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GI Path Flashcards

1
Q

Which has better prognosis: pedunculated or sessile polyps?

A

Pedunculated– easier to resect

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2
Q

What is the MCC of pseudopolyps in the colon?

A

Ulcerative colitis

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3
Q

Juvenile polyps: benign or malignant

A

Rarely malignant; can rarely get Polyposis Syndrome

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4
Q

ID

A

Peutz-Jeghers Syndrome: hyperpigmentation @ lips/gingiva + harmatomatous polys (benign)

Have increased risk of cancer, but not from polyps themselves

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5
Q

Colonic Hyperplastic Polyps:

  • Common or rare?
  • Benign or malignant?
A

Common

Benign but MUST be distinguished from Sessile Serrated Adenomas

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6
Q

When might you suspect Colonic Hyperplastic Polyps may actually be Sessile Serrated Adenomas?

A

Large (>1cm) in RIGHT colon

– DNA mismatch repair pathway affected

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7
Q

Adenoma of Colon:

  • common or rare?
  • Benign or malignant?
A
  • Common
  • ALWAYS have dysplasia – ALWAYS pre-malignant
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8
Q

Most colon cancers arise from what?

A

Adenoma of colon- always pre-malignant, but good to find because they can be removed before they become malignant

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9
Q

How can you tell if Adenoma of Colon has invaded?

A

Stromal desmoplasia

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10
Q

Familial Adenomatous Polyposis

A
  • Rare APC gene mutation
  • 100% develop colon cancer
  • Wall-to-wall adenomas = FAP until proven otherwise
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11
Q

Main risk factor for Colon Cancer besides genetics?

A

Diet– better to eat high fiber & fruits & veg

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12
Q

Dirty necrosis

A

Probably coming from colon

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13
Q

Mucin all up in that peritoneal cavity…

A

Check appendix!

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14
Q

Yellow tumor in small intestine

A

Carcinoid

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15
Q

Carcinoid syndrome:

A

HTN, flushing, diarrhea

MC metastatic site = liver (CT scan)

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16
Q

GIST: prognosis based on? diagnosis?

A

Prognosis based on size & mitotic rate

CD-117 stain helps confirm dx & prognosis

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17
Q

Appendiceal carcinoids: location? common? prognosis?

A

@ tip usually

Common

Good prognosis

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18
Q

Appendiceal Mucinous Cystadenocarcinoma: morphology

A
  • Mucin + epithelial cells in peritoneal wall
  • Pseudomyxoma peritonei (lots of mucin in peritoneal cavity)
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19
Q

ID

A

Tubulovillous Adenoma

(Intestinal adenomas can be Tubular, Villous, or Tubulovillous)

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20
Q

Morphology of Esophagus with Achalasia

A

Loss of inhibitory neurons in wall of intestine (enteric)

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21
Q

How are esophageal webs & rings formed?

A

Post-inflammational scarring (most common)

Tumors

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22
Q

What is the cause of diverticuli?

A

Esophageal spasms

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23
Q

What is the cause of Mallory-Weiss syndrome?

A

Persistent vomiting (alcoholics, eating disorder)

Usually not too severe

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24
Q

Cause of Esophageal Varices? Severity?

A

Portal HTN (from cirrhosis)

Can rupture– 50% mortality :(

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25
Q

What is the main complication of a hiatal hernia?

A

Reflux –> ulcer –> Barrett’s –> cancer

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26
Q

Histology of Reflux Esophagitis?

A

Long papillae

Inflammatory cells

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27
Q

What is a histological feature that MUST be present to diagnose Barrett’s Esophagus?

A

Goblet cells above gastroesophageal junction

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28
Q

ID cause of esophagitis

A

Herpes:

Multinucleate, fine chromatin cells in epithelium

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29
Q

ID cause of esophagitis

A

CMV– usually in stroma

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30
Q

White plaques in esophagus?

A

Candida esophagitis

-- ONLY IN IMMUNOCOMPROMISEED

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31
Q

Concentric rings in esophagus?

A

Eosinophilic esophagitis – Must have eosinophila (causes contractions of muscularis propria)

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32
Q

Esophageal biopsy:

A

High-grade dysplasia– still benign but predisposes to cancer

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33
Q

Adeno vs Squamous Cell CA of Esophagus

A

Adenocarcinoma has Barrett’s surrounding

Squamous cell CA has keratin pearls

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34
Q

Celiac Disease:

  • demographics
  • Histology
  • Mechanism
  • Complications
  • Management
A
  • White people with HLA-DQ2, -DQ8
  • Flat & inflamed histology
  • IgG or IgA ab aganst gliadin;
  • *IgA** against transglutaminase
  • Can cause T-cell lymphoma, adenocarcinoma
  • Avoid gluten
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35
Q

Patient has celiac symptoms, but recent diarrhea and trip to Dominica….

