GI Flashcards
Subepithelial neural appearing nodule
DDX:
- mucosal schwann cell hamartoma (S100+)
- perineurioma (Glut1+)
HCV vs late acute cellular rejection
- HCV should NOT have plasma cells or pericentral vein inflammation
- late ACR (or de novo AIH) can have plasma cells or pericentral vein inflammation
Portal triad: size of ducts vs arteries
- arteries should be smaller than ducts
- when arteries are larger it tell you there is a vascular problem
Portal vein thrombosis
-can see splitting of the veins in the liver
Prominent oxyntic rugal folds
-consider ZE
Collagenous colitis and lymphocytic colitis
-should be diffuse processes (meaning affecting more than one site of colon)
Subtype of hepatic adenomas
- HNF-1alpha mutations:
- fat and no cytologic atypia - Beta catenin activating mutations:
- cytologic atypia, acini, more likely to transform to HCC - Inflammatory/telangiectatic, IL6ST mutations:
- chronic inflammation
- sinusoidal dilatation
- increased IL6 signaling
Reactive changes in small intestine
- foveolar metaplasia
- goblet cell depletion
“Atypical HCC” by imaging
-do a CK7 to rule out cholangiocellular component
IPMN gross
- multilocular, papillary
- usually NOT unilocular
- should see messed up background pancreas due to obstruction
MCN gross
-usually multilocular
DDX cystic pancreatic tumor
- cystic NET (can be unilocular, looks like an eyeball)
- MCN
- IPMN
Crystals
- kayexylate (fish scales)
- sevelamer (fish scales)
- cholestyramine (dont cause mucosal injury)
Signet ring type adenoca in rectum
consider a NET too
LAMN
low grade appendiceal mucinous neoplasm
Major Patterns of Liver Injury
- predominantly portal inflammation
- prominent lobular injury
- ductular reactions
- steatosis
- fibrosis
Prominent ductular reaction
biliary disease
Mild ductular reaction
can indicate chronic viral hepatitis
Pathognomonic feature of PBC
florid duct lesion: non-necrotizing granuloma surrounding damaged bile duct (granulomatous duct destruction)
Pathognomonic feature of sinusoidal obstruction syndrome
AKA “veno-occlusive disease”
occluded central veins
Predominantly portal inflammation
- chronic viral hepatitis
- autoimmune hepatitis
- drug/toxin induced hepatitis
- chronic biliary diseases (PBC, PSC, strictures)
- metabolic disease (Wilson’s and alpha1antitrypsin)
- neoplastic (leukemia/lymphoma)
Chronic Hep C
- lymphoid follicles
- +/- mild epithelial bile duct damage due to direct infection
- lipogranulomas
- macrovesicular steatosis
- steatosis and insulin resistance associated with tx resistance and progression to fibrosis
collagen in cecum and rectum
can normally have increased collagen band; increase your threshold for collagenous colitis
cirrhotic background bile duct adenoma
have very high threshold, can see normally in cirrhosis