GI Path Flashcards
Endoscopic finding of Barrett’s esophagus
-tongues/islands of salmon-pink mucosa
Esophageal Adenocarcinoma
Adenocarcinoma = cancer of a glandular organ- aka the mucous secreting glands of the esophagus
-progression from Barrett’s (metasplasia) –> dysplasia (low or high grade) –> invasive adenocarcinoma
Causes: longstanding GERD, ulcers
Complications of Barrett’s esophagus
H-ulcers, strictures, adenocarcinoma
-degree of dysplastic changes correlates to the risk of adenocarcinoma
Are most polyps of the stomach neoplastic?
No, 90% are non-neoplastic meaning they have no risk of developing into cancer
Most common gastric malignancy
90-95% of gastric malignancies are gastric adenocarcinomas
Describe the progression of cancer progression in GI and gastric tumors
Normal –> Metaplasia –> Dysplasia –> Adenocarcinoma (invasive)
Leather bottle appearance
Mural thickening in type IV of advanced gastric cancer
What can cause increased risk of carcinoma in different organ than it’s location?
Peutz-Jaghers = non-neoplastic hamartomatous polyp
- can be sporadic or syndromic
- increases risk of carcinoma in pancreas, breast, lung, ovary, and uterus
- can possible cause intussusception
What is the most common cystic pancreatic neoplasm?
IPMN = intraductal papillary mucinous neoplasm
-however: recall that the majority of pancreatic cystic lesions (75%) are pseudocysts
Which cystic pancreatic neoplasm is in the head of the pancreas?
IPMN = intraductal papillary mucinous neoplasm
Which cystic pancreatic neoplasms are in the tail of the pancreas?
- MCN = mucinous cystic neoplasm
- Serous cystadenoma
Which cystic pancreatic neoplasm is inside the duct?
IPMN
-not MCN or serous cystadenoma
Which cystic pancreatic neoplasms are mucin producing?
IPMN and MCN
Which cystic pancreatic neoplasm has ovarian-like stroma?
MCN = mucinous cystic neoplasm
- contains dense stroma similar to ovarian stroma
- often associated w/ estrogen hormone dysregulation
Which cystic pancreatic neoplasms can progress to carcinoma?
IPMN and MCN
-not serous cystadenoma (no malignant potential)
What is the most common solid pancreatic tumor?
What is the prognosis?
Where in the pancreas is it most commonly seen?
Ductal adenocarcinoma (adenocarcinoma = tumor of the glandular tissue)
- poor prognosis
- 70% in the head of the pancreas => jaundice due to CBD obstruction
How does ductal adenocarcinoma stain on immunohistochemistry
Glycoproteins (CA-19-9)
How does acinar carcinoma stain on immunohistochemistry?
Enzymes: trypsin, lipase, and chymotrypsin
recall the acini are what produce the pancreatic enzymes
What solid pancreatic tumor can affect ppl at any age?
PEN = pancreatic endocrine neoplasm
-affects ppl 10-80 yoa
What is the most common clinical presentation of a pancreatic endocrine neoplasm (PEN)?
Hypoglycemia due to the excess insulin of the most common type of PEN = insulinoma (insulin secreting tumor)
What is the epithelium of the gall bladder
simple columnar
-helpful to absorb electrolytes and water to concentration the bile
What are choledochal cysts?
What are the triad of symptoms that accompany it?
= cystic dilation of the bile duct
-congenital abnormality
3 Symptoms:
(i) jaundice
(ii) RUQ abdominal mass
(iii) intermittent abdominal pain
What are cholelithiasis?
Gallstones!
-extremely prevalent (10-20% of adults) but most (80%) are asymptomatic
What is the composition of the majority of gallstones?
80% of gall stones are cholesterol stones
-most common in US and Europe
What is the composition of the minority of gallstones?
20% are pigmented stones
-more common in Asian and rural areas
2 most common causes of acute pancreatitis
Gallstones and alcohol
Treatment for acute pancreatitis
Supportive
Histology of chronic pancreatitis
- fibrosis
- calcification (sometimes visible on Xray)
- dilate ducts
Key pathological finding of autoimmune pancreatitis
sclerosis = hardening
-bulk, firm, and hard gross appearance
Key diagnostic feature of autoimmune pancreatitis
IgG4 plasma cells
What is acute cholecystitis? What are the two most common causes?
= acute inflammation of the gall bladder
- 90% due to obstruction of cystic duct by stones
- 10% due to cystic artery ischemia
What causes chronic cholecystitis
chronic gallbladder inflammation always caused by stones
Why is it good that tumors of the gall bladder are very rare?
b/c there’s insanely poor survival: 1% 5 yr survival
Most common primary liver cancer
hemangioma = benign tumor of endothelial cells lining the blood vessels
-F > M b/c female hormones promote growth
Most common malignancy of the tumor
Metastasis
-common sites from colon, lung, and breast
Most common hepatocellular nodule
FNH = focalnodular hyperplasia
- hyperplastic (proliferation w/ limits)
- non-neoplastic
- has normal hepatocytes, central scar, present portal triads
- F > M
Differentiate hyperplastic and neoplastic lesions
Hyperplastic is proliferation w/ limits while neoplastic is proflieration w/o limits
What is the most common bile duct tumor?
Adenoma
If you see HCC w/o cirrhosis what do you think?
Hep B
Why is HCC mostly seen w/ cirrhosis?
B/c it is the chronic inflammation that leads to repeated cycles of cell death and regeneration that allows for the genetic alterations to arise
Which liver hyperplastic nodule is associated w/ portal HTN?
NRH = nodular regenerative hyperplasia
- multiple small diffuse lesions
- benign, hyperplastic
- associated w/ abnormal bloodflow (so is FNH)
