Gastric Cancer

Question 1

Most gastric tumors are what type?

Answer 1

Gastric Adenocarcinoma

Question 2

What is the classic population affected by gastric adenomas?

Answer 2

Male, 50-60 y/o

Question 3

What genetic condition is associated with adenomas?

Answer 3

Familial Adenomatous Polyposis

Question 4

What gastric condition is normally concurrent with adenomas?

Answer 4

Chronic gastritis

Question 5

Diffuse Type Gastric AdenoCA

• Assoc. Genetic Mutations
• Histology
• Complications

Answer 5

• Genetic mutations:
  
  • E-cadherin
  • BRCA2
  • p53
• Histology:
  
  • Signet ring cells
  • No glands
• Complication:
  
  • Linitis plastica
    
    • Stomach wall is thickened
    • Hardening of wall
      
      • Signet ring cell infiltration

Question 6

Intestinal Type Gastric AdenoCA

• Assoc. Genetic Mutations
• Histology

Answer 6

• Assoc. Genetic Mutations
  
  • B-catenin
  • p53
  • Associated with FAP
• Histology
  
  • Glands resemble colon CA
  • Columnar gland-forming cells
  • Apical mucin vacuoles

Question 7

Where is Gastric AdenoCA typically located?

Answer 7

Lesser curvature of stomach

Question 8

What differentiates an “early” vs a “late” gastric CA?

Answer 8

• Early
  
  • confined to mucosa and submucosa
  • may or may not have spread to lymph nodes
• Advanced
  
  • Extends at least to muscularis propria

Question 9

Where does gastric adenoCA spread through local extension?

Answer 9

1. Duodenum
2. Pancrease
3. Retroperitoneum

Question 10

What are common sites of metastasis of gastric adenoCA?

Answer 10

• Left Supraclavicular Node
  
  • Virchow’s Nodule
• Paraumbilical region
  
  • Sister Mary Joseph nodule
  • “belly button bump” around umbilicus
• Ovaries
  
  • Krukenburg tumors
  • bilateral
  • signet ring cells

Question 11

Treatment of gastric adenoCA?

Answer 11

Resection

Question 12

Extra-nodal Marginal zone B-cell lymphomas (MALTomas)

• Cell markers
• Genetic mutations
• Concurrent gastric pathology
• Gross appearance

Answer 12

• Cell markers
  
  • Mature B cell markers
    
    • CD 19, CD 20
  • NOT CD5 or CD 10
• Genetic mutations
  
  • translocations
  • activation of NF-kB
• Concurrent gastric pathology
  
  • INFLAMMATION
    
    • Chronic gastritis
    • H. pylori infxn
• Gross appearance
  
  • Diffuse thickening of walls
  • Small subserosal nodules

Question 13

Gastric Carcinoid Tumors

• Cell of origin
• Cell markers (in staining)
• Associated conditions

Answer 13

• Cell of origin
  
  • Enterochromaffin cells
• Cell markers (in staining)
  
  • synaptophysin
  • Chromogranin A
• Associated conditions
  
  • Chronic atrophic gastritis
  • Zollinger Ellison syndrome
  • Endocrine cell hyperplasia
  • MEN1

Question 14

What is the best prognostic indicator in Carcinoid tumors of the GI tract? What is the treatment?

Answer 14

• Prognostic indicator
  
  • location in GI tract
  • best from foregut
    
    • rarely metastasize
• Treatment
  
  • cured by resection

Question 15

GI Stromal Tumors

• Cell of origin
• Cell marker
• Gene mutation
• Side effects

Answer 15

• Cell of origin
  
  • Interstitial cell of Cajal
    
    • Pacemaker cells in muscularis
• Cell marker
  
  • cKIT
• Gene mutation
  
  • c-KIT gain of function (80%)
  • PDGFR activation (8%)
• Side effects
  
  • Mass effects
  • Ulceration with blood loss
    
    • iron-deficient anemia
  • Metastasis to liver

Question 16

Inflammatory Gastric Polyps

• Associated condition
• Histology

Answer 16

• Associated condition
  
  • Chronic gastritis
• Histology
  
  • Hyperplasia of foveolar glands
    
    • dilated
    • elongated
  • Edema of lamina propria

Question 17

Fundic gland gastric polyps

• Associated condition
• Histology
• Classic presentation
• What medication makes it worse?

Answer 17

• Associated condition
  
  • FAP
    
    • show multiple polyps
• Histology
  
  • Polyps full of glands
    
    • Irregular
    • Dilated
    • Lined by flattened parietal and chief cells
• Classic presentation
  
  • 50 y/o women
• What medication makes it worse?
  
  • Proton pump inhibitor