Stomach Path II Flashcards Preview

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Flashcards in Stomach Path II Deck (38):
1

hypertrophic gastropathy

menetrier and zollinger ellision

can mimic cancer

2

menetrier disease

excessive TGF-alpha secretion
-unknown cause

protein losing enteropathy

weight loss, diarrhea, peripheral edema

body and fundic involvement

increased risk of adenocarcinoma

premalignant**

3

nausea, vomiting, loss of appetite, weight loss, hypoalbuminemia, edema, age 30-60yo

menetrier disease

increased risk for adenocarcinoma

4

tx of menetrier

high protein diet

cetuximab - M-Ab against EGFR

5

menetrier prognosis

children - goes away
adults - doesn't go away

6

zollinger ellison syndrome

gastrin secreting tumor
-gastrinoma

chronic diarrhea and multiple peptic ulcers

increase in number of parietal cells

7

tx zollinger ellison

block acid production and remove tumor

majority malignant**

8

ZES path

non-beta islet cell gastrin tumor of pancreas stimulating acid secretion of stomach

auto dom - MEN-1

pancreas, duodenum, or abdominal lymp nodes

majority malignant

9

diagnosis of ZES

secretin stimulation test
fasting gastrin levels - 3 occasions
gastric acid secretion and pH - > 15mEq/hour

10

octreotide

best drug for ZES tx

11

fundic gland polyps

proton pump inhibitor related - secondary to increased gastrin

12

gastric adenomas

benign

proliferative dysplastic epithelium

in chronic gastritis with atrophy and intestinal metaplasia

risk or carcinoma if >2cm

13

corkscrew shaped foveolar glands

hyperplastic gastric polyp

14

epithelial dysplasia

gastric adenoma

15

3rd most common cause of cancer death worldwide

carcinoma of stomach

80% with h. pylori infection

majority from surface of glandular epithelial of stomach - adenocarcinoma

aggressive

decreasing incidence in US

16

gastric cancers

going down in incidence in US

the intestinal type **

17

adenocarcinoma in stomach

two types

intestinal type - non-signet

diffuse type - signet ring

18

intestinal type adenocarcinoma

non-signet ring

decline in incidence

h. pylori association

APC/WNT pathway

masses that ulcerate

antrum/pylorus

19

diffuse type adenocarcinoma

signet ring

no decline in incidence

no association with h pylori

E-cadherin mutation

throughout stomach

20

WNT-APC pathway

control of beta-catenin levels

which goes to nucleus promoting cell division and cell cycle progression


mutation in APC - colon polyps - no destruction of beta-catenin - cells progress to cycle uncontrolled

21

E-cadherin mutation

signet ring
-diffuse type

cells don't stick together - diffuse

as well as lobular ca of breast

22

sister mary joseph

nodule on umbilicus

stomach carcinoma

23

irish node

axillary

stomach carcinoma

24

virchows node

left supraclavicular

stomach carcinoma

25

advanced stomach carcinoma

to muscularis propria and beyond

26

linitis plastica

gastric wall thick and folds lost

diffuse type

mutation in CDH1 - loss of E-cadherin

27

elevated mass with heaped up borders and central ulceration

intestinal type carcinoma

28

usual gastric carcinoma

intestinal type
-non-signet
-has h pylori association

most common antrum

29

intestinal type

has holes**

both mucin positive

30

signet type

no holes**

mucin in cytoplasm
-signet ring like shape**

both mucin positive

31

B cell MALT

5% gastric malignancies

32

most common site of extra-nodal lymphoma

stomach

MALToma - h pylori

high grade DLBCL

33

MALToma

t (11;18)
t(1;14)
t(14;18)

all constitutive activation of NF-kappaB

promotes B cell growth

often h pylori related

CD19 and CD20 positive - B cell markers

34

2nd most common gastric lymphoma

DLBCL

35

GIST

gastrointestinal stromal tumor

from interstitial cells of cajal - pacemaker cells

smooth m/neural

most common mesenchymal tumor**

Male age 60yo

36

mutation in GIST

c-KIT - CD117 mutation majority

also some PDGFRA mutation

37

gleevac

imatinib - tx of CML and GIST

same genetic defect - philly chromosome

ABL-BCR tyrosine kinase mutation

38

spindle cell feature

GIST