More GI Flashcards by Ben Saylor

Types of esophageal cysts

Simple

Bronchogenic cysts: anterior mediastinum, ciliated

Duplicaiton: foregut derived, attache dor within esophagus, muscular layer, variable types (esophagus, GI, stomach)

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Assoc. with achalasia?

H and E?

Cancer risk?

Secondary to scleroderma, chagas, amyloidosis, Parkinsons, Pseudoachalasia from tumor

See progessive inflammatory destruction of gangion cells with chronic ganglionitits or aganglionosis.

SCC!!! 33x

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SCC in esophagous associated with?

Some genes associated?

Black, China, Iran, France, Africa: Nitrosamines, moldy food, smoking, alcholol, HISTORY OF CAUSTIC INGESION, Plummer-Vinson (FE, glossitis, webs)

p53, p16, heterozygosity

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Key to differentiate regenerative (florid) Squamous Epithelium in Esophagus from SCC?

Histology of reflux?

Preserved architecture even though cells/groups can be atypical but fairly preserved; bridges can be more pronounced

<8 intraep eosin/HPF with neutrophils/lymphocytes, basal cell hyper plasia, elongated papilla, vascular lakes of dilated vessels, spongiosis

100% have mucosal damage

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Mucosal finding of Barrett’s esophagus?

H and E?

RIsk of adeno?

If gastric mucosa in upper or mid third consider?

Pink/salmon tongues of columnar mucosa: Short 3 cm; long >3cm

Glandular mucosa with intestinal metaplasia; Goblet cells, inflammed LP, disrupted muscularis mucosa, erosion

Risk 0.5-1.0% needs repreat; need to grade dysplasia

Islet patch

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What is basal crypt dysplasia?

IHC and Gene?

Barrett’s low grade vs high grade?

Rare entity, Deep crypts with dysplastic chagnes with MATURE SURFACE. Other areas of dysplasia common

P53+, 17p LOH

Low; gland budding, lumina infolding, psedovillous groups; loss of polarity, nuclear crowing, elongated

High: Gland complexity, cribiforming, villous groupth, Full thickness stratification, hyperchromasia, loss polarity, enlarge nuclei

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If struggling with adeno in esopogous consider what testing?

Surviability?

Loss of heterozygosist of p53, c-erB-2 (HER2) expression (15%), DNA mismatch repari mutations and adenomatous polyposis coli gene (rare)

T1 65-90% at 5 years

T4: 15% at 5 years

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Classic endo finding of Eosinophilic esophagitis?

H and E?

Tx?

Feline esophagous with rings/webs, vertial lines/furrows with white spots: more common in men

>15 eosinophils/HPF ; Eosinophilic microabscesses and degranulation, basal cell proliferation, intercellular edema, Upper and lower esophagus

Tx: eliminate food allergens and steroids

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Foveolar and parietal cells and chief cells are present?

H. P gastritis associated with?

In the body!

Parietal cells; Middle to deep

Chief cells: Admixed in lower 1/3rd

Gram - sea gull bacilus; ANTRUM (90%) and Multifocal atrophic (75%); MALT lymphoma and Adenocarcinoa (70-90%); intestinal type.

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Features of autoimmune atrophic gastritis, labs, H. Pylori?

Where is it?

IHC?

Features of Multifocal atrophic gastritis?

AAG: Diffuse body gastritis, Immune mediate (antiparietal and anti intrinsic factor)

HIGH GASTRIN; F>M; Low Vit B12. H. pylori <20%

BODY CONFIED!!!; Lymphoplasmocytic infilatre in LP, loss of parital cells and antral glands and intestinal metaplasia

GASTRIN STAIN to confirm body. (Positive in antrum and negative in body)

Multifocal atrophic gastritis: Multiforcal atrophy and gastris, not immune mediated, Normal/low gastrin, Normal B12, H. Pylori ~90-100%.

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Lymphocytic gastritis is assocaited with, definition, associations?

Eosinophlic gastritis is assocaited with, definition, associations?

Granulomatous gastritis is assocaited with, definition, associations?

Collagenmous gastritis is assocaited with, definition, associations?

Lymph gastrits >25 intraepithelial lymphs (CD8+)/100 epithelial cells, Celiac, H. Pylori, Crohn’s, HIV, edge of cancer/lymphoma.

Eos: >20 eos/HPS, deep into LP and muscularis mucosae, ALLERGIC SYNDROMS, connective tisue disease

Gran: Crohn’s, TB, Sarcoid, Foreign body, isolated gran gastritis

Collagenous: RARE; thick band

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Features of reactive gastropathy, associations?

DDx?

PPI effect?

