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What do you see here? Types?

- Stress-related mucosal disease: punctate erosions 

- Most critically ill pts admitted to hospital ICU's have histo evidence of gastric mucosal damage -> cause likely ischemic

1. Most common in ppl with shock, sepsis, or severe trauma

- CURLING: in proximal duodenum, and assoc with severe burns or trauma 

- CUSHING: gastric, duodenal, and esophageal ulcers in ppl w/intracranial disease -> high incidence of perforation 


What is this? Epi? Symptoms?

- Esophageal mucosal web: idiopathic, ledge-like protrusions of mucosa that may cause obstruction

1. Fibrovascular CT + overlying epithelium 

- EPI: women, age 40, GERD, chronic graft-versus-host disease, or blistering skin diseases

- In upper esophagus, may be accompanied by iron-deficiency anemia, glossitis, & cheilitis as part of the Paterson-Brown-Kelly or Plummer-Vinson syndrome  

- Main symptom non-progressive dysphagia assoc with incompletely chewed food


What do you see in these appendiceal histo images?

- Mucinous neoplasms: invasion through appendix wall can lead to intraperitoneal seeding and spread (may be mistaken for ovarian tumors in women) 

1. Advanced cases fill abdomen with tenacious, semisolid mucin -> pseudomyxoma peritonei

- May be held in check for yrs by repeated debulking but, in most instances, follows inexorably fatal course 

- Do NOT break these open in surgery

- NOTE: mucocele (dilated appendix filled w/mucin) may be obstructed appendix w/inspissated mucin or be mucinous cystadenoma /cystadenocarcinoma 

1. Can also get mucoceles on lip


Etiology and molecular markers of SCC in the oropharynx?

- 95% of cancers of head/neck SCC

- 70% of SCC in oropharynx (NOT the oral cavity), esp those involving tonsils, base of tongue, and pharynx, harbor oncogenic variants of HPV, esp HPV-16 

1. Better long-term survival if HPV+ cancer: over-express p16, cyclin-dependent kinase INH

- Typically advanced stage at dx; not amenable to screening, and may have multiple primary sites

- Genetic alterations w/molecular signature consistent w/tobacco carcinogen-induced cancers  


What are the features of Menetrier disease?

- Rare, acquired pre-malignant disease of stomach: associated with adenocarcinoma

- Mutations of TGF-alpha, leading to massive gastric folds and excess mucous production -> gastropathy

- 30-60 y/o's 

- Limited inflammation in body and fundus of stomach 

- SYMPTOMS: hypoproteinemia, weight loss, diarrhea


What are these? Difference?

- OMPHALOCELE (left): closure of abdominal muscles incomplete and abdominal viscera do not return to abdomen from umbilical cord, remaining in a ventral amnioperitoneal membranous sac

1. May be repaired surgically, but as many as 40% of these infants have other birth defects

- GASTROSCHISIS (right): similar to omphalocele, but it involves all of the layers of the abdominal wall, from the peritoneum to the skin; herniation through muscle near belly button (less frequently assoc with other defects than omphalocele) 


What is going on here?

- Sialadenitis: inflammation of salivary glands

- Can be infectious (viral, bacterial) or noninfectious (Sjogren syndrome, sarcoidosis, radiation)

- Staphylococcus aureus is often the pathogen (see attached image)

- Acute sialadenitis typically involves parotid gland, which becomes swollen, erythematous, and painful + purulent discharge drains from the duct


What are the features of fundal gland polyps?

- Age 50

- Parietal and chief cells

- No inflammation or symptoms 

- Risk factors: PPIs, familial adenomatous polyposis (FAP)

- Association with gastric adenocarcinoma only in syndromic FAP


What happened here?

- Graft-vs-host disease: after hematopoietic stem cell transplant -> small bowel and colon involved in most cases

- 2o to donor T-cells targeting Ag's on recipient's GI epithelial cells, but lamina propria lympho infiltrate is typically sparse 

- Epithelial apoptosis, particularly of crypt cells, is the most common histologic finding 

- Apoptotic debris in this image


What do you see here? Epi?

