Body PATH Flashcards
Polyarteritis Nodosa (PAN)
- Epi
- Affected parts ?
- Association ?
- Prognosis ?
Epi
- PAN is more common in MAN
Affects
- Renal (90% - microaneurysms), GI, Cardiac, CNS (aneurysms)
- spares Lung
Associations
- Hep B and C**
Prognosis
- Fatal if untreated (progressive renal failure or gastrointestinal complications)
PAN patho
PAN: Immune complex mediated
Wegners, Churg Strauss, Microscopic Polyangiitis: ANCA
HSP
- features
Most common vasculitis in Children
Systemic disease (GI most common)
Feature
- Painful bloody diarrhea
- Common lead point for Intuss
1) Intussusception
2) Scrotum with massive skin oedema
3) Colitis (thumb printing on x-ray)
Behcets
- Clinical presentation ?
- Feature
Clinical
- Mouth and genital ulcers
- Turkish descent
- Aortic thickening
Feature
- Pulmonary artery aneurysm (likely shown)*
- pericarditis
- CNS: T2 hyperintensities (thalamus, midbrain, and internal capsule): most common
Esophageal web
- location
- association
Location
- Upper esophagus
Association
- Plummer-Vinson syndrome: iron deficiency anemia, glossitis, and cheilosis
- graft-versus-host disease
- gastro-oesophageal reflux disease
- Radiation
Esophageal web
- Circumferential or Semi-circumferential
- Semi-circumferential (typically arise from the anterior wall and never from the posterior wall)*
Zenkers Diverticulum vs Killian-Jamieson location
Zenkers
- “Killian triangle” Hypopharynx (not cervical esophagus)
- Midline posterior wall of distal pharynx
- Pulsion type
- FALSE diverticulum (Traction diverticulum is TRUE diverticulum)
- increased risk for aspiration. Surgically treated with an endoscopic, surgical diverticulectomy, or diverticulopexy.
Killian-Jamieson
- Cervical esophagus (below cricopharyngeus)
- “Killian-Jamieson space”
- Anterolateral
- Pulsion type
- FALSE diverticulum (Traction diverticulum is TRUE diverticulum)
Epiphrenic Diverticula vs Para-esophageal hernia location
Epiphrenic Diverticula
- just above the Diaphragm (usually right)
- pulsion type
Para-esophageal hernia
- on the left
- pulsion type
Barrett esophagus
- Metaplasia of what to what ?
- Increased risk for ?
Cause
- Intestinal (Columnar) metaplasia of esophageal squamous epithelium
Increased risk
- 40x increased risk for adenocarcinoma* (10% progresses to adenocarcinoma*)
Barrett esophagus
- Microscopic finding
- Goblet cells (diagnostic), secrets mucin
Barrett Esophagus stricture at high, mid or low esophagus ?
Mid esophagus
Carcinoid
- risk factors
- Autoimmune chronic gastritis
- MEN-1
- NF-1 (gist also NF-1 RF)
- TS
- VHL
How common is Carcinoid syndrome
- Uncommon (<10%)
Other syndrome Carcinoid can cause ?
Zollinger Ellison
What can one measure for Carcinoid tumor
- 24 hour urine 5-HIAA (metabolite of serotonin)
- Chromogranin-A
What are the antibodies found in Celiac disease
- transglutaminate IgA antibodies (most sensitive), antigliadin IgA or IgG, and anti-endomysial antibodies.
Right vs Left clinical symptoms of Colon cancer
Caecal and right-sided colon cancers: Fatigue and weakness due to iron-deficiency anaemia.
Left-sided: Occult bleeding, changes in bowel habits.
Explain the classic adenoma-carcinoma sequence
Accounts for up to 80% of sporadic colon tumours ie. Majority arise from polyps (1st path way, the other pathway is Microsatellite instability pathway)
- “First hit” is either sporadic or inherited mutation of the APC allele followed by loss of the intact second
copy of APC which is the second hit. - Further mutations of KRAS or inactivation of p53 accumulate then lead to the development of carcinoma.
- Lose capacity to degrade B-catenin -> B-catenin accumulates -> Triggers cell proliferation
** KRAS gene is part of the signalling pathway that regulates cell growth
Ascending vs Descending colon cancer macroscopy
Ascending colon:
- Polypoid, exophytic masses, may be ulcerated
- Rarely obstruct
Descending colon:
- Annular lesions and cause luminal narrowing.
- Most are well to moderately differentiated adenocarcinomas with varying degrees of glandular differentiation and mucus production.
