GI - Pathology (Salivary glands & Esophagus)

Question 1

Are salivary gland tumors generally benign or malignant? Where do they generally occur?

Answer 1

Generally benign and occur in parotid gland

Question 2

What are 3 major types of salivary gland tumors?

Answer 2

(1) Pleomorphic adenoma (2) Warthrin tumor (3) Mucoepidermoid carcinoma

Question 3

What is the most common salivary gland tumor? What is another name for it?

Answer 3

Pleomorphic adeonoma (benign mixed tumor)

Question 4

What is pleomorphic adenoma, and how does it present?

Answer 4

Benign mixed tumor (of salivary gland); Presents as a painless, mobile mass

Question 5

Of what is pleomorphic adenoma composed? Under what conditions does it recur?

Answer 5

It is composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively

Question 6

What is another name for Warthrin tumor?

Answer 6

Warthrin tumor (papillary cystadenoma lymphomatosum)

Question 7

What kind of tumor is warthrin tumor, and what key histologic finding does it have?

Answer 7

Warthrin tumor (papillary cystadenoma lymphomatosum) is a benign cystic tumor with germinal centers

Question 8

What is the most common (salivary gland) malignant tumor? What kind of components does it have?

Answer 8

Mucoepidermoid carcinoma is the most common malignant tumor and has mucinous and squamous components.

Question 9

How does Mucoepidermoid carcinoma typically present?

Answer 9

Typically presents as a painless, slow-growing mass

Question 10

What is Achalasia, and what causes it?

Answer 10

Failure of relaxation of LES due to loss of myenteric (Auerbach) plexus; A-chalasia = absence of relaxation

Question 11

What is the major symptom of Achalasia, and why? How does this differ from esophageal obstruction?

Answer 11

High LES opening pressure and uncoordinated peristalsis => progressive dysphagia to solids and liquids (vs. obstruction - solids only)

Question 12

What does a barium swallow show in patients with achalasia?

Answer 12

Barium swallow shows dilated esophagus with an area of distal stenosis; “Bird’s beak” on barium swallow

Question 13

With what increased risk is achalasia associated?

Answer 13

Associated with an increased risk of esophageal squamous cell carcinoma

Question 14

From what condition may secondary achalasia arise?

Answer 14

Secondary achalasia may arise from Chagas disease

Question 15

What characterizes Boerhaave syndrome, and what causes it? What is the clinical approach towards it?

Answer 15

Transmural, usually distal esophageal rupture due to violent retching; Surgical emergency

Question 16

What is eosinophilic esophagitis? What are 3 of its associated symptoms, and what causes this? How does it respond to GERD therapy?

Answer 16

Infiltration of eosinophils in the esophagus in atopic patients. Food allergens => dysphagia, heartburn, strictures. Unresponsive to GERD therapy.

Question 17

With what 2 conditions/causes are esophageal strictures associated?

Answer 17

Associated with lye ingestion and acid reflux

Question 18

What characterizes esophageal varices?

Answer 18

Painless bleeding of dilated submucosal veins in lower 1/3 of esophagus secondary to portal hypertension

Question 19

With what 3 conditions/causes is esophagitis associated?

Answer 19

Associated with reflux, infection in immunocompromised (Candida: white pseudomembrane; HSV-1: punched out ulcers; CMV: linear ulcers), or chemical ingestion

Question 20

What patient population do infections leading to esophagitis target? What are 3 pathogens that cause esophagitis, and how does each appear?

Answer 20

Infection in immunocompromised (Candida: white pseudomembrane; HSV-1: punched out ulcers; CMV: linear ulcers)

Question 21

How does gastroesophageal reflux disease commonly present? What are 3 other symptoms with which is may also present? What physical/structural change occurs to esophagus?

Answer 21

Commonly presents as heartburn and regurgitation upon lying down. May also present with nocturnal cough and dyspnea, adult-onset asthma. Decrease in LES tone.

Question 22

What defines Mallory-Weiss syndrome? To what can it lead? In what 2 patient populations is it usually found?

Answer 22

Mucosal lacerations at the gastroesophageal junction due to severe vomiting. Leads to hematemesis. Usually found in alcoholics and bulimics.

Question 23

What triad characterizes Plummer-Vinson syndrome?

Answer 23

Triad of Dysphagia (due to esophageal webs), Iron deficiency anemia, and Glossitis; Think: “Plumbers DIG”

Question 24

What is the pathophysiology of sclerodermal esophagal dysmotility, and what symptoms/conditions can it cause? Of what larger syndrome is it a part?

Answer 24

Esophageal smooth muscle atrophy => decreased LES pressure and dysmotility => acid reflux and dysphagia => stricture, Barrett esophagus, and aspiration. Part of CREST syndrome.

Question 25

What defines Barrett esophagus? What causes it?

Answer 25

Glandular metaplasia - replacement of nonkeratinized (stratified) squamous epithelium with intestinal epithelium (nonciliated columnar with goblets cells) in the distal esophagus. Due to chronic acid reflux (GERD).

Question 26

What are 3 conditions/risks associated with Barrett esophagus?

Answer 26

Associated with esophagitis, esophageal ulcers, and increased risk of esophageal adenocarcinoma

Question 27

What are 2 types of esophageal cancer?

Answer 27

Can be squamous cell carcinoma or adenocarcinoma

Question 28

What are 2 signs/symptoms with which esophageal cancer typically presents? What is the prognosis like?

Answer 28

Typically presents with progressive dysphagia (first solids, then liquids) and weight loss; poor prognosis.

Question 29

What are 10 risk factors for esophageal cancers? If applicable, give the specific kind of esophageal cancer to which a risk factor applies.

Answer 29

(1) Achalasia (2) Alcohol - squamous (3) Barrett esophagus - adeno (4) Cigarettes - both (5) Diverticula (e.g., Zenker) - squamous (6) Esophageal web - squamous (7) Familial (8) Fat (obesity) - adeno (9) GERD - adeno (10) Hot liquids - squamous; Think: “AABCDEFFGH”

Question 30

What kind of esophageal is more common worldwide versus in the US?

Answer 30

Worldwide, squamous cell is more common; In the United Sates, adenocarcinoma is more common

Question 31

Where in the esophagus does squamous cell carcinoma versus adenocarcinoma affect?

Answer 31

Squamous cell - upper 2/3; Adenocarcinoma - lower 1/3