esophageal+gastric carcinoma 1/31

Question 1

etiology of esophageal SCC

Answer 1

genetic factors appear less important. Dietery and environmental causes

US+Europe=EtOH and tobacco

other countries=carcinogens like fungus or nitrosamine containing food stuff

Question 2

types of adenocarcinoma of esophagus and EG junction

Answer 2

of esophagus developing with BE

without BE

of gastric cardia

Risk factors:GERD,BE,Dysplasia

Question 3

gastric polyps

Answer 3

hyperplastic/inflammatory polyps (non-neoplastic)

majority are associated with chronic gastritis,should resect if over 1.5cm

Question 4

fundic gland polyps

Answer 4

can be sporadic or in people with FAP

associated with PPI

women>men

have cystically dilated irregular glands

Question 5

gastric polyps picture

Answer 5

Question 6

gastric adenoma (neoplastic polyp)

Answer 6

risks increase with age,men>women,FAP

associated with chronic gastritis with atrophy+intestinal metaplasia

see dysplastic intestinal-type epithelium+nuclear enlargement,elongation,hyperchromasia,irregular architecture (if high-grade)

risk of adenocarcinoma up if over 2cm in diameter

Question 7

gastric adenoCA

Answer 7

more common in east and europe than US

due to dietery+environmental factors.Also with BE

seen in people with lower socioeconomic status and pts with mucosal atrophy and intestinal metaplasia

Question 8

RF for gastric CA

Answer 8

nitrites,smoked salted and pickled food,lack of fruits+veggie

cigarettes

chronic gastritis

partial gastrectomy,menetrier’s disease,BE

blood groupA,family Hx,HNPCC

Question 9

types of gastric CA

Answer 9

intestinal+diffuse

loss of E-cadherin fx is key for diffuse type

see increased risk of intestinal type in pts with FAP,also increased incidence in Japan

chronic inflammation promotes neoplastic progression in both types

Question 10

histology of both types of gastric adenoCA

Answer 10

intestinal: gland formation.grossly,see large bulky tumor
diffuse: signet ring cells.grossly,see thickening of gastric wall(linitis plastica),can be difficult to see on slides

Question 11

intestinal type gastric CA

Answer 11

predominates in high risk areas,develops from precursor flat dysplasia or adenoma

mean age is 55,men>women

linked to atrophic gastritis and intestinal metaplasia

decreased incidence drastically

Question 12

diffuse type of gastric CA

Answer 12

no precursor lesions

men=women

uniform incidence across countries

Question 13

clinical presentation and Tx of gastric CA

Answer 13

similar to chronic gastritis

later see weight loss,early satiety,anemia

may be tipped off by periumbilical subcutaneous nodule (sister mary joseph nodule)

Tx:if early detected–>resection, usually discovered late

Question 14

gastric lymphoma

Answer 14

very rare

most are indolent extra-nodal marginal zone lymphomas of MALT

arise at sites of chronic inflammation,many HP+

low grade MALT lymphoma regresses if HP is treated

Question 15

morphology of gastric lymphoma+presentation

Answer 15

see dense lymphocytic infiltrate in lamina propria, often infiltrates gastric glands

lymphoepithelial lesions

express B cell markers

can show monoclonality

can present with pain,later weight loss

Question 16

carcinoid tumor

Answer 16

from endocrine cells,many seen in GI and next common site is lung

lesion is intramural or submucosal with overlying mucosa that can ulcerate

yellow or tan and firm tumor

see islands or strands of tumor cells that show ‘salt and pepper’ chromatin

stain for NE markers:chromogranin,synaptophysin,also see NE granules on EM

Question 17

GI stromal tumor (GIST)

Answer 17

most common mesenchymal tumor of abd

peak age is 60

if seen in child,think Carney triad:young female,paraganglioma,pulmonary chndroma.OR NF type I

most have oncogenic gain of fx mutation of gene encoding tyrosine kinase c-KIT (receptor for stem-cell factor)–>use as marker in Dx

tumor can be very large,fleshy mass covered by mucosa,can have abd mets

2 types:spindle cell+epitheloid

Question 18

source of GIST

Answer 18

interstitial cells of Cajal located in muscularis propria and serve as pacemaker for peristalsis

they express c-KIT,also known as CD117 and CD34

mutation of c-KIT is early event in sporadic GIST

Question 19

Tx of GIST

Answer 19

complete resection if localized (gastric GIST less aggressive than intestinal GIST)

with imantinib which is a tyrosine kinase inhibitor of c-KIT