Menetrier disease involvement which part of stomach
- Involves Fundus, spares Antrum
How does Pancreatic cancer cause Gastric Varices ?
- Splenic vein thrombosis –> Gastric varices
All findings in Crohn’s
- Cobble stone
- Creeping fat
- Crypt abscesses (UC also gets this)
- Non-caseating granulomas
- Pseudopolyps
- Transmural with Lymphoid aggregates (UC has NO mural thickening - serosal surface normal)
- Enlarged nodes (UC no enlarged nodes)
What are the 2 types of gastric cancer
Intestinal
- Preceded by Intestinal metaplasia*
- Bulky mass
- Form Glands*
- Broad cohesive fronts
- “neoplastic cells often contain apical mucin vacuoles”
- APC loss of function and gain of b-catenin function (c.f. Diffuse type)
Diffuse
- NO preceding intestinal metaplasia*
- Infiltrative
- Signet ring cell
- Don’t form glands
- Loss of e-cadherin (c.f. Intestinal type APC and b-catenin)
- Desmoplastic reaction*
Most common location of Gastric cancer in stomach
- Lesser curve, Antrum*
Risk factors for GIT lymphoma
H-pylori (chronic inflammation) -> MALtoma - indoldent marginal B-cell lymphoma (ANTRUM)
Celiac disease -> T-cell lymphoma in proximal small bowel
Immunodeficiency, AIDS
Mediterranean lymphoma: Background of mucosal plasmacytosis
Causes of Chronic Gastritis
H-Pylori
Autoimmune Gastritis (Pernicious anemia)
Juvenile polyps
- associations
- Morphology
- Sporadic (no malignant potential)
- Syndromic (Malignant potential of colonic adenocarcinoma)
- Have association with pulmonary AVMs.
Morphology
- characteristic cystic spaces representing dilated glands filled with mucin and inflammatory debris.
Peutz-Jeghers Syndrome
- increased risk for what ?
- Cervical cancer (adenoma malignum)
- Breast (50%)
- Pancreas (36%)
- Uterine, Ovary, Testis cancer
- Lung
- Intussusception*
- GI tract adenocarcinomas*
FAP mostly inherited or sporadic ?
Inherited (75%)
Gardner syndrome consists of ?
- Osteomas
- Desmoids tumours
- Epidermoid cysts
- Dental abnormalities
- Hypertrophy of the retinal pigment epithelium
- Follicular thyroid carcinoma
Most common syndromic form of colon cancer ?
HNPCC
HNPCC more common which side ?
Right side
HNPCC inheritance ?
AD
- MSH2 and MSH1
HNPCC increased risk for what cancers ?
- Endometrium
- Stomach
- Ovary
- Uterus
- Brain
- Small bowel
- Biliary tract
- Pancreas
- Skin
Which phase of Ischemic bowel does the most damage
two phases:
1. Initial hypoxic injury
2. Reperfusion injury: Greatest damage occurs
SCC esophagus Risk factors
HPV, smoking, alcohol, poverty, caustic oesophageal injury, achalasia, tylosis, Plummer-Vinson syndrome, radiation, diets deficient in fruit/veg and frequent consumption of very hot beverages
Causes Pneumatosis Coli
- Cystic Fibrosis, Asthma
- COPD
- IBD*
- Steroids and Chemo
- Scleroderma (and other connective tissue disease)
- Gas producing bacteria e.g. clostridium
Is Pseudomembranous colitis specific to C-diff ?
Pseudomembranes are not specific and can be seen in ischaemic bowel and necrotising infections.
Appendiceal carcinoid clinical presentation ?
- Usually asymptomatic and discovered incidentally at surgery*
- Otherwise may present with appendicitis or mucocele (less common) due to obstruction
Appendiceal carcinoid benign or malignant ?
- Almost always benign and distant spread is exceptionally rare*
Mucocele cause
- Mucocoele = macroscopic appearance of the appendix when it is distended with mucus.
Cause
- benign or malignant chronic obstruction of the appendix such as mucosal hyperplasia, adjacent caecal tumor, mucinous cystadenoma/adenocarcinoma
Mucocele ruptures often, T or F ?
F, rarely ruptures
Celiac disease bowel changes
- Dilated jejunum with complete loss of folds
- Jejunum loses folds and look like normal ileum (reversal)
Whipples disease involvement site
Proximal jejunum
Whipple’s ddx ? (pseudo-whipples)
MAI (instead of T.Whipplei)
- distinction done with acid fast stain
Spigelian Hernia location
- At the lateral border o f the rectus (Semilunar line)
Richter Hernia
Contains only one wall of bowel and therefore does not obstruct.
