Rosai Chapter 15 - Small Bowel Flashcards
(129 cards)
1
Q
The anatomic landmark for the duodenojejunal junction, at which site the bowel becomes unfixed and wrapped in mesentery
A
Ligament of Treitz
2
Q
other name of Transverse mucosal folds in the innerside of the small bowel
A
Valvulae conniventes or Kerckring folds
3
Q
a two-lip structure in which lymphoid tissue and often adipose tissue tends to accumulate and where the small bowel ends
A
ileocecal valve
4
Q
What small bowel segment?
Mucosa is Short and Stubby (sometimes leaf-like)
A
Duodenum
5
Q
What small bowel segment?
Mucosa is Tall and Club-like
A
Jejunum
6
Q
What small bowel segment?
Mucosa is of intermediate height
A
Ileum
7
Q
IHC of Normal small bowel enterocytes
Pattern of CK7 and CK20
A
- CK7 neg
- CK20 pos
8
Q
Most common location of heterotopic pancreas
A
Duodenum (particularly in the region of the Ampulla of Vater)
9
Q
The consequence of a persistent patency of the entire vitelline duct
A
Enteroumbilical fistula
10
Q
Most common complication of total intestinal aganglionosis
A
Enterocolitis
11
Q
Transverse mucosal folds in the proximal jejunum
A
Prominent
12
Q
Transverse mucosal folds in the terminal ileum
A
Flat or Absent
13
Q
Location of Peyer patches in the terminal ileum
A
Antimesenteric side
14
Q
This comprise the lower 20% of the small bowel epithelium and represent its proliferative zone
A
Crypts of Lieberkuhn
15
Q
A type of transmembrane glycoprotein involved in signaling and adhesion and has been found to stain the human lymph (lacteal) vessels of the bowel but not the lymph vessels of other organs
A
CD38
16
Q
Characteristic feature of the ileum
A
Peyer patches
17
Q
Lymph drainage of duodenum (2)
A
- Portal nodes
- Pyloric nodes
18
Q
Lymph drainage of jejunum and proximal ileum (2)
A
- Nodes located in the mesentery
- Nodes located around the SMA
19
Q
Lymph drainage of Terminal ileum
A
Ileocolic nodes
20
Q
An abnormal thickening of the pylorus that causes small bowel obstruction in the neonatal population
A
Infantile hypertrophic pyloric stenosis
21
Q
The result of persistence of the proximal portion of the vitelline duct
A
Meckel diverticulum
22
Q
Usual location of Meckel diverticulum in adults
A
approximately 80 cm proximal to the ileocecal valve
23
Q
Characteristic location of Jejunal diverticula
A
along the Mesenteric border
24
Q
a congenital anomaly resulting from an error in intestinal development such that (most commonly):
- Cecum is on the left
- Duodenal-jejunal flexure is on the right
- Mesentery is narrow and unstable in position
A
Malrotation
25
a congenital defect affecting collagen fibers throughout the body, may result in serious intestinal complication such as spontaneous perforation and massive bleeding
Ehlers-Danlos syndrome
26
Other name of Celiac disease (3):
- Celiac sprue
- Nontropical sprue
- Gluten-sensitive enteropathy
27
Characteristics of Celiac disease in its fully developed state (3):
- Totally flat mucosa
- a dramatic clinical and morphologic response to the removal of gluten from the diet
- Relapse when gluten is reintroduced
28
Macroscopic findings in Celiac disease (4):
- Scalloping or denting of the duodenal folds
- an absence or reduction in the number of folds
- a submucosal vascular pattern
- "Mosaicism", in which the mucosa has a somewhat nodular appearance
29
Preferred serologic test for Celiac disease in patients above 2 years old
-anti-tissue transglutaminase (TTG) IgA antibody
30
More specific, but much more expensive and technically difficult to perform serologic test for Celiac disease
-anti-endomysial antibodies
31
May be useful in children who are less than 2 years of age or in adults who are IgA deficient serologic test for Celiac disease (2):
- Deamidated gliadin peptide (DPG) IgA and IgG
| - anti-TTG IgG assay
32
Two types of Refractory Celiac Disease (RCD)
- Type I
| - Type II
33
Type of RCD
-the lymphocytes maintain a normal immunophenotype
-Type I
34