A

Tropical sprue

tx: abx

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36
Q

Whipple’s disease

A

@ small intestine

Foamy macrophages– plugs up lymphatics

Caused by atypical mycobacteria in immunocompromised (use Acid-Fast stain)

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37
Q

Lactase (disacccharide) deficiency: histo

A

NORMAL histo

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38
Q

Abetalipoproteinemia

A

Rare

See vaculoated epithelium with spur cells in blood (acanthocytes)

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39
Q

Where is helicobacter located?

A

Antrum of stomach (by pyloric sphincter)

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40
Q

What part of the stomach does autoimmune gastritis affect?

A

Body of stomach

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41
Q

Actue gastritis: S/S

A

quick course, can cause hemorrhage

Almost everyone in ICU has mucosal damage

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42
Q

Automimmune chornic gastritis

A
  • @ body & fundus- ab against parietal cells
  • More likely to get carcinoid tumors
  • less likely to get ulcers than H.pylori
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43
Q

Hyperplastic polyps

A
  • Assoc w/ H.pylori
  • Made of foveolar glands
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44
Q

Fundic Gland Polyps

A
  • Chief & parietal cells
  • Caused by PPIs
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45
Q

Gastric Adenomas

A

Assoc w/ FAP or atrophic gastritis w/intestinal metaplasia

Risk of adenocarcinoma increases with size

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46
Q

Tumor Adenoma vs Hyperplastic Polyp

A

Adenomas have DYSPLASIA

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47
Q

Histology of Diffuse Gastric Adenocarcenoma

A

Signet rings (lots of mucin pushese nucleus to side)

Diffuse thickening

Grossly: linitis plastica

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48
Q

Malignant vs Peptic Ulcers

A

Malignant ulcers have masses, heaped edges

Peptic ulcers are benign, clean and “punched out”

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49
Q

Marginal Zone Lymphoma

A

Look for H.pylori & treat it (can advance to more serious lymphoma)

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50
Q

Diffuse Large B-cell Lymphoma

A

LCA+ (leukocyte common ag)

50% respond to therapy

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51
Q

Prognosis of Autoimmune Gastritis w/ lots of Gastric Carcinoid Tumors

A

Good prognosis in stomach, esp with atrophic gastritis

resection usually curative

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52
Q

GI Stromal Tumors

A
  • Large submucosal masses– MC mesenchyma tumor of stomach
  • Mostly spindle cells
  • Prognosis directly correlated w/size & mitotic activity
  • Dx: c-KIT or CD117
  • Tx: Imantanib
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53
Q

Infectious bacterial colitis: histology

A
  • Toxin-producing organisms: NORMAL histo
  • All others show ACUTE COLITIS (Neutrophils)
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54
Q

C. dificil

A
  • In 3% normal people, 30% hospital pts
  • Most important risk factor for developing Pseudomembranous Colitis = abx tx
    • see pseudomembranes & inflammatory debris on surface
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55
Q

Irritable Bowel Syndrome: biopsy

A

NORMAL biopsy, stress related

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56
Q

You have a stressed patient with chronic diarrhea. Endoscopy looks normal. Should you biopsy?

A

YES– could be microscopic colitis (lymphocytic or collagenous)

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57
Q

Angiodysplasia: gross & complications

A
  • dilated vessels on endoscopy
  • causes bleeding in elderly
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58
Q

IBD vs Acute Infectious Colitis

A

Changes of CHRONIC colitis (gland distortion +/- paneth cell metaplasia) seen in IBD

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59
Q

Chron’s Disease: gross characteristics

A
  • Skip lesions @ small bowel
  • Transmural inflammation
  • Granulomas
  • Fistulas
  • Cobblestone
60
Q

Ulcerative Colitis: gross feats

A
  • Broad ulcers @ rectum
  • Pseudopolyps
  • Crypt abscesses
  • Toxic megacolon
61
Q

Patient has had IBD for 10 years… what is your concern?

A

Cancer. look for Dysplasia (screening endoscopy)

62
Q

Can Chron’s show crypt abscesses?

A

YES- but more common in UC

63
Q

Extra-intestinal lesions of IBD?

64
Q

What causes diversion colitis?

A

Blind pouch– no fecal flow

Tx: enema with short-chain FAs, or resection to restore fecal flowa

65
Q

Ischemic Bowel Disease: causes

A

Serious disease– don’t have to be transmural to cause problems

Mucosal Infarction comes before transmural infarct

  • Obstruction (increased luminal pressure or kinked /twisted bowel compromises blood supply)
  • Acute occlusion of arterial supply (atherosclerosis, thrombosis, emboli)
  • Hypoperfusion (shock, marked dehydration, heart failure, vasoconstrictive drugs)
66
Q

Diverticular disease

A

Common- caused by low fiber diet

Main complcations: diverticulitis, perforation, infection

67
Q

Acute Appendicitis requires inflammation of ___?