These are actually at higher risk for strangulation.
Femoral hernia location
- Inferior to inferior epigastric
- Medial to common femoral vein (often indents it)
- Below the pubic tubercle* (both inguinal hernias above)
- Obstruction more common than others*
Which side of paraduodenal hernia more common ?
Left
Features of left vs right paraduodenal hernia
Left (fossa of Lanzert)
- behind IMV
- DDx (Lesser sac hernia - behind stomach)
Right (fossa of Waldeyer)
- associated with Malrotation
- behind SMA and below duodenum
Sigmoid vs Caecal volvulus features
Sigmoid
- Haustra lost
- Points RUQ
Caecal volvulus
- Haustra maintained
- Dilated small bowel loops
Giant Hemangioma features and complication
Features:
- Incomplete fill in
- Peripheral calcifications
- Hemorrhage, Necrosis
Complications:
- Kasabach-Merritt syndrome: consumptive coagulopathy due to thrombocytopenia
- Rupture with hemoperitoneum
FNH test to do ?
Sulfur colloid hot
HIDA scan
OCP affect on FNH ?
- OCP use has a trophic effect, but does not cause FNH**
FNH association
- Hemangiomas
- Hepatic adenomas
- Meningioma, Astrocytoma
- AVMs
4 Cirrhosis microscopic changes ?
- Bridging fibrous septae
- Regenerative nodules
- Architectural disruption
- Vascular derangement
Hepatic adenoma 3 types
Inflammatory
- most common
- risk to bleed if >5cm
- associated with NAFLD, obesity, OCP
- small definite risk of cancer
- dystrophic vessels “telangiectatic”
HNF-1a
- ONLY in women
- associated with OCP
- Fat containing
- Multiple masses
B-catenin
- Cancer risk
- associated with Anabolic steroids, Glycogen storage disease, FAP
- MEN and WOMEN
Hepatic adenoma Microscopic finding
- Absence of portal and central vein and bile ducts**
- Contains fat mainly in HNF-1a
Management and prognosis of Hepatic adenoma (eg. b-catenin type)
- B-catenin type resected even if asymptomatic
- Tumors may regress on withdrawal of OCPs
- Risk of rupture is increased in pregnancy**
Serum AFP sensitivity for HCC screening
- Serum AFP is elevated in 50% of patients with advanced HCC
- Insensitive as a screening test as can be normal in patients with premalignant or early HCC.
HCC major and other risk factors ?
Major
- HBV, HCV, alcohol, NASH
Others:
- Hereditary haemochromatosis, alpha-1 antitrypsin deficiency, Wilson disease, tyrosinaemia, glycogen storage disorders, Primary biliary cholangitis/cirrhosis, Hepatic adenoma
PBC pathology and imaging and complication
Path:
- Destruction of small intrahepatic bile ducts, portal inflammation, and progressive scarring
- High AMA
Imaging:
- Lace-like fibrosis and periportal halo sign are seen together the sensitivity for primary biliary cholangitis can approach 70%
- Regional lymphadenopathy: tends to dominate in the gastrohepatic ligament and porta hepatis
Complication
- Cirrhosis
HCC genetic changes
Early changes
- Activation of b-catenin
- Inactivation of p53
Precursors
- dysplastic nodule
- small cell change
- large cell change
Hepatic adenoma associations/RFs
- Diabetes**
- Metabolic syndrome*
- Obesity
- Glycogen storage disease
- Anabolic steroids
- OCPs
HBV transmission route in high vs low prevalence areas
High prevalence
- Transmission during childbirth accounts for 90% of HBV cases in high prevalence areas
Low prevalence
- Unprotected sex and IVDU are the chief modes of spread
Aetiologies of Hepatitis
- Viral hepatitides
- Parasites
- Drug induced (Paracetamol, ETOH)
- Autoimmune
- Steatohepatitis
- Metabolic disease
Hepatitis B
- how many % ends in chronic infection ?
- how many % makes full recovery and clearance ?
- How many % get acute fulminant hepatitis ?
- 10% get chronic infection (c.f. HCV 90% chronic infection and 20% develops cirrhosis)
- 90% make full recovery and clearance
- 1% get acute fulminant hepatitis (HCV also very rare)
Hepatitis B dsDNA or RNA ?
