location of a carcinoid tumor?

Answer 35

1. Appendix 2. Ileum 3. Rectum 4. Bronchi

Question 36

What is the target group of carcinoid tumors?

Answer 36

Older patients.

Question 37

What hormones can carcinoid tumors secrete?

Answer 37

1. Gastrin (Zollinger-Ellison) 2. Insulin 3. Somatostatin 4. Serotonin