Ch. 17 Pathology: Chronic Inflammation and Adenocarcinoma

Question 1

what is the epidemiology of IBD?

Answer 1

Teens-early 20s
Caucasians and Ashkenazi Jews
North America, Europe and Australia

Question 2

Which IBD is characterized by thick wall appearance with strictures and skip lesions in the ileum and colon?

Answer 2

CD

Question 3

which IBD is characterized by thin wall appearance with diffuse distribution in the colon?

Answer 3

UC

Question 4

Which IBD is characterized by transmural inflammation, moderate pseudopolyps, and deep, knife-like ulcers?

Answer 4

CD

Question 5

Which IBD is characterized by mucosal inflammation, marked pseudopolyps, and superficial broad-based ulcers?

Answer 5

UC

Question 6

Which IBD has marked lymphoid rxn, fibrosis, serositis, granulomas and fistulae?

Answer 6

CD

Question 7

Which IBD has moderate lymphoid rxn without fibrosis, serositis, graulomas or fistulae?

Answer 7

UC

Question 8

What are the clinical features of CD?

Answer 8

perianal fistula
fat/vitamin malabsorption
malignant potential with colonic involvement
recurrence after surgery

Question 9

what are the cinical features of UC?

Answer 9

malignanct potential

may progress to toxic megacolon

Question 10

what is the clinical presentation of CD?

Answer 10

abd pain
diarrhea
N/V
weight loss
perianal disease common

Question 11

what is the clinical presentation of UC?

Answer 11

abd pain
rectal bleeding
hematochezia

Question 12

what is the pattern of CD distribution?

Answer 12

discontinuous skip lesions primarily in small intestine and colon

most commonly terminal ileum and cecum

Question 13

what is the pattern of UC distribution?

Answer 13

originates in the rectum and spreads proximally in a continuous pattern

Question 14

what are some oral manifestations of IBD?

Answer 14

stomatitis

aphthous ulcers

Question 15

what are some opthalmic manifestations of IBD?

Answer 15

episcleritis

uveitis

Question 16

what are some liver/biliary manifestations of IBD?

Answer 16

steatosis
gallstones
sclerosing cholangitis

Question 17

what are some renal manifestations of IBD?

Answer 17

renal stones
hydronephrosis
fistulae
UTI

Question 18

what are some joint manifestations of IBD?

Answer 18

spondylitis
sacroilitis
peripheral arthritis

Question 19

what are some skin/vascular manifestations of IBD?

Answer 19

erythema nodosum
pyoderma grangrenosum
phlebitis

Question 20

what is diversion colitis?

Answer 20

blind colon segment as the result of surgical treatment that results in an ostomy

Question 21

what is collagenous colitis?

Answer 21

watery diarrhea without weight loss

middle aged women

Question 22

what is lymphocytic colitis?

Answer 22

watery diarrhea without weight loss in the setting of celiac disease and autoimmune disease

Question 23

what is the presentation of intestinal graft v. host disease?

Answer 23

watery diarrhea that progresses to bloody diarrhea

intestinal crypts completely destroyed

Question 24

what is diverticular disease?

Answer 24

also called diverticulosis

acquired pseudodiverticular outpouchings of the colonic mucosa or submucosa

inflammation may cause diverticulitis and in extreme cases, perforation

Question 25

what is a sessile polyp?

Answer 25

without a stalk

Question 26

what is a pedunculated polyp?

Answer 26

with a stalk that indicates protrusion to adjacent cells

Question 27

what is the primary cause of a polyp?

Answer 27

result of decreased epithelial cell turnover and delayed shedding of surface epithelial cells leads to piling up of goblet cells and absorbative cells

Question 28

where are polyps most commonly found?

Answer 28

left colon

Question 29

what is an inflammatory polyp?

Answer 29

form as a result of chronic cycles of injury and healing

Question 30

what condition is associated with inflammatory polyps?

Answer 30

solitary rectal ulcer syndrome TRIAD: rectal bleeding mucus discharge anterior rectal wall polyp

Question 31

what are hamartomatous polyps?

Answer 31

polyps that occur sporadically or as components of various genetic syndromes associated with increased risk of cancer

Question 32

what are juvenile polyps?

Answer 32

``` sporadic or AD syndromic < 5 y/o rectal location with sporadic SB and stomach location in syndromic Digital Clubbing ```

Question 33

what complications are associated with juvenile polyps?

Answer 33

rectal bleeding intussusception intestinal obstruction polyp prolapse

Question 34

what is a concern for syndromic juvenile polyps?

Answer 34

early colon cancer

Question 35

what is Peutz-Jegher syndrome?

Answer 35

AD syndrome that presnts with multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation

Question 36

what is the median age of PJ syndrome?

Answer 36

11

Question 37

What mutation is associated with PJ syndrome?

Answer 37

LOF mutation in STK11 (serine/threonine kinase 11) *tumor suppressor gene

Question 38

Where are hamartomas most common in PJ syndrome?

Answer 38

small intestine

Question 39

what is the most common fatality in PJ syndrome?

Answer 39

intussusception

Question 40

what are the hallmarks of colorectal adenomas?

Answer 40

epithelial dysplasia | nucelar hyperchromasia, elongation and stratification

Question 41

what polyp characteristic is highly correlated with malignancy?

Answer 41

size ;)

Question 42

what is familial adenomatous polyposis?

Answer 42

AD disorder in which patients develop numerous colorectal adenomas as teenagers 100% of untreated FAP patients develop cancer between ages 30-50

Question 43

what is the mutation associated with FAP?

Answer 43

APC

Question 44

what is the epidemiology of colonic adenocarcinoma?

Answer 44

peak age 60-70 low fiber, high fat and carb diet ASA/NSAID prevention

Question 45

What are the 2 pathways involved in pathogenesis of colonic adenocarcinoma?

Answer 45

1. APC/B-catenin/Wnt pathway | 2. Microsatellite instability pathway

Question 46

What is the gatekeeper of colonic neoplasia?

Answer 46

APC - component of WNT pathway | BOTH copies of APC must be lost for adenoma to occur

Question 47

what is the most common syndromic form of colon cancer?

Answer 47

hereditary non-polyposis colorectal cancer/Lynch syndrome inherited mutations in mismatch repair genes

Question 48

what is the growth pattern of tumors in the proximal colon?

Answer 48

polypoid, exophytic masses that extend along one wall of the colon rarely cause obstruction

Question 49

what is the growth pattern of tumors in the distal colon?

Answer 49

tend to be annular lesions that produce "napkin-ring" constrictions and luminal narrowing sometimes cause obstruction

Question 50

what are the two most important prognostic factors for colonic cancer?

Answer 50

depth of invasion | presence of lymph node metastases