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Robbins Pathology GI (Chptr 16,17,18,19) > Chapter 17- Small Intestine And Colon Cancers > Flashcards

Chapter 17- Small Intestine And Colon Cancers Flashcards

1
Q

What is the most common neoplastic polyp

A

Adenoma, which is able to progress to cancer

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2
Q

When are colonic hyperplastic polyps commonly discovered

A

60/70s

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3
Q

What is the cause of hyperplastic polyps and what is the prognosis

A

Piling up of goblet cells and parietal cells, but do not have malignant potential

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4
Q

What location are hyperplastic polyps most commonly found

A

Left colon

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5
Q

What is the histological hallmark of the hyperplastic polyps

A

Serrated surface architecture

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6
Q

What is the triad of symptoms that lead to the diagnosis of inflammatory polyps

A

Rectal bleeding, mucus discharge, inflammatory lesion on the anterior rectal wall

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7
Q

What is that cause of inflammatory polyps

A

Impaired relaxation of the anorectal sphincter leads to a sharp angle of the anterior rectal shelf and leads to abrasion and ulceration

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8
Q

What are the histological hallmarks of an inflammatory polyp

A
  • Mixed Inflammatory infiltrates
  • Erosion
  • epithelial hyperplasia with fibromuscular hyperplasia
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9
Q

Inflammatory polyps develop as part of which syndrome

A

Solitary rectal ulcer syndrome

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10
Q

What is the cause of the formation of hamartomatous polyps

A

Germline mutations in the tumor suppressor genes or protooncogenes

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11
Q

What is the ability of harmartomous polyps to malignancy

A

There is an increased risk of cancer and they are characterized as pre-malignant

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12
Q

In which patients do the juvenile polyps form

A

Patients younger than 5

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13
Q

What is the main location of juvenile polyps and how do the typically preset

A

Rectum and present with rectal bleeding

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14
Q

What are complication of juvenile polyps

A
  • Intussusception
  • Intestinal obstruction
  • polyp prolapse
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15
Q

Patients with autosomal dominant syndrome of juvenile polyposis commonly have what characteristic of polyps and what is the treatment

A

Multiple (3 to 100) and must have colectomy to prevent perforation

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16
Q

What are the extraintestinal malformation of juvenile polyposis

A

Pulmonary arteriovenous malformation and other congenital abnormalities

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17
Q

What are the morphological findings of juvenile polyps

A

Pedunculated, smooth surfaced, reddish lesions with characteristic cystic spaces after sectioning, usually filled with mucin and inflammatory debris

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18
Q

What is the most common mutation found in juvenile polyps

A

SMAD4, which codes for the BMPR1A of the TGF pathway

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19
Q

Patients with juvenile polypropsis are most at risk for which condition

A

Development of colonic adenocarcinoma (30-50% of patients)

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20
Q

What is the clinical presentation of pests-jeghers syndrome

A

Multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation

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21
Q

What are the characteristics of the mucocutaneous hyperpigmentation seen in Peutz-Jeghers syndrome

A

Dark blue, brown macules on the lips, nodules, buccal mucosa, hands, genitals and perianal regions

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22
Q

What is the complication seen with Peutz-Jeghers polyps

A

Can cause intussuseption and multiple malignancies

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23
Q

Which tumors are monitored for in those with Peutz-Jeghers syndrome

A
  • Sex cord tumors of the testes (birth)
  • gastric and small intestine cancers (late childhood)
  • colon, pancreatic, breast, lung, ovarian, and uterine cancer (20s)
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24
Q

What is the mutation in Peutz-Jeghers

A

Loss of function mutation in STK11

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25
Q

What is the histological finding in Peutz-Jeghers syndrome

A

Arborizing network of connective tissue, smooth muscle

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26
Q

What are colorectal adenomas characterized by

A

Presence of epithelial dysplasia

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27
Q

What are the histological hallmarks for epithelial dysplasia in colon polyps

A

Nuclear hyperchromasia, elongation, and stratification

28
Q

How are sessile serrated adenomas secreted from the hyperplastic polyps

A

Located on the right side of the colon

29
Q

What are the histological findings of the sessile serrated adenomas

A

Have malignant potential, but tend to not have the cytological features of dysplasia
-have the serrated architecture through the full length of the glands, including the crypt base, dilation and lateral growth

30
Q

What are the histological characteristics of the intramucosal carcinoma

A

Dysplasia epithelial cells breach the membrane to invade the lamina propria

31
Q

What is the malignant potential of intramucosal carcinoma

A

Non metastatic because the lymphatic channels are absent in the colonic mucosa

32
Q

What is the most important characteristic of colorectal adenomas that correlates with malignancy