- Erythroplakia: much less common than leukoplakia

- Much more ominous than leukoplakia: virtually all (about 90%) disclose severe dysplasia, carcinoma in situ, or minimally invasive carcinoma 

- Epi: associated with tobacco use

1. People 40-70 y/o

2. Typically males

3. Can occur anywhere in oral mucosa 


What is this? Epi? Radiology? Histo? Tx?

- Odontogenic keratocyst (OKC; aka, keratocystic odontogenic tumor): assoc w/basal cell nevus syn

- EPI: posterior mandible in 10-40-y/o males 

- RADIOGRAPH: well-defined unilocular or multi-locular radiolucencies 

- HISTO: cyst lining a thin layer of keratinized stratified squamous epithelium w/prominent basal cell layer and corrugated epithelial surface (key to diagnosis)

- TX: requires complete removal of lesion b/c locally aggressive, and recurrence rates for inadequately removed lesions can reach 60%. 


What are these?

- Mallory-Weiss tears -> lacerations: longitudinal mucosal tears near gastroesophageal junction

- Most often associated with severe retching or vomiting secondary to acute alcohol intoxication

- Do not generally require surgical intervention, and healing tends to be rapid and complete 


What is going on here?

- Gastric antral vascular ectasia (GAVE): watermelon stomach -> red and white alternating mucosa (ex: can be seen in systemic sclerosis or cirrhosis)

- Can be recognized endoscopically as longitudinal stripes of edematous erythematous mucosa that alternate with less severely injured, paler mucosa 

1. Erythematous stripes are ectatic (dilated) mucosal vessels 

- HISTO: antral mucosa shows reactive gastropathy with dilated capillaries containing fibrin thrombi 

- Patients may present with occult fecal blood or iron deficiency anemia 


What do you see here?

Mucoepidermoid carcinoma: variable mixtures of squamous, mucus-secreting, and intermediate cells 

- 15% of all salivary gland tumors; 60-70% in parotid

- Grade is important determinant of 5-year survival: 

1. Low-grade = 90% (indolent)

2. High-grade = 50%

- Most comm malignant salivary gland tumor in kids

- Mucin stain (pink) can be helpful for diagnosis 


What is this?

- Esophageal ring, or Schatzki ring: similar to webs, but circumferential and thicker

- Include mucosa, submucosa, and, occasionally, hypertrophic muscularis propria 


What are the features of gastric adenomas?

- Age 50-60

- More common in the antrum than the body

- Dysplastic, intestinal cells 

- Variable amt/types of inflammation 

- Similar symptoms to chronic gastritis

- Risk factors: chronic gastritis, atrophy, intestinal metaplasia

- Frequent association with gastric adenocarcinoma


What are the 2 main types of appendiceal tumors?

- Carcinoid 

- Mucinous neoplasms 


What is the most common manifestation of esophageal malformations?

- Proximal esophageal atresia (B) 

- Esophagus continuous with the mouth ending in a blind loop superior to the sternal angle

- Distal esophagus arises from the lower trachea or carina 



What is this? Describe the histo. Epi?

- Leukoplakia: white patch or plaque that can't be scraped off, and can't be characterized clinically or pathologically as any other disease 

- Premalignant until proven otherwise; much lower threshold for calling things in oral cavity dysplasia vs. the cervix 

- HISTO -> severe dysplasia characterized by:

1. Nuclear and cellular pleomorphism

2. Numerous mitotic figures, and

3. Loss of normal maturation

- EPI: associated with tobacco use, 40-70-y/o males; can occur anywhere in oral mucosa 


What are these (appendiceal)?

Mucinous neoplasms: start worrying when cells become elongated and hyperchromatic

- TOP: tumor cells with abundant cytoplasmic mucin, enlarged, hyperchromatic basal nuclei, and minimal cytologic atypia

- BOTTOM: epi cells that are cytologically low grade, similar to neoplastic cells in the appendix

- ATTACHED: peritoneal mucin deposits with scant strips and clusters of mucin-containing epithelial cells (pseudomyxoma peritonei) 


What is this? Histo?