A

MUCOSAL inflammation

68
Q

Tests if you think pt has Carcinoid Syndrome?

This will be on final

A
  • Urine: 5-hydroxyindolacetic acid (5 HIAA)- serotonin metabolite
    • 5HT -> 5HIAA
  • Blood: Chromogranin A
69
Q

Esophagus: dx?

A

Squamous Cell CA– squamous epithelium on both sides– no Barrett’s

70
Q

Bipsy of Polyps in stomach (1, 3, 4)

A
  1. HYPERPLASTIC polyp
  2. Fundid gland Polyps
  3. Adenoma (Dysplasia- stratification)
71
Q

Stomach- dx?

A

Helicobacter

  • chronic gastritis (MCC = helicobacter)
  • yellow picture shows microorganism
72
Q

Gastric Biopsy

Dx?

A

adenocarcinoma w/signet rings

Any time you see clear cells in stomach in between normal glands…

73
Q

Gastric Biopsy

A

Lots of stroma, but glands are malignant (complex, mitotic activity, necrosis)

Desmoplastic adenocarcinoma- intestinal type

74
Q

Stomach. Dx?

A

CLEAR CELLS – signet rings

ADENOCARCINOMA

75
Q

Stomach. Dx?

A

Linus plastica

thickening of wall

Adenocarcinoma– diffuse (signet ring)

76
Q

Benign or Malignant?

A

Left: malignant

Right: benign

77
Q

Gastric Mass. Dx?

A

Marginal Zone Lymphoma

-bland, large lymphocytes

78
Q

Gastric Mass

A

Infiltrating into gland

B-cell marker (CD20)

Marginal Cell lymphoma

79
Q

Stomach Mass

A

Diffuse Large B Lymphoma

large lymphocytes

*diffuse adenocarcinoma can appear similar– immunostain (LCA, CD45, cytokeratin) to distinguish

80
Q

Stomach dx?

A

Benign ulcer

81
Q
A

Normal small intestine

82
Q
A

Celiac disease

@ small intestine, NO villi, lymphocytes @ surface

Problem: reaction to gliadin, glutan

83
Q
A

Whipple’s:

Foamy macrophages in lamina propria

84
Q
A

Abetalipoproteinemia

lack of transfer factor –> defx of lipid sol vitamins

acanthocytes

85
Q
A

Microscopic colitis

A. Collagenous colitis

B. Lymphocytic colitis

86
Q
A

Chron’s– segmental lesions (ends are normal)

87
Q
A

Chron’s

linear, sharp fissure-like ulcers

88
Q
A

Ulcerative Colitis

broad-based ulcers that form pseudopolyps when they heal

89
Q
A

Chron’s Disease

  • granulomas
  • transmural inflammation
90
Q
A

Left: Chron’s
- linear ulcers

Right: Ulcerative Colitis
- broad-based ulcers, pseudopolyps

91
Q
A

Low-grade dysplasia

92
Q
A

Acute appendicitis:

Must see MUCOSAL inflammation – if it’s just on the serosa - may be coming from elsewhere

93
Q
A

Mucosal acute inflammation (acute appendicitis)

94
Q

Polyp biopsy

A

Tubuladenoma

dark band of cells down center– piled up nuclei = feature of dysplasia

95
Q
A

Villous adenoma

  • Long papillary projections
  • On cross section- no evidence of invasion
96
Q
A

Villous Adenoma

  • long projections
97
Q
A

Pedunculated Tubulovillous Adenoma

98
Q
A

High grade dysplasia:

  • complex glands, shared walls, large ugly nuclei
  • Not invasive because no desmoplasia
99
Q

Dx? Bx would show? Gene assoc?

A

Familial Polyposis

Bx: tubularadenomas

Gene: APC (same as with sporadic colon cancers)

100
Q
A

Adenocarcinoma

  • complex glands
  • reactive desmoplastic stroma
101
Q
A

Dirty necrosis- colon

102
Q
A

Mucinous Adenocarcinoma

Extracellular mucin w/islets of tumor cells

worse prognosis in colon

103
Q
A

Carcinoid

yellow

104
Q
A

Carcinoid

Left: Ulcer w/ tumor invading down to wall

Right: Round, monotonous, clumpy chromatin

105
Q
A

GIST

prognostic factors: size, mitotic activity

Stain with: CD117 (c-KIT?)

