GI and Liver Flashcards

Question

Interpretation of HER2 in GOJ / Gastric Adenocarcinoma

Answer 1

HER2 is a receptor tyrosine kinase present on the surface of cells. Member of the epidermal growth factor receptor EGFR, family and is encoded by the HER2/neu oncogene. Amplification or overexpression of this oncogene is associated with the development and progression of certain breast and gastric carcinoma types. HER2 receptor can be targeted by monoclonal antibodies (e.g. trastuzumab) for therapy. In GOJ / gastric adenocarcinomas: HER2 amplification can be assessed by IPX or ISH studies. With IPX assessment is based on basolateral staining, intensity of the staining and the number of cells staining (biopsy 5 cells or more, resection \>10% of tumour cells)

Answer 2

NET's and NEC's are graded on the basis of mitotic count per 2mm2 / 10 HPF and Ki67 proliferation index. **Ki67** counted in a hot spot area. Count at least 500 cells. "eyeball" / manual count / or digital image analysis **Mitoses** count in ~50 HPF and report average per 10 HPF **Cut offs:** Ki67 \< \> 3% Mitoses \< \> 2 / 10 HPF

Answer 3

SATB2: rectum / appendix CDX2: small intestine PAX8 / IL1: pancreas TTF1: lung

Answer 4

Tissue transglutaminase antibody Deamidated gliadin eptide IgA levels HLA-DQ2/DQ8 typing for people at risk of CD (first degree relatives, T1DM, IgA deficiency, other autoimmune disease, Trisomy 21)

Answer 5

Persistent villous blunting, LP inflammation and IEL despite 6 - 12 months of strict gluten free diet ## Footnote _Consider and exclud_e: collagenous sprue, tropical sprue, autoimmune enteropathy and immune deficiency eg CVID. _Type 1 RCD_: IEL phenotype identical to usual Coeliac disease i.e. CD8=CD3+ IEL's. TCR gene rearrangement polyclonal. Can use immunosuppression. No increased risk of EATL. _Type 2 RCD:_ CD8 lost in \>50% of CD3+ IEL's. Loss of surface CD3, CD7, CD8. TCR gene studies oligo/monoclonal. Increased risk of EATL.

Answer 6

Bile Iron (PERLS +) Copper (Rhodanine +) Lipofuscin (Fontana-Masson +)

Answer 7

Number of tumours, size of each, distance to margins Histologic type and grade of tumour Treatment response to NAT - tumour regression score (Rubrei and Grant, only fibrosis counts, presence and %) MMR / BRAF Background liver: including sinusoidal obstruction syndrome due to oxiplatin and any concurrent disorder

Answer 8

_Steatosis_ = Abnormal accumulation of fat within hepatocytes _Steatohepatitis_ = Fat + Injury (balloon cells and lobular inflammation) These are part of the same disease process, and both lead to fibrosis, but steatohepatitis leads to fibrosis faster Changes usually seen in Zone 3 first. Portal infiltrates may be present, but are usually mild. If they are severe, consider additional Dx’s _Macrovesicular steatosis:_ Change in lipid metabolism. Nucleus pushed to the side by usually a single medium to large sized droplet. _Causes:_ metabolic disease, obesity, TPN, PEM, steroid therapy. _Microvesicular steatosis_: Usually represents mitochondrial injury. Nucleus remains central with innumerable, fine fat droplets. Only use this term if it is a diffuse change. _Causes:_ Acute fatty liver of pregnancy, Reye syndrome, in born errors of fatty acid metabolism, alcohol. _Quantifying Fat_ \< 5% Normal 5 - 33% Mild 33-66% Moderate \>66% Severe

Answer 9

_Grading:_ % of fat (mild, moderate, severe) Lobular inflammation Hepatocyte Ballooning _Staging:_ Fibrosis _Systems:_ SAF, NASH-CRN score

Answer 10

Haemochromatosis Thalassemia Excess RBC transfusions Small amounts of iron also seen in many chronic liver diseases e.g. NAFLD, ALD, Hep B / C, cirrhosis

Answer 11

_Modified Scheurer_ Grade 0 - discrete granules not visible or barely discernible at 400x Grade 1 - discrete granules barely discernible at 250x, easily seen at 100x Grade 2 - discrete granules resolved at 100x Grade 3 - discrete granules resolved at 25x Grade 4 - masses visible with naked eye or at 10x

Answer 12

_Lauren Classification_: Diffuse, Intestinal or Mixed _WHO Classification:_ Tubular, Poorly cohesive (includes signet ring cell carcinoma), Mixed, Mucinous, Papillary, Micropapillary, Hepatoid, Adenosquamous, SCC, Undifferentiatiated / Anaplastic, Gastroblastoma, SCNEC, LCNEC, MANEC

Answer 13

**_In appendix_**: LAMN and HAMN **_In peritoneum_:** _WHO 5th edition:_ G1: Low grade peritoneal mucinous neoplasia G2: High grade peritoneal mucinous neoplasia G3: High grade peritoneal mucinous neoplasia with signet ring cells **_PSOG:_** Low grade mucinous carcinoma peritonei High grade mucinous carcinoma peritonei High grade mucinous carcinoma peritonei with signet ring cells \* submit 1 / cm of mucinous deposits \* search for and sample solid areas

Answer 14

_Modified Ryan Scheme_ Score 0: No viable cancer cells (complete response) Score 1: Single cells or rare groups of cells (near-complete response) Score 2: Residual cancer with evident regrssion but more than single cells or rare groups of cells (partial response) Score 3: Extensive residual cancer without evidence of tumour regression (poor or no response)

Answer 15

Wilson's diseae Chronic cholestatic liver disease PBC, PSC (periportal hepatocytes) Indian childhood cirrhosis PFIC