GI - Pathology (Salivary glands & Esophagus) Flashcards
Pg. 349-351 in First Aid 2014 Sections include: -Salivary gland tumors -Achalasia -Esophageal pathologies -Barrett esophagus -Esophageal cancer
Are salivary gland tumors generally benign or malignant? Where do they generally occur?
Generally benign and occur in parotid gland
What are 3 major types of salivary gland tumors?
(1) Pleomorphic adenoma (2) Warthrin tumor (3) Mucoepidermoid carcinoma
What is the most common salivary gland tumor? What is another name for it?
Pleomorphic adeonoma (benign mixed tumor)
What is pleomorphic adenoma, and how does it present?
Benign mixed tumor (of salivary gland); Presents as a painless, mobile mass
Of what is pleomorphic adenoma composed? Under what conditions does it recur?
It is composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively
What is another name for Warthrin tumor?
Warthrin tumor (papillary cystadenoma lymphomatosum)
What kind of tumor is warthrin tumor, and what key histologic finding does it have?
Warthrin tumor (papillary cystadenoma lymphomatosum) is a benign cystic tumor with germinal centers
What is the most common (salivary gland) malignant tumor? What kind of components does it have?
Mucoepidermoid carcinoma is the most common malignant tumor and has mucinous and squamous components.
How does Mucoepidermoid carcinoma typically present?
Typically presents as a painless, slow-growing mass
What is Achalasia, and what causes it?
Failure of relaxation of LES due to loss of myenteric (Auerbach) plexus; A-chalasia = absence of relaxation
What is the major symptom of Achalasia, and why? How does this differ from esophageal obstruction?
High LES opening pressure and uncoordinated peristalsis => progressive dysphagia to solids and liquids (vs. obstruction - solids only)
What does a barium swallow show in patients with achalasia?
Barium swallow shows dilated esophagus with an area of distal stenosis; “Bird’s beak” on barium swallow
With what increased risk is achalasia associated?
Associated with an increased risk of esophageal squamous cell carcinoma
From what condition may secondary achalasia arise?
Secondary achalasia may arise from Chagas disease
What characterizes Boerhaave syndrome, and what causes it? What is the clinical approach towards it?
Transmural, usually distal esophageal rupture due to violent retching; Surgical emergency
What is eosinophilic esophagitis? What are 3 of its associated symptoms, and what causes this? How does it respond to GERD therapy?
Infiltration of eosinophils in the esophagus in atopic patients. Food allergens => dysphagia, heartburn, strictures. Unresponsive to GERD therapy.
With what 2 conditions/causes are esophageal strictures associated?
Associated with lye ingestion and acid reflux
What characterizes esophageal varices?
Painless bleeding of dilated submucosal veins in lower 1/3 of esophagus secondary to portal hypertension
With what 3 conditions/causes is esophagitis associated?
Associated with reflux, infection in immunocompromised (Candida: white pseudomembrane; HSV-1: punched out ulcers; CMV: linear ulcers), or chemical ingestion
What patient population do infections leading to esophagitis target? What are 3 pathogens that cause esophagitis, and how does each appear?
Infection in immunocompromised (Candida: white pseudomembrane; HSV-1: punched out ulcers; CMV: linear ulcers)
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?
Commonly presents as heartburn and regurgitation upon lying down. May also present with nocturnal cough and dyspnea, adult-onset asthma. Decrease in LES tone.
What defines Mallory-Weiss syndrome? To what can it lead? In what 2 patient populations is it usually found?
Mucosal lacerations at the gastroesophageal junction due to severe vomiting. Leads to hematemesis. Usually found in alcoholics and bulimics.
What triad characterizes Plummer-Vinson syndrome?
Triad of Dysphagia (due to esophageal webs), Iron deficiency anemia, and Glossitis; Think: “Plumbers DIG”
What is the pathophysiology of sclerodermal esophagal dysmotility, and what symptoms/conditions can it cause? Of what larger syndrome is it a part?
Esophageal smooth muscle atrophy => decreased LES pressure and dysmotility => acid reflux and dysphagia => stricture, Barrett esophagus, and aspiration. Part of CREST syndrome.
What defines Barrett esophagus? What causes it?
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).
What are 3 conditions/risks associated with Barrett esophagus?
Associated with esophagitis, esophageal ulcers, and increased risk of esophageal adenocarcinoma
What are 2 types of esophageal cancer?
Can be squamous cell carcinoma or adenocarcinoma
What are 2 signs/symptoms with which esophageal cancer typically presents? What is the prognosis like?
Typically presents with progressive dysphagia (first solids, then liquids) and weight loss; poor prognosis.
What are 10 risk factors for esophageal cancers? If applicable, give the specific kind of esophageal cancer to which a risk factor applies.
(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”
What kind of esophageal is more common worldwide versus in the US?
Worldwide, squamous cell is more common; In the United Sates, adenocarcinoma is more common
Where in the esophagus does squamous cell carcinoma versus adenocarcinoma affect?
Squamous cell - upper 2/3; Adenocarcinoma - lower 1/3
