Flashcards in Pathology of Esophagus and Stomach Deck (38):
What is the triad associated with Plummer-Vinson Syndrome?
Iron deficiency anemia
*Postmenopausal women, increased risk of esophageal squamous cell carcinoma.
What is a Schatski ring?
Similar to a web but thicker and circumferential
A ring is above the GE junction
B ring is at the GE junction
What causes esophageal stenosis?
Inflammation and scarring from things like chronic GERD, irradiation, scleroderma or caustic injury
What are the three characteristics of achalasia?
1. Incomplete LES relaxation
2. Increased LES tone
3. Aperistalsis of esophagus
What are some complications associated with Achalasia?
1. Squamous cell carcinoma
2. Candida esophagitis
4. Aspiration pneumonia
What are some causes of pseudoachalasia?
Nerve damage from:
1. Tyrpanosoma cruzi
2. Metastatic tumor
What are some possible complications of a hiatal hernia?
What is a Zenker diverticulum?
Outputting just above the UES
Can be caused by motor dysfunction, increased stress on wall or GERD
Some symptoms include dysphagia, regurgitation, mass in neck or aspiration of contents
Where does a traction diverticula occur?
Near the midpoint of the esophagus
From scarring of mediastinal lymphadenitis or same as Zenkers
Where does a Epiphrenic diverticulum occur?
Just above the LES
Caused by dyscoordination of peristalsis or LES relaxation
Symptoms include massive nocturnal regurgitation
What causes esophageal varies?
Secondary to portal hypertension -- can lead to massive hemorrhage
What are some histological features of reflux esophagitis?
1. Elongation of the lamina propria papillae
2. Reactive epithelial changes
3. Acute and chronic inflammatory cells
4. Basal and supra-basal cell hyperplasia
What are some general consequences of reflux?
What are some features of eosinophilic esophagitis?
1. GERD symptoms
2. No response to GERD therapy
3. Characteristic endoscopic appearance (rings)
4. Allergic etiology?
What does the histology look like for eosinophilic esophagitis?
Basal cell hyperplasia
>20 eosinophils per high power field
What type of cells are prominent in Barrett's Esophagus?
Goblet cells in the intestinal metaplasia
Where do most esophageal adenocarcinomas arise?
Near the GE junction in Barrett's esophagus
Occurs after age 40, mean age of 60
What are some common presentations of squamous cell carcinoma of the esophagus?
Occurs after age 50
What are some factors associated with development of squamous cell cancer?
Predisposing esophageal disorder
Regurgitation and projectile vomiting
Palpable mass, visible peristalsis
No bile in vomit
2-4 weeks of age
Hypertrophic pyloric stenosis
What does acute gastritis pathology look like?
Punctate erosions with dark adherent blood
What is chronic gastritis?
Chronic mucosal inflammatory changes leading to atrophy and metaplasia
Set-up for dysplasia and neoplasia
What are some causes of chronic gastritis?
Chronic infection (H. pylori) - type B
Immunologic (in association with pernicious anemia) - type A
How does the morphology of chronic gastritis appear?
Lymphocytic mucosal infiltrate -- neutrophils in epithelium and gastric pits
In autoimmune gastritis, what are the antibodies against?
Parietal cells and intrinsic factor --> achlorhydia, hypergastrinemia, and pernicious anemia
Name some diseases associated with H. pylori.
Peptic Ulcer Disease
What layer does PUD penetrate?
The muscularis mucosa
Where is the most common location for PUD?
Duodenum, first part
Within Barrett mucosa
What is the most frequent complication of PUD?
Bleeding -- may be life threatening
Curling ulcers and Cushing ulcers are types of what?
Acute Gastric Ulceration
What causes curling ulcers?
Proximal duodenum associated with severe burns or trauma
What causes Cushing ulcers?
Associated with intracranial injury, operations or tumors; high incidence of perforation
What are some types of hypertrophic gastropathy?
Menetrier disease -- massive hyperplasia of surface mucous cells
Hypertrophic-hypersecretory gastropathy -- hyperplasia of parietal and chief cells
Gastric gland hyperplasia due to excessive gastrin secretion -- setting of gastrinoma: ZE syndrome
Are polyps common in the stomach?
No -- majority are associated with chronic gastritis and are non-neoplastic but must remove when seen because they can bleed and transform
What is a Virchow node?
involvement of the left supraclavicular node from metastasis from the stomach
What is Sister Mary Joseph nodule?
Local spread of gastric carcinoma to periumbilical region
What is Krukenberg tumor?
bilateral metastases to the ovaries, abundant mucus, signet ring cells