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GEM > 3.03 Patho: Upper GI Cancers 36/49* > Flashcards

3.03 Patho: Upper GI Cancers 36/49* Flashcards

1
Q

Barrett’s esophagus is metaplasia of LES mucosa from stratified squamous epithelium to what?

A

non-ciliated columnar epithelium + goblet cells

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2
Q

Is Barrett’s esophagus a malignant condition?

A

no, pre-malignant (it in itself does not have metastatic potential)

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3
Q

What leads to Barrett’s esophagus?

A

chronic irritation usually from GERD

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4
Q

Risk factors of Barrett’s esophagus?

A

male, white, 50s

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5
Q

Where does the normal squamocolumnar junction of the esophagus and stomach meet?

A

tips of the rugal folds

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6
Q

What can help you indicate that a biopsy is of the tubular esophagus?

A

esophageal submucosal glands*, ducts, or multilayered muscosa

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7
Q

What do you need to establish a Barrett esophagus from the biopsy?

A

biopsy is from the lower esophagus via “tongue”/landmarks
columnar metaplasia WITH goblet cells
must designate a dysplasia category (+/-)

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8
Q

Patients with high-grade dysplasia Barrett’s esophagus have at 30% chance of progressing to invasive what?

A

adenocarcinoma

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9
Q

What are Barrett’s esophagus gross endoscopy findings?

A

salmon “tongue” above GEJ that extend out
velvety mucosa

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10
Q

What are some clinical features of Barrett’s esophagus?

A

asymptomatic or GERD related (heartburn, chest pain, dysphagia)

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11
Q

90% of Barrett’s esophagus involves what genetic abnormality?

A

p16 (INK4/CDKNA)

(TP53 mutations are also frequent)

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12
Q

What is the most rapidly increasing cancer in the USA and thought to be related to increasing obesity, GERD, and declining H/pylori infections?

A

Adenocarcinoma

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13
Q

Malignant epithelial tumor of the esophagus with glandular differentiation?

A

Esophageal Adenocarcinoma (EAC)

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14
Q

Alcohol is strongly associated with what cancer?

A

esophageal squamous cell cancer

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15
Q

What are EAC risk factors?

A

obesity, smoking, alcohol, 7% familial

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16
Q

Virtually all EAC develop in the setting of what?

A

intestinal metaplasia (ex. Barrett’s Esophagus)

17
Q

What are some microscopic features that indicate EAC?

A

gland crowding, cribriform glands, dirty necrosis

18
Q

Where does EAC usually take place?

A

Distal 1/3 esophagus (from Barrett’s and extensive)

19
Q

What are some characteristics of EAC late gross lesion?

A

fungating or annular mass, ulcer

20
Q

Advanced EAC tumors that were not detected can lead to what clinical symptoms?

A

progressive dysphagia to solids –> liquids, weight loss, retrosternal/epigastric pain

21
Q

Malignant epithelial neoplasm with squamous cell differentiation?

A

squamous cell carcinoma (SCC)

22
Q

Keratinocyte-like cells with intracellular bridges +/- keratinization

A

SCC

23
Q

What are SCC risk factors? Western? Strong? Overall?

A

West - Tobacco
STRONG - alcohol
Overall - vitamin deficiency or nitrosamines in moldy/pickled food, Plummer Vinson Syndrome, achalasia, tylosis, celiacs, corrosive ingestion

24
Q

AD skin disorder with Ch 17 RHBDF2 mutations?

A

Tylosis aka focal nonepidermolytic palmoplantar keratoderma

25
Q

sever long-term iron deficiency anemia with dysphagia due to esophageal webs?

A

Plummer Vinson Syndrome

26
Q

Most SCCs are found where in the esophagus? Where does it have the worst outcomes?

A

middle 1/3

(worst at upper 1/3)

27
Q

malignant epithelial cell tumor of gastric origin?

A

gastric adenocarcinoma

28
Q

What is the difference between adenocarcinomas of early vs. late stage?

A

early limited to mucosa + submucosa while late can invade muscularis propria or deeper

29
Q

What is the pathogenesis of gastric adenocarcinomas?

A

multifactorial + strong environment & chronic mucosal injury

30
Q

People with what are up to x5 times greater risk of developing gastric adenocarcinoma?

A

H. pylori infection (cagA)

31
Q

What are the risk factors of gastric adenocarcinoma?

A

H. pylori, GERD, bile reflux gastropathy (gastric surgery), autoimmune gastritis, diet, smoking

32
Q

What will you find in the intestinal gland forming gastric adenocarcinoma?

A

bulky tumors with infiltrating glands and tubules with enlarged hyperchromatic nuclei

33
Q

What will you find in diffuse infiltrative gastric adenocarcinoma?

A

singlet rings growing in nests, cords, or singlets, with plasmacytoid or epitheliod cells aligning with inflammatory damage, stomach may look like a leather bottle

34
Q

What are signs that the gastrocarcinoma went metaplastic?

A

Virchow (left supraclavicular)
Krukenberg (ovaries)
Sister Mary Joseph (periumbilical)
Leser-Trelat
Hemategnous = Liver + Lung
Ascites + Intraabdominal

GEM (28 decks)

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