Type of RCD
-there is clonal expansion of an aberrant population of T-cells that many believe represents an early form of enteropathy-associated lymphoma and have thus designated as "Cryptic intraepithelial lymphoma"
-Type II
35
Two types Enteropathy-associated T-cell Lymphoma (EATL):
- Type I or Classical
| - Type II or Monomorphic Epitheliotropic
36
Type of EATL
-associated with Celiac disease
-Type I or Classical
37
Type of EATL
-Majority of cases
-Type I or Classical
38
Type of EATL
-NOT typically associated with CD or the CD-associated HLA haplotypes
-Type II or Monomorphic Epitheliotropic
39
Features in favor of Tropical Sprue (3):
- isolation of enterotoxigenic coliform bacilli
- the endemic nature of the disease
- well-known response to antibiotics
40
other name of Whipple disease
-intestinal lipodystrophy
41
Characteristic microscopic finding in Whipple disease
-infiltrate of histiocytes that fills the lamina propria and distorts the villi
42
An immune-mediated disease due to an abnormal response to gluten and related proteins in genetically susceptible people
Celiac disease (CD)
43
CD vs Tropical sprue
-Most prominent in the proximal small bowel with decreasing involvement distally
-Celiac disease (CD)
44
CD vs Tropical sprue
-BOTH the distal and proximal small bowel are involved
-Tropical sprue
45
Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies
Grade 0
Normal
46
Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies
Grade 1
Intraepithelial lymphocytes (IELs) only
47
Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies
Grade 2
IELs PLUS crypt proliferation
48
Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies
Grade 3a
Mild shortening of villi
49
Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies
Grade 3b
Moderate shortening of villi
50
Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies
Grade 3c
Severe shortening of villi
51
This disease of malabsorption is characterized by increased deposition of eosinophilic hyaline material within the lamina propria, in addition to villous blunting and inflammatory changes
Collagenous sprue
52
This disease of malabsorption is clinically defined as persistent or recurrent symptoms and an abnormal biopsy, despite adherence to a gluten-free diet and the exclusion of other entities that could cause malabsorption
Refractory celiac disease (RCD)
53
Type of EATL
-Microscopically very variable, consisting of a mixture of pleomorphic variably sized cells with conspicuous nucleoli and variably present necrosis
-Type I or Classical
54
Type of EATL
- Positive: CD3, CD7, TIA-1 and the ab T-cell receptor
- Negative: CD4, CD5, and CD56
- Variably expressed: CD8 and CD30
-Type I or Classical
55
Type of EATL
-composed of monotonous small to intermediate sized cells with inconspicuous nucleoli
-Type II or Monomorphic Epitheliotropic
56
Type of EATL
- Positive: CD3, CD7, CD8, and CD56
- Negative: CD5
-Type II or Monomorphic Epitheliotropic
57
A complication of CD which is characterized by abdominal pain, fever, and intestinal perforation or obstruction superimposed on a background of a malabsorption syndrome
Ulcerative duodenojejunoileitis
58
CD vs Tropical sprue
-PARTIAL villous atrophy with increased lamina propria inflammation and increased IELs
-Tropical sprue
59
This malabsorption disease is associated with both folate and vitamin B12 deficiencies and responds to vitamin supplementation and tetracycline
Tropical sprue
60
A systemic disorder with protean manifestations including arthritis, diarrhea, weight loss, malabsorption, and neurologic symptoms
Whipple disease
61
a malabsorption disease with increased IELs and the apical villous cytoplasm shows striking vacuolation
Abetalipoproteinemia
62
a malabsorption disease in which a protein-losing enteropathy develops probably as a result of the entrance of protein-rich fluid into the extracellular space of the lamina propria from the dilated lymphatic channels, and subsequent drainage into the gut lumen
