Pathology of Neoplastic & Non-Neoplastic Polyps and Colon Cancer

Question 1

What is the most common side of colonic adenocarcinoma metastasis?

Answer 1

Liver - lymph nodes, bones, and lungs, are also common sites

Question 2

What are the most common locations of carcinoid tumors?

Answer 2

Small intestine, appendix

Question 3

Levels of this marker can be monitored to evaluate the management of adenocarcinomas.

Answer 3

CEA

Question 4

Where are sessile serrated adenomas most commonly located?

Answer 4

Right colon

Question 5

What are the general characteristics of cancers of the right colon?

Answer 5

Cauliflower-like masses, occult blood in stool

Question 6

True/False. Familial adenomatous polyposis is a benign disorder that does not increase the risk of other cancers.

Answer 6

False - by age 40, nearly polyps become invasive adenocarcinoma.

Question 7

What gene is mutated in familial adenomatous polyposis and its function?

Answer 7

APC gene - regulates beta-catenin in the Wnt pathway

Question 8

What is the most important factor in determining the prognosis of a colonic adenoma?

Answer 8

Size - greater than 4cm is very likely to be cancerous.

Question 9

These non-neoplastic colonic lesions are usually less than 5cm, most common in the left colon, and have a serrated appearance of goblet cells.

Answer 9

Hyperplastic Polyps

Question 10

What is the most common cancer of the appendix?

Answer 10

Appendiceal carcinoid

Question 11

A patient presents with the accompanying dermatological complaint. What is the name diagnosis and cause?

Answer 11

Mucocutanoues hyperpigmentation associated with Peutz-Jeghers Syndrome

Question 12

Mutations of these genes are associated with colonic adenomas.

Answer 12

p53, SMAD4, APC

Question 13

What is Turcot syndrome?

Answer 13

A rare variant of FAP that includes CNS tumors (gilomas)

Question 14

This disease is autosomal dominant, most common in children <5yo, and has a cystic dilation appearance on histology.

Answer 14

Juvenile Polyposis

Question 15

Carcinoid syndrome is a complication of carcinoid tumors. What is the pathophysiology and accompanying symptoms?

Answer 15

Occurs due to elaboration of serotonin due to carcinoids metastatic in the liver. Symptoms include flushing, diarrhea, right endocardial fibrosis, and bronchoconstriction

Question 16

True/False. Villous lesions are more likely to cause cancer.

Answer 16

True - they can more easily penetrate the submucosa and muscularis propria than pedunculated lesions

Question 17

Inflammatory polyps are non-malignant and due to chronic cycles of inflammation. What is the clinical triad of presentation?

Answer 17

Rectal bleeding, mucus discharge, inflammatory lesions on rectal wall

Question 18

This disorder is a variant of FAP that also includes osteomas and abnormal dentition.

Answer 18

Gardner syndrome

Question 19

What is the most common malignancy of the GI tract?

Answer 19

Colonic adenocarcinoma

Question 20

What is the most common cause of pseudomyxoma peritonei?

Answer 20

Appendiceal mucinous cystadenocarcinoma

Question 21

True/False. Grading is the most important prognostic factor for colonic adenocarcinoma.

Answer 21

False - staging is always more important in prognosis than grading.

Question 22

What characteristics are considered in cancer staging?

Answer 22

Invasion of the lamina propria, lymph node involvement, metastasis

Question 23

What are the two types of adenomatous polyps?

Answer 23

Pedunculated tubular and sessile villous

Question 24

Polyps associated with Lynch Syndrome are most common where in the colon?

Answer 24

Right colon - ascending and transverse

Question 25

This autosomal dominant juvenile disorder is characterized by mucocutaneous pigmentation, polyps with an arborizing network and increased risk of intussusception and other cancer.

Answer 25

Peutz-Jeghers Syndrome

Question 26

What are the general characteristics of cancers of the left colon?

Answer 26

“Napkin-ring” configuration, “apple core” lesion, changes in bowel habits

Question 28

What is the histological appearance of carcinoid tumors?

Answer 28

Nesting and trabecular pattern of small uniform cells

Question 29

This disorder is caused by mutations of the MSH2 and MLH1 genes, responsible for DNA mismatch repair.

Answer 29

Lynch Syndrome - due to microsatellite instability

Question 30

What two genetic pathways may lead to colonic adenocarcinoma?

Answer 30

Mutations of the APC gene (B-catenin pathway), mutations of DNA mismatch repair (microsatellite instability)