GI pathology Flashcards
inflammatory lesions of salivary glands
sialadenitis
Symptoms of sialadenitis
Dry mouth and/or gland swelling with pain
2. Sarcoidosis, mumps and salivary duct stones with obstruction
what is an autoimmune salivary gland disease
Sjogren’s Disease
Sjogren’s Disease happens more in who? and when? and symptoms
women, 5th decade Dry mouth (xerostomia), dry eyes (kerato-conjunctivitis sicca)
Sjogren’s histo features
Intense lymphocytic infiltrate in salivary glands
Increased incidence of lymphoma
most salivary gland tumors happen in which gland
parotid (80%), most benign
complications with parotid gland tumor
if malignant can affect facial nerve with subsequent pain, paralysis, numbing.
salivary gland tumor benign called what
Pleomorphic adenoma (mixed tumor)
Pleomorphic adenoma (mixed tumor)
- Most common neoplasm
- Mesenchymal and epithelial component
- 10% recurrences
Warthin’s tumor (Papillary cystadenoma lymphomatosum)
- Occurs virtually only in the parotid gland
- Epithelium lining spaces and lymphoid tissue
- 10% recurrences
Salivary gland tumor malignant called what and affects what cells
Mucoepidermoid carcinoma
squamous and mucous cells
Reflux esophagitis
reflux of gastric juices-central to GERD (gastroesophageal reflux disorder) associated mucosal injury.
main symptom of reflux esophagitis and associated symptoms
Odynophagia=pain on swallowing.
dysphagia, heartburn, regurgitation gastric contents.
Barrett Esophagus
intestinal metaplasia within the esophagus squamous mucosa. Complication of GERD and note increased risk of adenocarcinoma.
diagnosis features of barrettes esophagus
1) extension abnormal mucosa above gastro-esophageal junction, 2) demonstration of squamous metaplasia (intestinal metaplasia).
esophagus benign lesions
- leiomyomas (tumors of smooth muscle),
2. Squamous papillomas, lipomas (tumor of fat)
esophagus malignant lesions
- Esophageal adenocarcinoma
2. Squamous cell carcinoma
Esophageal adenocarcinoma more in males or females
males
Esophageal adenocarcinoma associated with what
GERD
Esophageal adenocarcinoma usually develops where
distal 1/3
in advanced forms of Esophageal adenocarcinoma is there good or poor prognosis
very poor
Squamous cell carcinoma more in males of females, at what age
male >45 years old
risk factors of Squamous cell carcinoma
Risk factors: EtOH, tobacco use, very hot beverages, caustic esophageal injury.
Squamous cell carcinoma usually develops where
middle 1/3
Squamous cell carcinoma presents as…
polypoid, fungating mass, poor prognosis.
most common esophagus malignancy worldwide is what
squamous cell carcinoma
Stomach-reactive lesions
- Acute gastritis
- Chronic gastritis
- Approximately 75% of gastric polyps are inflammatory or hyperplastic.
Acute gastritis characteristics
may range from asymptomatic to pain, nausea and vomiting. May develop erosion and/or hemorrhage.
Chronic gastritis caused by what
H. pylori in patients with H. pylori (spiral or curved bacilli) autoimmune-gastritis
chronic gastritis is usually contracted when?
childhood.
benign Stomach neoplasia
: hyperplastic, fundic gland polyps, adenomas & inflammatory polyps
Gastric adenomas are increased in who? and arise in a background of what?
Familial adenosis polyposis (FAP) patients and most frequently arise in a background of atrophy and intestinal metaplasia.
most common stomach tumor is
Gastric adenocarcinoma (90%)
decrased in gastric adenocarcinomas cuz of what
Overall marked decrease in U.S. due to reduced use of smoked and salt-cured meat.
Linitis plastica
“leather bottle appearance” markedly thickened stomach wall, very aggressive and deadly form of stomach cancer. Linitis plastica is a diffuse type of intestinal adenocarcinoma.
Risk factors for development of gastric adenocarcinomas:
- -Hereditary factors
- -Additional factors e.g. consumption of smoked and salt cured meat, GERD
- -Pernicious anemia (B12deficiency), atrophic gastritis (intestinal metaplasia)
- -A pre-existing adenomatous polyp
Small Intestine-reactive, non-neoplastic conditions
- Celiac disease
- Infectious enterocolitis
- viral gastroenteritis and parasitic enterocolitis.
- Inflammatory Bowel Disease
Celiac disease-
celiac sprue or gluten-sensitive enteropathy.
Infectious enterocolitis
Vibrio cholerae, Campylobacter jejuni-acute, self-limited colitis “traveler’s diarrhea”.
Inflammatory Bowel Disease
arises from inappropriate mucosal immune activation.