- Partially dsDNA (c.f. HCV ssRNA)
Hepatitis C association ?
- Associated with Metabolic syndrome
- Will give rise to insulin resistance and NAFLD
Majority or Minority of HCV will clear virus ?
- only Minority will clear virus* (c.f. Hep B Majority)
Which hepatitis dependent on HBV ?
Hep D dependent on HBV either as co-infection or superinfection*
Hepatitis E high mortality rate in what demographic ?
- High mortality rate in pregnant women*
Pancreatic serous cystadenoma
- Location
- Benign or malignant
Location
- Pancreatic head (most common)
Path
- Lots of small cysts , tend to be < 10mm separated by fibrous septa radiating from a central scar which may be calcified
- Benign
Mucinous cystadenomas
- how many % associated with invasive component ?
Can be precursors to invasive pancreatic carcinoma, around 20% associated with invasive component –> need to be resected
What pancreatic lesion is Peutz-Jegher associated with
- IPMN
- Pancreatic ductal adenocarcinoma
Classic feature of Pancreatic insulinoma
- Amyloid deposition**
Features of Glucagonoma
- Diabetes and skin rash
- sometimes DVT and PE
Features of VIPoma
- Diarrhea
- Hypokalemia
- Achlorydia
Features of Somatostatinoma
- Diabetes
- Biliary dyskinesia with stones
- Steatorrhea
Clinical findings of PBC including labs
Usually identified on work up of raised ALP and GGT when it is asymptomatic.
When symptomatic, there are insidious findings of fatigue and pruritus.
What’s unique about PBC cirrhosis ?
- Hepatomegaly cirrhosis (rather than shrunken)
- Not all end stage PBC end up with cirrhosis
What microscopic lesion is diagnostic of PBC ?
- Florid duct lesion: small bile ducts are actively destroyed by lymphoplasmacytic inflammation with or without the formation of granulomas.
Lab findings of PBC
- characteristic laboratory finding is antimitochondrial antibodies. ALP and GGT are raised.
Echinoccoccus granulosus vs Echinococcus multilocularis
Echinoccoccus granulosus (more common)
- dogs definitive host
- sheeps intermediate host
- human accidental host
- better prognosis*
Echinococcus multilocularis
- fox definitive host
- rodent intermediate host
- worse prognosis* - more invasive
Which layer of Hydatid cyst gives rise to daughter cyst
- Endocyst layer
Type I Hypersensitivity reaction
- type ?
- examples ?
Type I Hypersensitivity reaction
- Immediate
- IgE and Mast cell mediated
Examples
- Anaphylaxis
- Bronchial asthma
- Allergic rhinitis
- Food allergies
Type II Hypersensitivity reaction
- type ?
- examples ?
Type II Hypersensitivity reaction
- Antibody mediated*
- IgG or IgM tags cell for phagocytosis
Examples
- Autoimmune haemolytic anaemia
- Pemphigus
- ANCA vasculitis
- Goodpasture
- Acute rheumatic fever
- Graves, myasthenia
- Pernicious anaemia
Type III Hypersensitivity reaction
- type ?
- examples ?
Type III Hypersensitivity reaction
- Immune complex mediated
- Inflammation and tissue injury from immune complex deposition
Examples
- SLE
- Post strep GN
- PAN
- Serum sickness
- Reactive arhtirits
Type IV Hypersensitivity reaction
Type IV Hypersensitivity reaction
- T-cell mediated
- Caused by inflammation resulting from cytokines produced by CD4 T cells, and cell killing by CD8 T cells
Examples
- Rheumatoid arthritis
- MS
- T1 DM
- IBD
- Psoriasis
- Contact sensitivity
- Tuberculin reaction
Stages of Cysticercosis/neurocysticercosis
- Larval tissue invasion
- Vesicular
- Colloidal vesicular
- Granular nodular
- Calcified
Who gets a Nutmeg liver ?
Nutmeg liver: Inhomogeneous mottled appearance
- Budd Chiari
- Hepatic veno-occlusive disease
- Right heart failure
- Constrictive pericarditis
Who gets massive caudate lobe hypertrophy ?
- Budd-Chiari (chronic phase, caudate hypertrophy and peripheral atrophy)
- Primary Sclerosing Cholangitis
- Primary Biliary Cirrhosis
Is portal HTN a contraindication to Liver transplant ?
