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YEAR 5: Histopathology > Histo: Lower GI Disease Pt.2 > Flashcards

Histo: Lower GI Disease Pt.2 Flashcards

1
Q

Describe the epidemiology of Crohn’s

A
  • Mainly affects white people
  • Onset typically late teens - 20s
  • Women
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2
Q

List some characteristic features of Crohn’s disease.

A
  • Can affect whole GI tract (mouth to anus)
  • Skip lesions with cobblestone mucosa
  • Transmural inflammation
  • Non-caseating granulomas
  • Fissure/sinus/fistula formation
  • Bowel wall is thickened
  • Mostly affects large bowel and terminal ileum
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3
Q

List some extra-intestinal features of Crohn’s.

A
  • Arthritis
  • Uveitis
  • Stomatitis/cheilitis
  • Skin lesions - pyoderma gangrenosum, erythema multiforme, erythema nodosum
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4
Q

Describe the epidemiology of UC

A
  • Slightly more common that Crohn’s
  • Mainly affects white people
  • Onset typically 20-25 years
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5
Q

List some characteristic features of ulcerative colitis.

A
  • Involves rectum and colon in a continuous fashion (starts at rectum)
  • May see backwash ileitis (involvement of the terminal ileum)
  • Inflammation is confined to the mucosa
  • Shallow ulceration
  • Bowel wall is normal thickness
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6
Q

List some complications of ulcerative colitis.

A
  • Severe haemorrhage
  • Toxic megacolon
  • Adenocarcinoma (20-30x increased risk)
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7
Q

List some extra-intestinal manifestation of UC

A
  • Arthritis
  • Myositis
  • Uveitis/iritis
  • Skin lesion - erythema nodosum, pyoderma gangrenosum
  • Primary sclerosing cholangitis
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8
Q

Which hepatobiliary condition is associated with UC?

A

Primary sclerosing cholangitis

NOTE: PSC is big risk factor for cholangiocarcinoma

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9
Q

List some types of tumour affecting the of colon and rectum

A

Non-neoplastic polyps

Neoplastic Epithelial Tumours

  • Adenoma
  • Adenocarcinoma
  • Neuro-endocrine tumours - carcinoid (mainly affects small bowel)

Mesenchymal lesions

  • Lipoma
  • Leiomyoma

Lymphoma

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10
Q

What is a polyp?

A

A growth that protrudes into the lumen of an organ

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11
Q

List some non-neoplastic and neoplastic polyps of the colon and rectum

A

Non-neoplastic

  • Hyperplastic and sessile serrated lesions
  • Inflammatory pseudopolyps seen in UC
  • Hamartomatous polyps (Peutz-Jeghers)

Neoplastic

  • Adenoma
  • Adenocarcinoma
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12
Q

What are sessile serrated lesions?

A

Type of hyperplastic polyp with architectual abnormalities that may be premalignant and show dyplasia

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13
Q

What are adenomas? What are the types of adenoma?

A

Benign tumours that characterised by excessive epithelial proliferation and may be dysplastic

  • Tubular
  • Tubulovillous
  • Villous (highest risk of carcinoma)
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14
Q

What are the risk factors for cancer in an individual adenoma polyp?

A
  • Size (>4cm = 45%)
  • Proportion of villous component (finger-like projections)
  • Degree of dysplasia
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15
Q

List some observations that have given rise to adenoma-carcinoma sequence theory.

A
  • Areas with a high prevalence of adenomas have a high prevalence of carcinoma
  • Adenomas tend to appear 10 years before a carcinoma
  • Risk of cancer is proportional to the number of adenomas
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16
Q

What are some genetic causes of colon cancer?

A

Familial adenomatous polyposis

  • Gardner’s
  • Turcot

Hereditary non-polyposis colon cancer (Lynch syndrome)

All are autosomal dominant

17
Q

What is Lynch syndrome (HNPCC)?

A
  • Autosomal dominant condition
  • Affects DNA mismatch repair genes - MSH2 most commonly affected
  • Associated with increased risk of colorectal, endometrial, gastric, and ovarian cancers
18
Q

What is familial adenomatous polyposis?

A
  • Autosomal dominant condition
  • Caused by mutation in APC tumour supressor gene (chr 5)
  • Characterised by numerous (average 1000) colorectal polyps
  • Virtually 100% will develop colorectal cancer within 10-15 years
19
Q

What is Gardner’s syndrome?

A

FAP plus extra-intestinal manifestations e.g.

  • Cranial osteomas
  • Desmoid tumours
  • Epidermoid cysts
20
Q

Where does colon cancer typically arise in HNPCC?

A

Colon cancer typically arises proximal to splenic flexture (proximal colon) and is typically poorly differentiated

21
Q

Describe the epidemiology of colorectal cancer?

A
  • 98% are adenocarcinoma
  • Average age affected is 60-79
  • If <50 years consider familial syndrome
  • Primarily affects western population
22
Q

List some risk factors for colorectal cancer

A
  • Familial
  • Diet (low fibre, high fat)
  • Lack of exercise
  • Obesity
23
Q

List some prediposing conditions to colorectal cancer

A
  • Adenomas
  • IBD
24
Q

What are the symptoms of Colorectal Cancer?

A
  • Change in bowel habit
  • Blood in stool
  • Anaemia
  • Weight loss
  • Pain
25
Q

Describe the grading and staging of CRC?

A
  • Grade - degree of differentiation
  • Staging - TMN
26
Q

List some types of stromal lesions that occur in the GI tract.

A
  • Stromal tumours
  • Lipoma
  • Sarcoma
  • Other: lymphoma

YEAR 5: Histopathology (33 decks)

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