Ch. 7 - Gastrointestinal Tract

Question 1

What are some indications for GI brushing (rather than biopsy?)

Answer 1

Useful for sampling wide areas, for evaluating lymphoid cells, and for patients with clotting disorders.

Question 2

What are some different methods of GI cytologic sampling?

Answer 2

Fine needle aspiration
Brushing
Balloon/encapsulated sampling

Question 3

What does the “cleanness” of a smear background indicate?

Answer 3

A clean background usually indicates a benign process. A dirty background may represent inflammation or malignancy.

Question 4

Describe the cytology of repair (esophagus)

Answer 4

Cohesive cells in a flowing/streaming pattern with visible nucleoli that are however small and few.

Question 5

Describe the cytology of Barrett’s esophagus.

Answer 5

Goblet cells (large single cytoplasmic vacuole), may confer a “swiss cheese” appearance.

Question 6

What are the strengths & weaknesses of cytology in evaluating Barrett’s esophagus? What are some causes for false positives?

Answer 6

Not great at evaluating goblet cells, but good at evaluating HGD.

Sampling of gastric cardia (which has neutral mucin, rather than the goblet cell acidic mucin).

Question 7

Distinguish between the morphology of LGD and HGD in the esophagus.

Answer 7

LGD: Crowded stratified groups with mild atypia
HGD: Groups or isolated cells with marked atypia

Question 8

Describe the cytology of esophageal adenocarcinoma.

Answer 8

Increased cellularity with feathered edges surrounding haphazard 3D atypical clusters. Cytoplasm may be vacuolated. Diathesis may be present.

Question 9

Describe the cytology of esophageal SQC.

Answer 9

Well-differentiated has prominent keratinization and necrosis. Poorly-differentiation still looks angulated and pyknotic. In both cases, nuclei are more centrally located than in adenocarcinoma.

Question 10

What is the most common mesenchymal/spindle cell tumor of the esophagus? How may it be stained?

Answer 10

Leiomyoma (Desmin+, DOG1/CD117-)

Question 11

How does cytology compare to biopsy for the identification of H. Pylori?

Answer 11

It is comparable, at least when multiple staining methods are used on the smear.

Question 12

What is dysplasia of the stomach associated with?

Answer 12

Usually associated with atrophic gastritis.

Question 13

Describe the cytology of gastric adenocarcinoma (intestinal type)

Answer 13

Increased cellularity, dyshesion, tumor diathesis. The usual dysplastic features…

Question 14

Describe the cytology of gastric adenocarcinoma (signet ring type)

Answer 14

Isolated cells obscured by inflammation. Vacuolization with crescent-shaped hyperchromatic nucleus.

Question 15

How are neuroendocrine tumors graded in the GI tract?

Answer 15

Grade 1: up to 1 mitosis per 10hpf, <3% proliferation rate.
Grade 2: 2-10 mitoses per 10hpf, 3-20% proliferation.
Grade 3: >20 mitoses per 10hpf, >20% proliferation.

Question 16

Describe the cytology of neuroendocrine tumors.

Answer 16

Dyshesive monomorphic cells, with salt-pepper chromatin. May be plasmacytoid and/or have stripped nuclei. May see rosetting.

Question 17

What lymphomas may be found in the stomach?

Answer 17

DLBCL > MALT lymphoma.

Question 18

What mesenchymal/spindle cell is most common in the stomach, and how may it be stained?

Answer 18

GISTs; stain for CD117/DOG1.

Question 19

What infectious organisms can be seen in the duodenum? Describe their morphology.

Answer 19

Giardia: Pear-shaped flagellated “smiley-face” bug.
Microsporidium: Aggregates of tiny eosinophilic organisms.
Cryptosporidium: Small basophilic round organisms.

Question 20

How is anal cancer evaluted?

Answer 20

With pap smears in an identical fashion to that of the cervix.