Ch. 17 Pathology: Chronic Inflammation and Adenocarcinoma Flashcards
what is the epidemiology of IBD?
Teens-early 20s
Caucasians and Ashkenazi Jews
North America, Europe and Australia
Which IBD is characterized by thick wall appearance with strictures and skip lesions in the ileum and colon?
CD
which IBD is characterized by thin wall appearance with diffuse distribution in the colon?
UC
Which IBD is characterized by transmural inflammation, moderate pseudopolyps, and deep, knife-like ulcers?
CD
Which IBD is characterized by mucosal inflammation, marked pseudopolyps, and superficial broad-based ulcers?
UC
Which IBD has marked lymphoid rxn, fibrosis, serositis, granulomas and fistulae?
CD
Which IBD has moderate lymphoid rxn without fibrosis, serositis, graulomas or fistulae?
UC
What are the clinical features of CD?
perianal fistula
fat/vitamin malabsorption
malignant potential with colonic involvement
recurrence after surgery
what are the cinical features of UC?
malignanct potential
may progress to toxic megacolon
what is the clinical presentation of CD?
abd pain diarrhea N/V weight loss perianal disease common
what is the clinical presentation of UC?
abd pain
rectal bleeding
hematochezia
what is the pattern of CD distribution?
discontinuous skip lesions primarily in small intestine and colon
most commonly terminal ileum and cecum
what is the pattern of UC distribution?
originates in the rectum and spreads proximally in a continuous pattern
what are some oral manifestations of IBD?
stomatitis
aphthous ulcers
what are some opthalmic manifestations of IBD?
episcleritis
uveitis
what are some liver/biliary manifestations of IBD?
steatosis
gallstones
sclerosing cholangitis
what are some renal manifestations of IBD?
renal stones
hydronephrosis
fistulae
UTI
what are some joint manifestations of IBD?
spondylitis
sacroilitis
peripheral arthritis
what are some skin/vascular manifestations of IBD?
erythema nodosum
pyoderma grangrenosum
phlebitis
what is diversion colitis?
blind colon segment as the result of surgical treatment that results in an ostomy
what is collagenous colitis?
watery diarrhea without weight loss
middle aged women
what is lymphocytic colitis?
watery diarrhea without weight loss in the setting of celiac disease and autoimmune disease
what is the presentation of intestinal graft v. host disease?
watery diarrhea that progresses to bloody diarrhea
intestinal crypts completely destroyed
what is diverticular disease?
also called diverticulosis
acquired pseudodiverticular outpouchings of the colonic mucosa or submucosa
inflammation may cause diverticulitis and in extreme cases, perforation
what is a sessile polyp?
without a stalk
what is a pedunculated polyp?
with a stalk that indicates protrusion to adjacent cells
what is the primary cause of a polyp?
result of decreased epithelial cell turnover and delayed shedding of surface epithelial cells
leads to piling up of goblet cells and absorbative cells
where are polyps most commonly found?
left colon
what is an inflammatory polyp?
form as a result of chronic cycles of injury and healing
what condition is associated with inflammatory polyps?
solitary rectal ulcer syndrome
TRIAD:
rectal bleeding
mucus discharge
anterior rectal wall polyp
what are hamartomatous polyps?
polyps that occur sporadically or as components of various genetic syndromes
associated with increased risk of cancer
what are juvenile polyps?
sporadic or AD syndromic < 5 y/o rectal location with sporadic SB and stomach location in syndromic Digital Clubbing
what complications are associated with juvenile polyps?
rectal bleeding
intussusception
intestinal obstruction
polyp prolapse
what is a concern for syndromic juvenile polyps?
early colon cancer
what is Peutz-Jegher syndrome?
AD syndrome that presnts with multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation
what is the median age of PJ syndrome?
11
What mutation is associated with PJ syndrome?
LOF mutation in STK11 (serine/threonine kinase 11)
*tumor suppressor gene
Where are hamartomas most common in PJ syndrome?
small intestine
what is the most common fatality in PJ syndrome?
intussusception
what are the hallmarks of colorectal adenomas?
epithelial dysplasia
nucelar hyperchromasia, elongation and stratification
what polyp characteristic is highly correlated with malignancy?
size ;)
what is familial adenomatous polyposis?
AD disorder in which patients develop numerous colorectal adenomas as teenagers
100% of untreated FAP patients develop cancer between ages 30-50
what is the mutation associated with FAP?
APC
what is the epidemiology of colonic adenocarcinoma?
peak age 60-70
low fiber, high fat and carb diet
ASA/NSAID prevention
What are the 2 pathways involved in pathogenesis of colonic adenocarcinoma?
- APC/B-catenin/Wnt pathway
2. Microsatellite instability pathway
What is the gatekeeper of colonic neoplasia?
APC - component of WNT pathway
BOTH copies of APC must be lost for adenoma to occur
what is the most common syndromic form of colon cancer?
hereditary non-polyposis colorectal cancer/Lynch syndrome
inherited mutations in mismatch repair genes
what is the growth pattern of tumors in the proximal colon?
polypoid, exophytic masses that extend along one wall of the colon
rarely cause obstruction
what is the growth pattern of tumors in the distal colon?
tend to be annular lesions that produce “napkin-ring” constrictions and luminal narrowing
sometimes cause obstruction
what are the two most important prognostic factors for colonic cancer?
depth of invasion
presence of lymph node metastases
