Path carcinoid, GI stromal tumor, & lymphoma Flashcards Preview

GI & Liver Fall 2013 CBD > Path carcinoid, GI stromal tumor, & lymphoma > Flashcards

Flashcards in Path carcinoid, GI stromal tumor, & lymphoma Deck (20):
1

positive chromogranin stain

carcinoid

2

another name for carcinoid

gastric neuroendocrine tumor

3

carcinoid % association with hypergastrinemia, characteristics

% not associated with hypergastrinemia, characteristics

80% indolent, mets uncommon

10% aggressive, mets at diagnosis, carcinoid syndrome association

4

targeted therapy for CD 117/C-KIT

imatinib

5

immunostain that can identify liver met

gastrin stain

6

zollinger-ellison syndrome dx criteria (2)

fasting gastrin level >1000 pg/ml, gastric pH 200 pg/ml (83% Sn, 100% Sp)

7

zollinger-ellison syndrome tx

solitary, non-met disease: surg, high dose PPI, long acting somatostatin analog

met disease: streptozocin/doxorubicin or temozolomide

8

intestinal neuroendocrine tumor presentation

late middle-aged pt
ileum & appendix
multiple
abdominal pain
intermittent obstruction
rectal tumors small, rarely met

9

carcinoid syndrome

flushing (95%), diarrhea, wheezing, colicky abd pain, right heart endocardial fibrosis (50%)

10% of carconoid tumor pts, typically b/c of liver mets

high urine 5-hydroxyindole acetic acid (5-HIAA) (limited Sn/Sp)

10

zollinger-ellison syndrome

gastrinoma of pancreas or duodenum

11

colorectal neuroendocrine tumor

colon - large, right mass
rectum - found incidentally, carcinoid rare,

12

GIST

gastrointestinal stromal tumors

13

GIST epidemiology, location, molecular

uncommon, older adults

stomach, SI

derive from interstitial cells of Cajal, GI pacemaker cells.

mutation in KIT tm TK, activating it. positive immunostain CD117

regarded as malignant or possibly malignant

14

GIST presentation, dx

overt GI bleeding (40%)
abdominal mass
abdominal pain (20%)

CT detection, biopsy false negative,
FINA (82% Sn, 100% Sp)

15

tx of GIST

surg, imatinib mesylate

16

PTLD

post-transplant lymphoproliferative disorder

17

PTLD etiology

EBV-infected b cells proliferate.

Detection of EBV serology for DNA

18

GI lymphoma

rare, older adults
70% in stomach, 30% small bowel
H pylori associated, autoimmune disease
50% low grade MALTomas, the rest are diffuse B-cell lymphomas

germinal centers in mucosa, lamina propria

19

3 types of GI lymphoma

low grade MALToma
IPSIL malabsorption presentation
T-cell related increased sprue risk

20

GI lymphoma presentation, dx, tx, prognosis

epigastric pain (93%), anorexia (47%), weight loss (25%), occult bleeding (19%)
Dx endoscopy & biopsy
Tx antibiotics for MALToma, rad/chemo for other

prognosis good for MALToma, bad for others.