intestinal lymphangiectasia
63
a prerequisite for the formation of duodenal peptic ulcer
-a preserved fundic mucosa in the stomach
64
usual site of Crohn disease
ileum
65
Most typical ulcers in Crohn disease
Fissures
66
Features of transmural involvement in Crohn disease (7):
- Transmural inflammation
- often with prominent Lymphoid follicles in a linear or "string of beads" array
- Edema
- Lymph vessel dilation
- Thickening of the muscularis mucosae
- Neural hyperplasia
- Fibrosis
67
Microscopic features of Crohn disease that have greater diagnostic significance (3):
- Transmural involvement
- Fissures
- Granulomas
68
Two microscopic features of Crohn disease that have greater diagnostic significance which may not be appreciable on mucosal biopsy
- Transmural involvement
| - Fissures
69
ileitis typically associated with ulcerative colitis
-"Backwash" ileitis
70
Main changes in Backwash ileitis (5):
"SNAPP"
- Superficial erosions
- Neutrophilic and mononuclear inflammation in the lamina propria
- villous Atrophy with crypt regeneration
- Patchy cryptitis and crypt abscesses
- with or without Pyloric metaplasia
71
Most common mycobacterium isolated from the GIT and it is frequently found in the small bowel
MAI
72
Most common side effect of Mycophenolate mofetil (MMF)
GI toxicity, specifically diarrhea
73
Main change morphologically of Idiopathic eosinophilic enteritis and gastroenteritis
-Patchy or diffuse eosinophilic infiltration of any layer of the intestinal wall
74
Second most common symptomatic primary immunodeficiency after IgA deficiency
CVID
75
Most consistent microscopic change in GVHD
single epithelial cell necrosis
76
in Intussusception, what do you call the part which swallows the part of the bowel just proximal to it?
intussuscipiens
77
in Intussusception, what do you call the swallowed portion
intussusceptum
78
Most frequently involved site in GI amyloidosis
Small bowel
79
other name of Microvillous inclusion disease
Familial microvillous atrophy
80
IHC staining pattern of CD10 in Microvillous inclusion disease
Cytoplasmic
81
other name of Brunner gland nodules (4):
- Brunner gland hamartoma
- Brunner gland adenoma
- Nodular hyperplasia of Brunner glands
- Brunneroma
82
Most common location of Brunner gland nodules
-Posterior wall of the duodenum at the junction between the 1st and 2nd portions
83
Neoplasms associated with Peutz-Jeghers syndrome (4)
- a distinctive ovarian neoplasm knowns as sex-cord tumor with annular tubules
- Adenoma malignum of uterine cervix
- ovarian Mucinous tumors
- Breast carcinoma (often bilateral)
84
Microscopically, the most common pattern of WNET
Solid nests of monotonous-appearing cells with:
- Small, round nuclei
- a moderate amount of finely granular cytoplasm
- indistinct nucleoli
85
Basis of grading of WNET (2)
- Mitotic rate and/or
| - Proliferation (Ki-67) index
86
Small bowel WNET vs. Gastric carcinoid
TTF-1 - negative
Small bowel WNET
87
Small bowel WNET vs. Gastric carcinoid
TTF-1 - weakly positive
Gastric carcinoid
88
Small bowel WNET vs. WNET of Appendix
S100 - negative
Small bowel WNET
89
Small bowel WNET vs. WNET of Appendix
Origin - Endocrine cells from Lieberkuhn crypts
Small bowel WNET
90
Small bowel WNET vs. WNET of Appendix
Origin - Subepithelial endocrine cells related to nerves
WNET of Appendix
91
Small bowel WNET vs. WNET of Appendix
S100 - positive
WNET of Appendix
92
Most common genetic alteration in small bowel WNET
loss of all or most of chromosome 18
93
DUODENAL vs. ILEAL endocrine tumors
PDX-1 - positive
Duodenal endocrine tumors
94
DUODENAL vs. ILEAL endocrine tumors
CDX-2 - negative
Duodenal endocrine tumors
95
DUODENAL vs. ILEAL endocrine tumors
PDX-1 - negative
Ileal endocrine tumors
96
DUODENAL vs. ILEAL endocrine tumors
CDX-2 - positive
Ileal endocrine tumors
97
Mixed adenoneuroendocrine carcinomas (MANECs) should contain what percentage of neuroendocrine component?
