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?
- 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