A

Size, but there is some with high grade dysplasia

33
Q

What is the hereditability of Peutz-Jeghers syndrome

A

Autosomal dominant

34
Q

What is the hereditability of Familial adenomatous polyposis

A

Autosomal dominant

35
Q

Which mutation and pathway is affected in Familial adenomatous polyposis

A

APC for Wnt pathway

36
Q

How many polyps are present for Familial adenomatous polyposis tobe diagnosis

A

At least 100, but may be 1000s

37
Q

Patients with Familial adenomatous polyposis are guaranteed to get which condition

A

Colorectal adenocarcinoma

38
Q

What is the treatment for patients with Familial adenomatous polyposis

A

Prophylactic colectomy

39
Q

Despite removal of the colon, patients with Familial adenomatous polyposis develop adenomas in which location

A

Adjacent to the ampulla of Vater in the stomach

40
Q

Which extraGI manifestation is commonly seen at birth in patients with Familial adenomatous polyposis

A

Congenital hypertrophy of the retinal pigment epithelium

41
Q

What is the condition called when Familial adenomatous polyposis also have a mutation in MYH gene

A

Autosomal recessive MYH associated polyposis

42
Q

What are the other names for Hereditary non-polyposis colorectal cancer

A

HNPCC

Lynch syndrome

43
Q

What is the most common Syndromic form of colon cancer

A

HNPCC

44
Q

In patients that have HNPCC, what cancers are common

A

Colorectal, endometrium, stomach, ovaries, urease, brain, small bowel, pancreas, and skin

45
Q

What are the clinical presentations that can give away HNPCC patients

A

Colon cancers at a younger age and are located on the right side

46
Q

What is the most common malignancy of the GI tract

A

Adenocarcinoma of the colon

47
Q

What is the relative amount of tumors in the small intestine

A

Very rare

48
Q

What dietary factors are most related to increased risk of colorectal cancer

A

Low intake of unabsorbable vegetable fiber and high intake of refined carbs and fat

49
Q

How do NSAIDs have a protective effect on colorectal cancer development

A

Inhibition of COX2, which is over-expressed in adenocarcinomas

50
Q

In colorectal cancer, what is the process of formations with the mutations that are the “hits”

A 
First hit-loss of first APC
Second hit-Loss of second APC and beta catenin 
Subsequent:
-Protoonogene mutations in KRAS
-TP53
-SMAD
51
Q

What is the role of APC in the Wnt pathway

A

Negative regulator of Beta-catenin

52
Q

Where in the stage of colorectal cancer do mutations in TP53 occur

A

Late

53
Q

In patients with DNA mismatch repair deficiency, mutations occur in which areas

A

Microsatallite instability (MSI)

54
Q

In colorectal cancers without mutations in DNA mismatch repair, what is commonly seen

A

CpG island hypermethylation phenotype (CIMP)

55
Q

In those colorectal cancers with CIMP, what is the promoter region commonly affected

A

MLH1, with mutations in BRAF region

56
Q

What are the mutations in the colon cancers with increased CpG methylation wihtoutthe microsatallite instability

A

KRAS mutation

57
Q

Invasive carcinomas with microsatellite instability have which characteristics

A

-Mucinous differentiation and peritumoral lymphocytic infiltrates i the right side of the colon

58
Q

How can tumors with microsatellite instability be recognized histologically

A

-Absence of Immuno histological staining for mismatch repair proteins or by molecular genetic analysis of sequences

59
Q

What is a high risk for patients with HNPCC

A

Second malignancies of the colon and other organs

60
Q

What are the characteristics of the adenocarcinomas in the proximal colon

A

Polyposis, exophytic masses, rarely causing obstruction

61
Q

What are the characteristics of adenocarcinomas of the distal colon

A

Annular lesions with “napkin ring lesions” with lumen narrowing

62
Q

Which location is common to see “napkin ring” and luminal narrowing

A

Distal colon

63
Q

What is the clinical appearance of patients with Cecil and right sided colon cancers

A

Fatigue and weakness due to iron deficiency anemia

64
Q

What are the clinical presentations of the patients with left sided colon adenocarcinomas

A

Occult bleeding, bowel habit changes, cramping, and left lower quadrant discomfort

65
Q

What are the prognostic factors for colorectal cancers

A

-Depth of invasion and lymph node metastases

66
Q

What is the most common site of metastasis in colorectal cancers

A

Liver

67
Q

What causes condylomata acuminatum

A

HPV

Robbins Pathology GI (Chptr 16,17,18,19) (32 decks)

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