at least 30%
98
other name of Gangliocytic paraganglioma (2):
- Nonchromaffin paraganglioma
| - Paraganglioneuroma
99
Three cell components present in Gangliocytic Paraganglioma
- Endocrine cells with a carcinoid-like appearance arranged in compact nests and trabeculae containing dense-core granules ultrastructurally
- isolated Ganglion cells
- spindle-shaped Schwann cells and/or Sustentacular cells
100
Gangliocytic Paraganglioma cell component immunoreactive for a variety of markers, particularly PP
-Endocrine cells with a carcinoid-like appearance arranged in compact nests and trabeculae containing dense-core granules ultrastructurally
101
Gangliocytic Paraganglioma cell component immunoreactive for NSE and other neural markers
-isolated Ganglion cells
102
Gangliocytic Paraganglioma cell component immunoreactive for S100 protein
-spindle-shaped Schwann cells and/or Sustentacular cells
103
the presence of this characteristic structure in small bowel GIST is a sign of good prognosis
Skeinoid fibers
104
Leiomyomas & Leiomyosarcomas vs. IFP
Smooth muscle markers - positive
Leiomyomas & Leiomyosarcomas
105
Leiomyomas & Leiomyosarcomas vs. IFP
CD117 & DOG1 - negative
BOTH Leiomyomas & Leiomyosarcomas and IFP
106
Leiomyomas & Leiomyosarcomas vs. IFP
KIT mutation - negative
Leiomyomas & Leiomyosarcomas
107
Leiomyomas & Leiomyosarcomas vs. IFP
PDGFR mutation - negative
Leiomyomas & Leiomyosarcomas
108
Leiomyomas & Leiomyosarcomas vs. IFP
SMA - variable
Desmin - negative
IFP
109
Leiomyomas & Leiomyosarcomas vs. IFP
Gain-of-function mutation in PDGFRA
IFP
110
Leiomyomas & Leiomyosarcomas vs. IFP
CD34 - positive
S100 - negative
IFP
111
Most common location of small bowel Hemangiomas
mid-jejunum
112
Most common variety of small bowel Hemangioma
Cavernous hemangioma
113
GI involvement in von Recklinghausen disease may manifest in a variety of ways (6):
- Hyperplasia of the submucosal and myenteric nerve plexuses
- Mucosal ganglioneuromatosis
- GISTs showing varying degrees of neural or smooth muscle differentiation
- Somatostatin-rich endocrine tumor of the duodenum
- Adenocarcinoma with (and perhaps without) neuroendocrine features
- Gangliocytic paraganglioma
114
other name of small bowel IMFTs (2):
- inflammatory pseudotumors of the GIT
| - Plasma cell granulomas
115
Important concepts to consider when evaluating malignant lymphomas involving the small bowel include (3):
- whether or not they are truly primary versus part of a systemic disease
- their cell lineage (B, T, or NK cell)
- the presence and type of an associated or predisposing condition
116
Most common site of primary extranodal lymphoma
GIT
117
Most frequent extranasal site of involvement of Extranodal NK/T cell lymphoma (ENKTL), nasal type
GIT
118
Positive or Negative IHCs of ENKTL, nasal type:
CD56
Positive
119
Positive or Negative IHCs of ENKTL, nasal type:
TIA-1
Positive
120
Positive or Negative IHCs of ENKTL, nasal type:
Granzyme B
Positive
121
Positive or Negative IHCs of ENKTL, nasal type:
CD4
Negative
122
Positive or Negative IHCs of ENKTL, nasal type:
CD8
Negative
123
Positive or Negative IHCs of ENKTL, nasal type:
surface CD3
Negative
124
Most common type of lymphoma found in the small bowel
B-cell lymphomas
125
Key features of low-grade extranodal marginal zone B-cell lymphoma of "MALT type" (3):
- Predominance of small lymphoid cells (centrocyte-like or monocytoid B cells)
- Formation of lymphoepithelial lesions
- presence of Reactive follicles
126
other name of Immunoproliferative Small Intestinal Disease (IPSID) (2):
- Mediterranean Lymphoma
| - Middle Eastern Lymphoma
127
Most common location of lymphoid hyperplasia
-ileocecal region
128
Most important features of lymphoid hyperplasia when the differential diagnosis is malignant lymphoma (4):
- presence of highly reactive germinal centers
- numerous cell types
- prominent Vascularity
- Polyclonality (as determined immunohistochemically)
129
Most common types of tumor metastasizing to the small bowel
Malignant melanoma