Inflammatory Bowel Disease includes ____ and _____
- Ulcerative colitis
2. Crohn disease
Ulcerative colitis. what is it? where? and what lining does it affect?
severe ulcerating inflammatory disease that is limited to the colon and rectum-extends only to mucosa and submucosa.
Crohn disease
enteritis-may involve any area of the GI tract-and is frequently transmural. “skip lesions”-note noncaseating granulomas.
Both UC and Crohn’s-are more frequent in…….
women, teens and early 20s for presentation.
UC and Crohns are both _____ not auto-immune. what is the most probable cause
idiopathic-
Felt these 2 diseases result from a combination of
1. deficits entailing host interactions and GI microflora,
2. intestinal epithelial dysfunction and
3. aberrant mucosal immune responses.
UC related to Crohn-but UC is limited to the _____ and always occurs in ______
colon-and UC always involved the rectum.
hybrid of the 2 diseases is called what
Indeterminant Colitis”
Tumors of the Small Intestine account for less than ____ % of all GI tumors
5%
benign tumors of small intestines
leiomyoma
malignant tumors of small intestines
Adenocarcinomas, carcinoid tumors (often associated with hormone production) and lymphoma.
Most common malignancy of the GI tract is what
Adenocarcinoma of the Colon
T/F Although the small intestine comprises 75% of the length of the GI tract, colon is site of many more tumors. Overall, the GI tract is an uncommon site for neoplasia.
TRUE
small intestines or colon has more tumors?
colon
what is second only to lung cancer deaths in the US
colorectal cancer
what is implicit is causing adenocarcinoma
Dietary factors are implicated- especially low intake of unabsorbable vegetable fiber and high intake of refined carbohydrates and fat.
Genetic component: increased incidence in FAP patients.
T/F Most cancers arise within pre-existing adenomas
TRUE
staging of colon cancer
T- depth of invasion
N- lymph nodal involvement
M- presence of metastasis
Depth of invasion T1-T4
T1= invasion of submucosa; T2= invasion of Muscularis propria; T3= invasion into subserosa or non peritonealized pericolonic fat; T4= invasion of contiguous structures
Familial Adenomatous Polyposis.
Adenomas throughout colorectum
what is Most common polyposis syndrome of the gastrointestinal tract
Familial Adenomatous Polyposis.
if you have Familial Adenomatous Polyposis what are you almost certainly going to develop
colon cancer
FAP + Extraintestinal lesions =
Gardner’s syndrome.
Oral manifestions of Gardner syndrome
Unerupted teeth, supernumerary teeth, dentigerous and mandibular cysts, increased risk for odontomas. Also develop benign skin lesions.
you need what to diagnose FAP
Require > or equal to 100 polyps
Second most common polyposis syndrome
Peutz Jegher Syndrome
Peutz Jegher Syndrome
- Gastrointestinal hamartomatous polyps and pigmented macules of mucous membranes and skin.
- Melanin deposits around nose, lips, buccal mucosa, hands and feet, genitalia and perianal region.
Crohn’s Disease Clinical manifestations
a. Chronic intermittent diarrhea +/- blood, colicky abdominal pain
b. Presents in young adulthood
Pathology of Crohns
a. Segmental transmural inflammation of bowel, particularly ileum
b. Frequently spares the rectum
c. Ulcerations, granulomas, thickened bowel wall with fat wrapping, fissure and fistula formation
Crohn’s disease - Oral manifestations:
Multifocal, linear, nodular, polypoid or diffuse mucosal thickening with predilection for labial and buccal mucosa and mucosal folds –Can be confused with aphthous ulcers.
Subepithelial, noncaseating granulomatous inflammation identical to those seen in the bowel. Infections (fungal, TB) should be ruled out.
Ulcerative Colitis clinical
Diarrhea, tenesmus, colicky lower abdominal pain
risk for development of carcinoma
Pathology Ulcerative Colitis
- Begins in rectosigmoid area and extends proximally. Not transmural
- Continuous (diffuse) involvement, not patchy
- Small to large ulcerations, crypt abscessesGreater risk of dysplasia and adenocarcinoma
- Association with primary sclerosing cholangitis (PSC)
Ulcerative colitis - Oral manifestations:
- Scattered, clumped or linearly oriented pustules on an erythematous mucosa at multiple oral sites with variable severity. 10% of patients develop arthritis of temporo-mandibular joints.
- Lesions mimic the crypt abscesses of colonic lesions with no evidence of granulomas. Rule out candidiasis, benign migratory glossitis, and pemphigus vegetans.
severe ulcerating inflammatory disease that is limited to the colon and rectum-extends only to mucosa and submucosa. ….Ulcerative colitis or Crohns
Ulcerative colitis
regional enteritis-may involve any area of the GI tract-and is frequently transmural. “skip lesions”-note noncaseating granulomas….ulcerative colitis or Crohns
Crohns
Both UC and Crohn’s are more frequent in who
are more frequent in women, teens and early 20s for presentation.