- NO, only makes it more challenging
Normal transplant liver US features
- Rapid systolic upstroke
- RI between 0.5 - 0.7
- Hepatic artery peak velocity <200cm/s
- Hepatic artery is KING in a transplanted liver, it is the primary source of blood flow for the bile ducts
PSC vs AIDS Cholangitis
AIDS Cholangitis
- Infection of the biliary epithelium {classically Cryptosporidium)
- Appearance mimics PSC with intrahepatic and/or extrahepatic multifocal strictures.
- The classic association/finding is papillarv stenosis (which occurs 60% of the time).
Oriental Cholangitis (Recurrent pyogenic cholangitis) Features and Association ?
- Dilated ducts that are full of pigmented stones
- “Straight rigid intrahepatic ducts”
- The anatomically longer, flatter left biliary system tends to make the disease burden left dominant
(the opposite of hematogenous processes
which favor the right lobe).
Association
- Clonorchiasis, ascariasis, and nutritional deficiency.
Causes of Portal Vein Pulsatility:
Right-sided CHF, Tricuspid Regurg, Cirrhosis with Vascular AP shunting.
Causes o f Portal Vein Reversed Flow:
The big one is Portal HTN (any cause).
Amyloidosis stains
Congo red stain – under ordinary light imparts a pink/red colour to tissue deposits
Apple-green birefringence of the stained amyloid when observed by polarised light microscopy
Which type of amyloidosis worst prognosis and which one good
- Prognosis very poor for AL type (<2 year survival).
- Secondary amyloidosis AA type prognosis is better (Chronic inflammation, RA, TB, RCC etc)
Cholesterol gallstone RF ?
female sex
middle age
obesity
positive family history
recent rapid weight loss**
Sickle cell and Crohn disease cause what type of gallstone ?
Black Pigmented stone
Acute vs Chronic hepatitis morphology ?
Periportal inflammation only seen in Chronic*
Cholangiocarcinoma risk factors ?
- BRCA2
- Opisthorchis spp. and Clonorchis spp.
- PSC, PSC, hepatolithiasis, Caroli disease, choledochal cysts
Wilson’s disease lab findings ?
- FREE serum copper: Increased (*serum copper reduced)
- Urinary copper: Increased
(everything else, including ceruloplasmin are reduced)
Wilson’s disease manifestations ?
Hepatic
- Acute hepatitis
- Chronic hepatitis
- Cirrhosis
- Fulminant hepatic necrosis
Brain
- Abnormal T2 hyperintensity in the putamina is the most common MRI abnormality, followed by midbrain, pons, and thalamus
- dysarthria, dystonia, tremor, parkinsonism, choreoathetosis, and ataxia and gait anomalies
MSK
- premature osteoarthritis
- osteopenia
List out Calcium, PTH, and phosphate levels for the 3 types of Hyperparathyroidism
Primary hyperparathyroid - high Ca, low phosphate, high PTH
Secondary hyperparathyroid - TRUE, low Ca, high PTH, and high phosphate
Tertiary hyperparathyroid - high Ca, and VERY high PTH, low phosphate
Features may indicate that a polyp is higher risk
> 2cm
> 3 adenomas
high grade dysplasia
Villous features
What are secondary causes of hemochromatosis ?
- Iron transfusion
- Thalassemia, Sickle cell
- Bantu siderosis
Differentials for Hemochromatosis
Amiodarone Therapy
- Iodine-containing antiarrhythmic medication
- Diffuse, homogeneously dense liver on NECT
Glycogen Storage Disease
- ↑ or ↓ attenuation of liver on NECT
- Depends on specific type of disease
- Associated with multiple hepatic adenomas (60%)
Other signs of Hemochromatosis apart from liver
- Dilated cardiomyopathy
- Hepatomegaly: 90%
- Arthralgia: 50%
- Diabetes: 30%
- Dilated cardiomyopathy
GIST associated syndromes
- Carneys triad
- Carneys Stratakis syndrome
- NF-1
GIST
- arise from what cell ?
- stains what ?
- genetic mutation of what ?
- Arise from interstitial cell of Cajal
- CD117 (c-KIT) positive stain
- SDH subunit gene alternation
What is Medullary spong kidney disease
sporadic condition where the medullary and papillary portions of the collecting ducts are dysplastic and dilated and in most cases develop medullary nephrocalcinosis.
What are the associated syndromes of GIST ?
Carneys triad
- Extra-adrenal Paraganglioma
- GIST
- Pulmonary Chondroma
Carneys stratikis
NF-1
What are the causes of Caecal volvulus ?