- Carcinoid tumor: most common tumor of appendix

- Usually incidental, and almost always BENIGN

- Frequently forms solid, bulbous swelling at distal tip of the appendix (like in the image on front of card)

1. Golden, yellow appearance 

- Although intramural and transmural extension may be evident, nodal metastases are very infrequent, and distant spread is exceptionally rare 

- HISTO: nested, bland cells with salt and pepper chromatin, like all NE tumors (see attached)


What is the most common form of congenital intestinal atresia?

- Imperforate anus: due to failure of cloacal diaphragm to involute 

- These infants fail to pass meconium 




What is this (anorectal biopsy)? Most significant prognostic factors?

- Squamous cell carcinoma: assoc w/HPV-16 (most common anorectal malignancy)

- Tumor size (T stage) & nodal status (N stage) are most significant prognostic factors for pts with anal squamous cell carcinoma (SCC) 

1. 5-year survival by stage: 

T1 and T2 – 86%

T3 – 60%

T4 – 45%

N0 – 76%

Node-positive – 54%


What are the features of Zollinger-Ellison syndrome?

- Gastrinoma, leading to peptic ulcers and neutro inflammation

- INC HCl released by parietal cells in the fundus of the stomach 

- No association with adenocarcinoma 

- Risk factor: MEN-1

- Around age 50


What is this? Describe 3 types.

- Esophageal diverticulum: outpouching of mucosa through muscular layer of the esophagus 

- Can be asymptomatic or cause dysphagia and regurgitation 

- Dx by barium swallow; sx repair rarely required

- Several types, each of different origin: 

1. Zenker (pharyngeal): posterior outpouchings of mucosa/submucosa through cricopharyngeal muscle; lack of coordination b/t pharyngeal propulsion and cricopharyngeal relaxation

2. Midesophageal (traction): traction from mediastinal inflam lesions or motility disorders

3. Epiphrenic: just above diaphragm and usually accompanies motility disorder (achalasia, diffuse esophageal spasm)


What do you see here?

Thyroglossal duct cyst: thyroid anlage begins in foramen cecum at base of tongue, and descends to midline location in anterior neck in devo 

- Remnants can persist, and are lined by stratified squamous epi when located near base of tongue, or pseudostratified columnar epi in lower locations -> variable histo appearance makes anatomic location important for diagnosis 

- CT wall of cyst may harbor lymphoid aggregates or remnants of recognizable thyroid tissue -> tx is EXCISION


What do you see in these images?

- Viral esophagitis

- GROSS: postmortem specimen with multiple, overlapping herpetic ulcers in the distal esophagus

- TOP RIGHT: multinucleate squamous cells containing herpesvirus nuclear inclusions

- BOTTOM RIGHT: CMV-infected endothelial cells with nuclear and cytoplasmic inclusions -> can be a real problem in people with UC and Crohn's



What are these? What are the divisions of the anal canal? Carcinomas?

- Condyloma acuminatum: can be precursor lesions to pure squamous cell carcinoma of the anal canal (freq associated w/HPV infection

- DIVISIONS (1/3rds): 

1. Upper zone: columnar rectal epi 

2. Middle: transitional epithelium

3. Lower: stratified squamous epi -> below dentate/pectinate line (palpable on exam) 

- NOTE: carcinomas of anal canal may have typical glandular or squamous patterns of differentiation 

1. Tend to be squamous below dentate line, but more mucosal, and adeno above (only 5%)


What is this?

- Diaphragmatic hernia: incomplete formation of the diaphragm allows abdominal viscera to herniate into the thoracic cavity

- When severe, space-filling effect of the displaced viscera can cause pulmonary hypoplasia that is incompatible with life 

- Liver in thoracic cavity in image on the front of card, and bowel in left side of the thoracic cavity in the attached imaging


What is this?

- Branchial (cervical lymphoepithelial) cyst: vast majority thought to arise from remnants of 2nd branchial arch -> young adults (20-40-y/o)

- Upper, lateral aspect of the neck along the sternocleidomastoid (SCM) muscle

- MICRO: fibrous walls, usually lined by stratified squamous or pseudostratified columnar epithelium

1. Cyst wall typically contains lymphoid tissue with prominent germinal centers