esophagus

Question 1

congenital abnormalities

it is usually discovered after birth due to regurgitation during feeding
*most lesions are incompatible with survival without sx
*

Answer 1

atresia and fistula

Question 2

congenital abnormalities

omphalocele

Answer 2

extraembryonic gut fails to return to abdominal cavity and closure of abdominal musculature is incomplete

*membrane covered by amnion and peritoneum separated by wharton jelly

chromosomal abnormalities

Question 3

congenital abnormalities

similar to omphalocele except it involves all the layers of abdominal wall (from peritoneum to the skin)

Answer 3

gastroschisis

Question 4

congenital abnormality

usually limited to the intestine, occurs as an isolated defect without other abnormalities

Answer 4

gastroschisis

Question 5

congenital abnormalities

blind outpouching of alimentary tract that communicates with the lumen and includes all 3 layers of bowel wall (true diverticulum)

Answer 5

meckel diverticulum *ileum

most common congenital anomaly of GI tract

Question 6

congenital abnormalities

failed involution of the vitelline duct

connects the lumen of developing gut to the yolk sac

Answer 6

meckel diverticulum

Question 7

in this condition, severity of symptoms is not closely related to the degree of histologic damage *histologic abnormalities may be found w/o typical GERD symptoms

Answer 7

reflux esophagitis

Question 8

reflux esophagitis

gross description

Answer 8

• simple hiperemia in mild GERD
• erosions in significant gastric reflux

Question 9

congenital abnormalities

incomplete formation of diaphragm allows the abdominal viscera to herniate into the thoracic cavity

most common on left side

Answer 9

diaphragmatic hernia

Question 10

congenital abnormalities

can lead to potential fatal pulmonary hypoplasia

Answer 10

diaphragmatic hernia

Question 11

reflux esophagitis

causes & risk factors of GERD

Answer 11

• transitien LES relaxation
• alcohol, tobacco use, obesity
• hiatal hernia

Question 12

reflux esophagitis

histology of GERD

Answer 12

** basal zone hyperplasia (thickening)
**** elongation of lamina propria papillae**
* dilation of vascular channels at tip of papillae –> hyperemia
* scattered intraepithelial eosinophils
* superficial coagulative necrosis in nonkeratinized squamous epithelium
* inflammatory cells (granulocytes, lymphocytes, macrophages) *associated with bacterial or fungal infection or chemical damage

Question 13

barrett esophagus

histologic description of BE

Answer 13

-intestinal-type metaplasia-
GOBLET CELLS
*gastric-type foveolar cells (?)

Question 14

barrett esophagus

gross description

Answer 14

• tongues of red, velvety mucosa extending upward from gastroesophageal junction
• metaplastic mucosa alternates with residual smooth, pale squamous mucosa (esophageal) mucosa and interfaces with light-brown columnar (gastric) mucosa distally

Question 15

barrett esophagus

nondysplastic reactive BE shows the presence of 4 lines

Answer 15

1. gastric foveolar type mucin droplet
2. base of the foveolar mucin vacuole
3. cytoplasm below the mucin vacuole
4. row of nuclei

Question 16

barrett esophagus

dysplasia

Answer 16

atypical mitoses, nuclear hyperchromasia, irregularly clumped chromatin, increased nuclear-to-cytoplasmic ratio, failure of epithelial cells to mature as they migrate to esophageal surface

Question 17

pathophysiology of barrett esophagus

Answer 17

intestinal metaplasia –> genomic instability (TP53 inactivation) –> genome doubling and copy number alterations –> malignancy

Question 18

dysplastic glands display budding, irregular shapes, and cellular crowding

Answer 18

barrett esophagus

Question 19

usually occurs in distal third of esophagus and may invade adjacent gastric cardia

Answer 19

esophageal adenocarcinoma

Question 20

initially appears as flat or raised patches in otherwise intact mucosa and may grow into large masses of 5 cm or more in diameter

Answer 20

esophageal adenocarcinoma

Question 21

esophageal adenocarcinoma

signet ring cell morphology is associated with a…

Answer 21

poor prognosis

Question 22

histologic description of esophageal adenocarcinoma

Answer 22

• typically produce mucin and form glands often with intestinal-type morphology
• barrett esophagus is frequently present adjacent to the tumor

Question 23

squamous cell carcinoma risk factors

Answer 23

• alcohol and tobacco use
• poverty
• caustic esophageal injury
• achalasia
• plummer-vinson syndrome
• diets deficient in fruits or vegetables
• frequent consumption of very hot beverages
• previous radiation to mediastinum

Question 24

gross description of squamous cell carcinoma

Answer 24

• middle third of the esophagus

Question 25

# esophageal adenocarcinoma differece between low grade and high grade dysplasia

Answer 25

low grade will have **cytological** atypia but little to no architectural atypia | (high)dysplastic epithelial cells are still limited by basement membrane

Question 26

clinical features of esophageal adenocarcinoma

Answer 26

* pain or dysphagia * progressive weight loss * hematemesis * chest pain * vomiting

Question 27

# esophageal adenocarcinoma low grade dysplasia is characterized by...

Answer 27

* mucin loss * hyperchromatic and enlarged nuclei * dysplasia generally extends to the surface at least focally

Question 28

squamous cell carcinoma gross description

Answer 28

* middle third of esophagus * begins as an in situ lesion (squamous dysplasia) * early lesions: small, gray-white, plaque-like thickenings

Question 29

esophageal cancer that may invade surrounding structures including respiratory tree (causing pneumonia), aorta (catastrophic exsanguination), mediastinum and pericardium

Answer 29

squamous cell carcinoma