- Developmental failure of peritoneal fixation allows the proximal colon to be free and mobile: this occurs in 11-25% of the population
- Restriction of the bowel at a fixed point within the abdomen, acting as a fulcrum for rotation, e.g. adhesion, abdominal mass, scarring from calcified lymph nodes
Renal TB seen in what kinda patients ?
Immunocompromised
- results from haematogenous spread at the time of primary infection
Renal TB radiology findings
Early
- papillary necrosis
Progressive
- multifocal strictures and hydronephrosis
- mural thickening and enhancement (on cross-sectional imaging
End stage
- Shrunken kidney with amorphous dystrophic calcifications
- Autonephrectomy
Renal TB DDx
- Medullary sponge kidney
- Papillary necrosis
- XGP
What are the indications for TIPS ?
Transjugular intrahepatic portosystemic shunt (TIPS)
- bypass the liver by forming communication between Portal vein and Hepatic vein ( The target portosystemic gradient after TIPS formation is <12 mmHg)
Indications
- Portal HTN with
- variceal bleed
- ascites refractory to treatment
- hepatorenal syndrome
- Budd-Chiari
- Malignant compression of hepatic or portal veins
how does one get Tuberous Sclerosis ?
- Spontaneous (80%)
- AR (20%)
Lipid poor AML DDx
- RCC (calcification, irregular, large, invade sinus)
- Retroperitoneal liposarcoma invading kidney
- Oncocytoma (May contain fat)
AMLs are part of what group ? and are composed of what components ?
PEComas (perivascular epitheliod cells tumor group)
- Others include LAM
Composed of
- blood vessels (-angio) lacking elastic tissue, plump spindle cells (-myo), and adipose tissue (-lipo).
XPG (Xanthogranulomatous pylonephritis)
- causative organism ?
- Escherichia coli and Proteus mirabilis
- Struvite stones
Pheochromcytoma associations
- MEN2a/2b: Almost never extra-adrenal, almost always bilateral
- VHL
- NF1
- Carney triad (extra-adrenal pheo)
Pheochromocytoma arises from what cell ?
- Chromaffin cells of the Adrenal medulla
Locations of Pheochromocytoma
10% extra-adrenal: more likely to be malignant and metastasise
Along the sympathetic chain as well as in the urinary bladder and organ of Zuckerkandl (origin of IMV).
Thoracic paragangliomas are rare and only account for 1-2% of all cases of phaeochromocytoma
Pheochromocytoma genetics mutation
(SDHB) gene mutations
Can you differentiate pheochromcytoma benign to malignant ?
- No
- Need to see invasion of adjacent structures
Clinical features and radiology of Pheochromocytoma
Secondary hypertension and positive urinary catecholamines
Usually large and heterogeneous adrenal masses, with cystic and necrotic components
Vivid enhancement in arterial/portal venous phase is suggestive: >110-120 HU
Management of Pheochromocytoma
Definitive treatment is surgical, and if complete resection is achieved, without metastases, then surgery is curative and hypertension usually resolves.
MEN-1
MEN-2
MEN-1
- Parathyroid hyperplasia (most common)
- Pituitary adenoma (Prolactinoma)
- Pancreatic Neuroendocrine tumor (Gastrinoma > Insulinoma)
MEN-2
- Pheochromocytoma
- Medullary thyroid cancer
- Parathyroid hyperplasia
3 types of Cholangiocarcinoma ?
Intraductal
Periductal
Mass forming
Classification for resectability of Cholangiocarcinoma
Bismuth-Corlette classification
Innervation of Anal Sphincters
Internal anal sphincter:
- parasympathetic and sympathetic fibres from the superior and inferior hypogastric plexus
External anal sphincter:
- Pudendal nerve (inferior rectal and deep perineal branches)
Anal tumor vs Rectal tumor staging ?
Anal tumor staging is mostly based on size and extension, rather than wall invasion.
Anal tumor most common type (adeno, scc etc.)
SCC
Anal tumor risk factors
HIV
HPV
Immunosuppression
Two sub types of rectal tumor ?
Adenocarcinoma (majority)
1. Mucinous adenocarcinoma
2. Signet ring cell adenocarcinoma
Prognostic factors of rectal tumor
EMVI (extra mural venous invasion)
Tumor deposits
Lymph node metastases
CRM (Circumferential resection margin) less than 1-2mm is poor prognosis
Layers of the rectum
From inside to out
- Muscularis Mucosa
- Submucosa (T1)
- Muscularis propria (T2)
Most useful sequence for rectal cancer MRI
High Resolution T2 with 1.0mm voxel