106
Q
A

Carcinoid– obstruction of lumen by tumor @ tip

Uniform cells, clumpy chromatin (same histology as the other carcinoid)

Good prognosis

107
Q
A

Mucinous Cystadenoma

No invasion, just some stratification

108
Q
A

Pseudomyxoma peritonei

look @ appendix!

109
Q
A

Left: cholesterol- fat female forty

Right: bilirubin- blood disorders

110
Q
A

Acute pancreatitis (lots of hemorrhage)

2 risk factors: alcohol & obstruction

stone would have to be @ ampulla to cause this

111
Q
A

Acute pancreatitis

lots of neutrophils, hemorrhage

112
Q
A

Fat necrosis

Fat necrosis all over belly? Pancreatitis (activation of lipase)

113
Q
A

Chronic Pancreatitis

lots of fibrosis

alcoholics, chronic obstruction

114
Q
A

Fibrous adhesion

  • usually caused by post-inflammatory (surgery)
  • can cause ischemic bowel
115
Q
A

Ischemic Bowel

50% fatal– bad prognosis

116
Q
A

Diverticular disease

old peeps, low-fiber diet

complications: inflammation, diverticulitis, perforation, rupture

117
Q
A

Hemochromatosis

118
Q
A

a1-atrypsin deficiency

  • blue balls in cytoplasm
  • Also get emphysema b/c can’t turn off inflammation quick enough
  • Can cause jaundice in newborn
119
Q
A

Primary Biliary Cirrhosis

  • intralobular bile duct under attack of lymphocytes
  • check for anti-mitochondrial antibodies
120
Q
A

Cholestasis

121
Q
A

Sclerosing Cholangitis

Extrahepatic ducts –> beaded appearance

Assoc w/ ulcerative cholitis

122
Q
A

Esophageal Varices

  • portal HTN (mainly from cirrhosis)
  • If they rupture & hemorrhage.. 50% mortality
123
Q
A

Hemorrhoids

124
Q
A

Cirrhosis:

jaundice + ascites

125
Q
A

Nutmeg Liver– chronic passive congestion

  • due to RHF
  • Patients are very ill
126
Q
A

Adenocarcinoma

dysplastic stroma, complex glands

127
Q
A

Bile Duct Harmatoma

won’t cause problem, but if you seen them while doing sx, might be worried about metastatic disease

128
Q
A

Focal nodular hyperplasia

  • central scar
  • needle biopsy is NORMAL
  • not serious
129
Q
A

Hemangioma

  • most common tumor of liver
  • benign
130
Q
A

Adenoma

  • bland, thin cords, no portal tracts, no central veins
  • SERIOUS– can rupture and cause hemorrhage
  • often seen in young women on Oral contraceptives
131
Q
A

Cirrhosis + Hepatocellular Carcinoma

  • Green– bile
  • Bad prognosis
132
Q
A

Hepatocellular Carcinoma

(normal on Left)

133
Q
A

Fibrolamellar Variant Hepatocellular Carcinoma

seen in YOUNG

better prognosis (still 50% but better)

134
Q
A

Metastatic Disease

135
Q
A

Hepatoblastoma

poor prognosis without treatment

with treatment - 80% cure

in young children

136
Q
A

Angiosarcoma

  • freely anastomosing vascular pattern
  • Caused by vinyl chloride, arsenic, thorotrast
  • Decades-long latent period
  • Very serious
137
Q

55-year old man with heartburn and sub-sternal chest pain.

See he has Barrett’s

2 years later, comes back with dysphagia. See a mass. What is it most likely to be?

Adenocarcinoma

Biopsy, then Esophagectomy

138
Q

Esophagus

A

Barrett’s

GOBLET CELLS

139
Q

Edge of adenocarcinoma

A

Dysplasia– looks like tubularadenoma -stratefied

140
Q

Middle of mass

A

Adenocarcinoma

Muscle strand surrounded by cancer

141
Q

What is the major predisposing condition for adenocarcinoma?

142
Q

55-year old woman, stomach pain, GI endoscopy

See ulcer- benign or malignant?

A

Benign- Peptic Ulcer

debris, granulation tissue, fibrosis– just reactive necrosis

143
Q

31-year old woman- has had intermittent bloody diarrhea for 10 years

Sigmoidoscopy shows friable, ulcerated colonic mucosa extending from anus -> splenic flexure

Dx?

A

Ulcerative Colitis

continuous, crypt abscesses, 10 years

144
Q

56 year old woman with positive stool occult blood test.

Colonoscopy: large mass– probably adenocarcinoma

Biopsy:

A

Adenocarcinoma

145
Q
A

Adenocarcinoma

Within fat (right-hand side)

Large blue blob = lymph node - probably involved because not uniform in color

146
Q

Resected Lymph node

A

Cancer- adenocarcinoma

S4M2 (10 decks)

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