NSAIDs/steroids, Alcohol, bile, radiation

Foveolar hyeprplasia, serrated gastric pics (corkscrew), mucin depletion, splaying muscularis, no H. P

DDx: hyperplastic polyp, gastric antral vascular ectasia, protal hypertensive gastropathy (need history)

PPI: Dilatation of glands lined by parietal cells (Pink, granular cytoplasm, fried egg) and narrowing of surface epithelium

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Menetrier disease features?

H and E?

Association?

ZE syndrome?

Association?

Rare males>50 yrs. Gross: Giant polypoid body/fondus

H and E: Foveolar hyperplasia (surface) with atrophy of oxyntic cells,

Associated with H. P, CMV. TGF-A immunostain +

ZE: Gastrin and hypersection, MEN1 (gastrinoma) and <5% G-cell hyperplasia

Gross: Hypertrophy of rugal body and fu ndus fold, ANTREM SPARED/Atrophic

Parietal hypertrophy and hyperplasia (Chief and Mucus cells)

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Most common gastric polyp?
H and E?

Genes?

Fundic

Small <2mm

Cystially dilated glands lined foveolar, chief, and parietal cells; if only foveolar it is Hyperplastic polyp (pits, branching, dilated foveolar epithelium)

APC (like FAP) and B-catenin (sporatic)

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Hyperplastic polyp H and E?

What do 0.6-0.9% of HP’s have?

Solitary; only fundic mucosa, branching and pits common

Signet Adeno

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Hamartomatous polyps, H and E?

Syndrome/gene?

Inflammatory fibroid polyp H and E?

Associated with what gene/IHC?

Arborizing bundles of smooth muscle derived from mscularis mucosae and foveolar hyperplasia

STK11/LKB1 chr 19p13.3; Peutz-Jegher

IFP: Benign, submucosa, myxoid stroma, bland spindle cells, prominent blood vessels and eosinophils

PDGFR (>50%) and CD34+

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Gastric xanthoma H and E?

Gastric adenoma types?

Genes mutated?

Associated with

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Lipid laden machrophages in LP; M:F 3:1; Oil Red O, Sudan black, CD68+, KERATIN -

GA:10% polyps in elderly; Intestinal (goblet or paneth), gastric (foveolar)
KRAS, p53, APC, MSI

35-100% FAP and Gardner’s

Gastric adenocarcinoma associations?

Hereditary diffuse/signet ring carcnoma gene?

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More common in Japan

H. P with 100% itestinal type and less with diffuse type

Premalignant: adenomas, Hyperplastic polyps, chronic atrophic gastritis, BLOOD GROUP A,

Hereditary signet ring cell: Auto dominant E Cadhering (CDH1)

Gastric adenocarcinoma genes?

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Intestinal: APC (30-40%); c-met p54 (25-40%), Her2 (5-15%)

Diffuse: APC (2%), c-met (20-40%), Her2 (1%), CDH1

2 types of GIST?

5% associated with?

Which one is malignant?

GIST Risk features?

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Spindle (short fasicles with cells with vaculoes) and epithelioid (Halo of pale cytoplasm and clear space; can be focal keratin +)

Carney’s triad (GIST, Paraganglioma, Pulmonary chondroma), and NF1

Spindle: 20-25% of gastric spindle are malignant; C-kit and PDGFRA

Risk: Size, mits, location

What is a Meckle diverticulum?

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2% population, 2 feet form IC valve, 2 inches, symptomatic before 2 years:
Gastric mucosa or pancreatic tissue;from failure of obliteration of mophalo-mesenteric duct

Acute duodenitis H and E?

Most common organism?

Other organisms?

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Neutrophils in LP, lymphs and plasma cells, erosions and **foveolar metaplasia

H. Pylori most common from antral gastrits**

Immunocompetent: G. Lamblia, Strongyloides

Immunosuppressed, Cryptosporidium, microsporidium, MAI, Isospora belli

Cryptosporidium H and E?

Cryptococcus H and E?

Giardia H and E?

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Small blue balls on apical border of enterocytes; 2-5 microns

See white space; capsule doe snot stain; GMS+ and Mucicarmine +; 4-10 microns

Teardrop shapped; 12-15 microns with eye on surface of duodenum; can look like junk

Whipple disease organism?

Patient population?
H and E?

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T. Whippelii

Men ~40 yrs

Broadening of villi by foamy macrophages with PASD+ bacilli (DDx MAI: AFB+); swiss cheese look on H and E

Circumferential stritures in terminal ileum related to? Celiac related to what diatry thing? Age peaks? Labs? HLAs? Complicatons?

