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gi- week 2 > Gastric Neoplasia I > Flashcards

Gastric Neoplasia I Flashcards

1
Q

What are the main types of non-neoplastic gastric polyps?

A

Inflammatory/hyperplastic poylps and

fundic gland polyps, which

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2
Q

What are the neoplastic gastric polyps?

A

Adenomas-precursors to gastric cancer

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3
Q

Describe hyperplastic gastric polyps

A

These are developed in the presence primarily (60%) in the antrum of the stomach in the chronic gastric inflammation, partially due to H. pylori infection

These are mostly benign, with only a small risk of dysplasia

Most common non-neoplastic polyp

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4
Q

What are these? Describe them

A

Fundic gland gastric polyps, commonly found in the more proximal (body or fundus) stomach that are usually small (less than 1 cm(, cystic appearing, and clustered on a background of normal, not inflammed stomach

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5
Q

What causes most fundic gland gastric polyps?

A

These may be sporadic, associated with PPI use, or associated with FAP and rarely have malignant potential unless associated with FAP

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6
Q

Describe gastric adenomas

A

These are mostly found in the antrum of the stomach and Almost always occur on a background of chronic gastritis with atrophy and intestinal metaplasia.

They are composed of intestinal-type columnar epithelium that exhibits varying degrees of dysplasia, and the risk of malignancy increases with size, villous lesions, and/or high grade dysplasia

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7
Q

T or F. Gastric adenomas are pre-malignant neoplastic lesions with a high risk of transformation to invasive cancer

A

T. •Like fundic gland polyps, the incidence of adenomas is increased in individuals with FAP.

These need to be removed endoscopically

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8
Q
A
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9
Q

What pt. pop gets gastric cancer?

A

More common in lower SC groups and in developing countries with a 2:1 male predominance and an average onset of around 70 yo

NOTE: There is declining incidence in US of distal gastric cancers except in Caucasiasn aged 29-39

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10
Q

What are the main risk factors for gastric cancer?

A
  • Chronic atrophic gastritis
  • Pernicious anemia b/c of change in pH
  • Prior gastric surgery b/c of change in pH
  • High dietary nitrates
  • Adenomatous gastric polyps (precursor)
  • Smoking and obesity
  • Family history gastric cancer-<10 % (Diffuse type)
  • Helicobacter pylori infection (Increases risk 3-6 times)
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11
Q

Nitrite is a carcinogen

A
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12
Q

Notice the continuing trends of decreased incidence of gastric cancer. What are some main reasons why?

A

1) Tx H. pylori
2) Refrigeration and decreased meat curing/smoking of meat
3) Increase consumption of vegetables

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13
Q

What are some common symptoms associated with gastric cancer?

A
  • diaphragmatic invasions can lead to chronic hiccups
  • early perineural invasion can lead to dull pain
  • adjacent tissue infiltration can lead to decreased gastric compliance causing early satiety and contributing to weight loss
  • Gastric outlet obstruction-distal lesions may obstruct stomach outlet- these will vomit 2-3 hrs after eating
  • Ulceration may lead to anemia or hematoemeis and/or melena
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14
Q
A

Endoscopy is the main way to diagnose. Biopsy needed for distinction between ulcer and malignancy. 6-8 biopsies taken usually

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15
Q
A
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16
Q

What are the main types of gastric cancer?

A

90% adenocarcinoma (two types: intestinal and diffuse)

3% lymphoma

0.2% carcinoid

GI stromal tumor (GIST)

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17
Q

What pts is the intestinal type of gastric adenocarcinoma more common in?

A

males and at older ages

18
Q

What pts is the diffuse type of gastric adenocarcinoma more common in?

A

little difference between sexes and more frequent at younger ages

Diffuse may be familial

19
Q
A
20
Q

What is this?

A

Linitis plastica- a very aggressive diffuse type adenocarcinoma representing around 5% of gastric cancers and marked by transmural infiltration of the gastric wall (poor prognosis) resulting in a rigid, leather-bottle, thickened stomach

21
Q
A
22
Q

Where does gastric cancer usualy MET to?

A

liver, peritoneum, or distal lymph nodes such as:

left supraclavicular node (aka Virchow’s node)

periumbilical nodule (aka Sister Mary Joseph node)

23
Q

Staging of gastric cancer is based on what?

A

depth of infitlration into the gastric wall

NOTE: Even early lesions only carry a 5yr survival of 70%- much worse prognosis than colon cancer

24
Q
A

A. Weight loss and anemia suggest cancer

25
Q

B. More likely to be an adenocarcinoma (lymphoma actually has a better prognosis than adenocarcinoma)

A

A.

26
Q
A
27
Q

What is this?

A

A hyperplastic gastric polyp

Micro: Dilated, elongated and tortuous gastric foveolar epithelium with edematous lamina propria containing inflammatory cells

28
Q

What are these?

A

Fundic gland gastric polyps

Micro: Cystically dilated lined by flattened parietal and chief cells

29
Q

How does gastric cancer form?

A

It is multifactorial with interplay of host and environmental factors. Intially the normal gastric mucosa is subjected to host gene polymorphisms or H. pylori infection which promotes a superficial gastritis, and eventually chronic gastric inflammation exacerbated by a high salt diet or smoking, as well as ROS generation.Chronic inflammation gives rise to atrophic gastritis and eventually metaplasia and dysplasia leading to carcinoma

30
Q
A
31
Q

Adenoma= low grade dysplasia (left)

Right= high grade

A
32
Q

What kind of gastric adenocarcinoma is this?

A

Intestinal type, which tends to form bulky antral (along lesser curvature) masses

33
Q

What kind of gastric adenocarcinoma is this?

A

diffuse types, which infiltrates the wall diffusely, thickens it, and is typically composed of signet ring cells

34
Q

Familial diffuse gastric cancer is strongly associated with germline loss-of-function mutations in the tumor suppressor gene ____, which encodes the cell adhesion protein E-cadherin.

A

CDH1. 10% of gastric carcinomas are caused by hereditary factors –E-cadherin

35
Q

Individuals with _____ mutations are at increased risk of developing diffuse gastric cancer.

A

BRCA2

36
Q

What is this?

A

When there are large areas of infiltration involved with a diffuse gastric adenocarcinoma, diffuse rugal flattening and a rigid, thickened wall may impart a leather bottle appearance termed linitis plastica

37
Q

C.

B would be a mutation in VHL

A
38
Q

What kind of gastric cancer is this?

A

Sporadic type

39
Q

Sporadic type gastric cancer is associated with what mutations?

A

These include loss-of-function mutations in the adenomatous polyposis coli (APC) tumor suppressor gene and gain-of-function mutations in the gene encoding β-catenin (Increased signaling via the Wnt pathway)

Sporadic types are associated with APC, K-RAS and Tp53 alterations (AK-53)

NOTE: FAP patients, who carry germline APC mutations, have an increased risk of intestinal-type gastric cancer.

40
Q

Left: intestinal type gastric carcinoma

A

Higher-magnification

41
Q
A

B. Seeing goblet cells

42
Q
A

gi- week 2 (27 decks)

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