Dr. Starling

Question 1

Barrett’s esophagus

Answer 1

• intestinal metaplasia: strat squamous epith. -> non-ciliated cuboidal epith. with goblet cells
• red, velvet patches

Question 2

risk factors for esophageal SCC

Answer 2

• EtOH and Tobacco

- middle 1/3

Question 3

risk factors for esophageal adenocarcinoma

Answer 3

• obesity and GERD
• due to Barrett’s
• distal 1/3

Question 4

progressive difficulty swallowing solids then liquids + unexplained weight loss

Answer 4

esophageal adenocarcinoma

Question 5

chronic gastritis

Answer 5

• due to H. pylori -> increase risk of MALTlymphoma
• due to autoimmune -> risk of NE tumor

-both increased risk for gastric adenocarcinoma

Question 6

FAP

Answer 6

-associated w/ fundic gland polyps -> can lead to dysplasia and gastric adenocarcinoma

Question 7

sites of gastric adenocarcinoma metastases

Answer 7

1. left supraclavicular node (virchow node)
2. periumbilical (sister Mary Joseph nodule)
3. left axillary node (irish node)
4. ovary (Krukenburge tumor)
5. pouch of Douglas (blummer shelf)

Question 8

intestinal gastric adenocarcinoma

Answer 8

-ulcerated with heaped up margins

Question 9

diffuse gastric adenocarcinoma

Answer 9

• no heaped up margins
• thickened rugae -> linitis plastica
• signet ring cells
• loss of E-cadherin mut.

Question 10

prognosis and treatment of gastric adenocarincoma

Answer 10

• depth of invasion and extent of nodal/distant metastasis best predictors
• surgery preferred

Question 11

Gastric Lymphoma - Extranodal marginal zone B cell lymphoma (aka MALToma)

Answer 11

• due to H. pylori

- t (11;18) (q21;q21)***

Question 12

GIST

Answer 12

• most common mesenchymal tumor
• arise from interstitial cells of Cajal (pacemakers)
• Carney triad, Neurofibromatosis type 1, Carney Stratakis syndrome
• histo: paranuclear vacuoles with KIT marker

Question 13

carcinoid tumor

Answer 13

• neuroendocrine tumor of GI tract -> more aggressive if arise in small intestine
• can arise in lungs
• markers: synaptophysin and Chromagranin A+
• MIDGUT tumors most aggressive

Question 14

hemartomatous polyps

Answer 14

• associated w/ Juvenile Polyps -> SMAD4 mut.

- associated w/ Peutz-Jegher syndrome -> HYPERPIGMENTATION and STK11 mut.

Question 15

adenomatous polyps

Answer 15

• risk of colorectal carcinoma
• start colonoscopy at age 50
• start 10 years prior to when family member was diagnosed
• villous type has highest risk of cancer

Question 16

sessile serrated adenomatous polyps

Answer 16

• full length of gland and precursor to colorectal carcinoma
• hyperplastic serrations don’t run full length of gland

Question 17

adenoma-carcinoma sequence path

Answer 17

-mutations in APC/B-catenin

-

Question 18

microsatellite instability path

Answer 18

• DNA mismatch repair enzyme mut.

- mut. in MSH2, MSH6, MLH1, PMS2 -> CIMP and BRAF

Question 19

Fe deficiency anemia in old man or post-menopausal women

Answer 19

GI cancer until proven otherwise

-need colonoscopy

Question 20

what is the most common place for colorectal adenocarcinoma metastasis?

Answer 20

LIVER

Question 21

FAP

Answer 21

• APC mutation
• 100% progress to CRC; >100 polyps
• adenoma-carcinoma sequence -> LEFT side
  1. Garner’s syndrome -> FAP + osteoma, skin, retinal involvement
  2. Turcot syndrome -> FAP + brain (gliomas and medulloblastomas)

Question 22

HNPCC -Lynch syndrome

Answer 22

• mismatch repair genes (MMR) mutation
• MLH1, MSH2 mut.
• microsatellite path -> RIGHT side
• most common form of syndromic colorectal carcinoma

Question 23

what anal canal tumor is associated w/ HPV and condyloma acuminatum?

Answer 23

squamous cell carcinoma

-strat. squamous epith.

Question 24

mutation most commonly associated w/ tubular adenomas?

Answer 24

KRAS

-BRAF seen in villous sessile adenomas