Chronic slow release NSAID usage; called iaphragm disease Gliadin, Gluten 0-3-and 20-40 **IgA anti transglutaminase (90% specific)** IgA anti-endomysial and IgA antigliandid (not sensitive or specific) HLA-DQ2 (95%); HLA-DQ8 (5%) **Enteropathy associated T-cell lymphoma, small intestin adeno**

Celiac disease, see what cells in LP? What can cause false negative serologies in kids with Celiac?

\>30 IEL/100 enterocytes or \>40 IEL/enterocytes in jejunum, CD3+, CD8+ **IgA deficency**

Tropical sprue caused by? Treatment?

Colonizaiton of small intesting by E. Coli, Klebsiella, Enterobacter See changes similar to celiac but in Jejunum and TI **Antibiotics, folate and B12**

What is Waldenstrom Macroglobulinemia? Associated with? H and E?

Lyphoproliferative dx with monoclonal IgM production/deposition Men\>65 yrs, lymphplasmacytic lymphoma (B-Cell) Dilated lymphatic with acelluarl eosinophlic material: **IgM+, PASD+, Congo Red-**

Abetalioprotenimia gene expression (AD, AR, etc)? H and E?

Caused b autosomal co-dominant pattern of Apopliprotein B mutation See vacuoles/foamy of clear material on mucosal surface of enterocyte

Appendiceal Adenoma H and E? Low grade appendicieal mucinous neoplasm? Adeno of appendix?

Flat undulating dysplastic epithelium with **preserved muscularis mucosae; luminal mucin present** Like above but with **Loss of muscularis mucoase and fibrosis of submucosa; mucin/dysplastic cells in wall and outside appendix; can be high grade** **Needs in vasion including budding and irregular glands; dysplastic stroma**

What is Goblet cell carcinoid of appendix? Can a mass be seen grossly?

Older patients; **mucin producing cells with NE and glandular differentiation (**goblet like Paneth; pink granular); connentric pattern infiltation into appendix wall; **NO GROSS MASS**

What is ameobic colitis? What is in the trophocyte?

**E. HIstolitics; Trophozoities 10-60 microns**; Nucleus 3-5 microns with karyosome and peripheral rim of chromosome **Numberus fine vacuoles in cytoplasm resembling histeocytes** Ingrested RBCs and histeocytes in background

Most common appendix polyp?

Serrated; serrated lumen with distal crypt dilation touching muscularis mucosa

Lymphocytic colitis? Associations?

NO LP inflammation; T lymphocytes **CD8+)** in LP; more common in females A/W: **Autoimmune disease, E. coli, C. jejuni,** drugs: NSAID, flutamide, cimetidine, carbamaepine, sertaline

Collagenous colitis? Associations?

Females; watery diarrhea **Thick superficial collagenous band \>10 micros (dripping candle)** A/W: Autoimmune, Drugus: NSAIDS, lanosprazole, ticlopidien, simvastatin

Pseudomembranous colitis associated with? Endo result? H and E? Lab test to order?

Drugs: Clindamycin, linomycin, apicillin, cephalosporins. Patient with watery/bloody diarrhea 2-5mm yellow plauques Mushroom lesion of superfical inflammation and necrosis **C. Diff toxin**

Who gets solitary rectual ulcer syndrome (mucosal prolapse)? Endoscopy results? H and E?

20-50 year olds; due to abnormal sphincter contraction during pooping Anterior wall ulcer (40%), multiple ulcers (20%), polypoid lesion (25%) Histology: ulceration, crypt hyperplasia, luminal serration, mild distorion of arch, fibromuscular replacement of LP, **scant inflammation**

Ischemic colitis? H and E?

Old patients with cardio issues Mimics IBD: Withering of epithelium, hylanizatno of LP, mild inflammation, crypt loss/whitering

How many years after to start IBD dysplasia screening? Risk of invasive cancer at 30 years? What to do if patient has normal endoscopy but has dysplasia on H and E? What about polypoid dysplasia?

8 years 20-30% after 30 years (similar to familial syndromes; APC, TP53, KRAS common) Colectomy; high risk!! Can monitor; low risk of invasion

Sessile serrated polyp criteria? Dysplastic ones lose what? Most common rectum polyp?

One gland dilated at muscularis mucosae; presence of microvesicular mucin (distal portion); **absense of neuroendocrine cells** **MLH1** **Rectum: Traditional serrated adenoma**, eosinophilic cytoplasms, tufting, papillary infolding, atopic crypts in surface epithelium, pencilate nuclei

What gene can be used as surrogate marker for Lynch syndrome? Most colorectal cancers that are MSI stable have what mutation?

**BRAF negative but microsatellite high!** KRAS

More GI Flashcards

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