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S2B1: Pathology > GI Pathology: Stomach > Flashcards

GI Pathology: Stomach Flashcards

1
Q

What is shown in the provided image?

A

normal gastric mucosa

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2
Q

What is the names of these types of mucosa?

Where are these types of mucosa found in the stomach?

A
  • Oxyntic types mucosa
    • body and fundus
      • Parietal cells
        • HCl
        • intrinsic factor
      • Chief cells
        • pepsinogen
        • lipase
    • neutralize acid
  • Antral type mucosa
    • antrum
    • gastrin secreting cells
    • bicarb to neutralize acid
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3
Q

What is shown in the provided image?

A

congenital diaphragmatic hernia

  • small intestien has herniated into right thoracic cavity with partial collapse of right lung and deviation of trachea to the left
  • acquired forms in adults
    • abdominal trauma
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4
Q

What is the difference between omphalocele and gastroschisis?

Causes?

A
  • Herniation of abdominal contents through an abdominal wall defect
  • Omphalocele
    • defect of abdominal wall (abdominla contents get soved into umbilical chord)
      • herniation of viscera into base of umbilical cord
      • viscera covered by membranous sac of amnion, Wharton jelly, and peritoneum
      • due to incomplete closure of abdominal musculature
    • Cause:
      • Beckwith-Wiedemann syndrome and other developmental abnormalities
      • maternal smoking
  • Gastroschisis
    • defect of abdominal wall
      • no involvement of umbilical cord
      • herniation of viscera with no surrounding membranous sac
    • Causes
      • possibly due to vascular injury to abdominla wall
      • less association with other developmental abnormalities
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5
Q

What is congeintal hypertrophic pyloric stenosis?

Symptoms?

Causes?

A
  • Pyloric stenosis (anatomic cause of obstruction)
  • Symptoms
    • 3-5:1 M/F
    • Presents in first 3-12 weeks of life
      • new onset regurgitation
      • persistent, projectile, nonbilious vomiting
    • Firm, ovoid abdominal mass
  • Causes (can occur on its own)
    • Turner Syndrome, Trisomy 18
    • Erythro/Azithrmycen from mom
    • Acquired form in adults usually is due to tumors or scarring
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6
Q

What is shown in the provided images?

A

Pyloric Stenosis

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7
Q

What are the intrinsic and extrinsic mechanism of gastric injury and protection. Continual injury will eventually lead to what problem?

A

gastritis – sever injury is ulcer

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8
Q

What is shown in the provided image?

A

Acute hemorrhage gastritis

pinpoint superficial erosion (can’t tell what caused it)

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9
Q

What is shown in the provided image?

A

Acute gastritis

PMNs on surface

Diffuse mucosal erosion

Residual glands are seen at the base of the mucosa (white open arrow)

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10
Q

What types of ulcers can develop under conditions of severe physiologic stress?

A
  • All the little black dot are full thickness mucosal defects; usually found at autopsy
  • Cushing Ulcer- head trauma (vagal stiumlation)
  • Curling Ulcer - (stress related to splanchnic vasoconstriction)
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11
Q

What is the most common cause of chronic gastriris?

A
  • H. Pylori
    • spiral or curved bacilli
    • fecal-oral transmission
    • virulence:
      • flagella, urease, adhesins, CagA
    • predominantly anral, but can progress to cause patchy proximal disease with oxyntic atrophy
    • initially results in increased acid production (risk of ulcers), but with body/fundus involvement, decreased acid production, and IM (risk gastric carcinoma)
      • CagA expressing strains increase risk of proximal migration and cancer development
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12
Q

What is shown in the provided image?

A
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13
Q

What is shown in the provided image?

A

Chronic gastritis is too many plasma cells in the lamina propria

In H. pylori, there is a tendency for that infiltrate to be more superficial

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14
Q

What is shown in the provided image?

A

PMN infiltration of epithelium and gastric glands

acute inflammation on top of chronic gastritis

more common with H. pylori

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15
Q

What is shown in the provided images?

A
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16
Q

What diseases are associated with H. pylori?

A
  • Chronic (active) gastritis
  • Peptic ulcer disease
  • Antrophic gastritis (preneoplastic)
    • intestinal metaplasia
    • glandular dysplasia
  • Gastric adenocarcinoma
  • Gastric mucosa-associated lymphoid tissue (MALT) lymphoma
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17
Q

Describe the endoscopic appearance of peptic ulcer disease?

Major causes?

A
  • sharply defined ulcer with gray fibrinopurulent exudate and a surrounding rim of fibrous tissue (black curved arrow). Slight erythema (white curved arrow) is seen in the surrounding mucosa
  • Cause
    • H. pylori
    • NSAIDs
  • Because H. pylori infection initially increases acid production, you can get ulcers in the duodenum
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18
Q

What is shown in the provided image?

A

notice the abrupt loss of gastric mucosa

19
Q

What is the difference between the two endoscopies?

A
20
Q

What is the difference between the to images of autoimmune gastritis?

A

In the severe autoimmune gastritis, there is a bunch of space between glands and there are very few glands

additional goblet cells

21
Q

you What are the indicated signs of autoimmune gastritis with atrophy?

A

you usualy don’t have an active phase with PMNs like in helicobacter

22
Q

What freatures of autoimmune gastritis with atrophy are shown in the provided images?

A
23
Q

Table

A
24
Q

What is reactive/chemical gastropathy?

A
  • Foveolar hyperplasia with mucin depletion and serrated gastric pits
  • mucosal edema with dilated capillaries
  • Splaying of muscularis mucos (not shown)
  • NSAIDS an EtOH common causes
25
Q

What are hypertrophic gstropathies?

A
  • Giant rugal folds (“cerebriform”)
  • uncommon
  • linked ot excessive growth factor release
    • Menetrier disease (TGF-alpha)
    • Zollinger-Ellison Syndrome (Gastrin)
26
Q

What condition is shown in the provided image?

A
27
Q

What is the name of the syndrome that produces gastrin-secreting tumors (gastrinomas) of the small intestine or pancreas?

Associated symptoms?

A

Zollinger-Ellision Syndrome

  • gastrinomas asre malignant, but slow-growing
  • 25% of patients have MEN I
    • duodenal ulces and/or chronic diarrhea
28
Q

What is shown in the provided images?

A
29
Q

What is shown in the provided images?

A
30
Q

Describe the provided image

A

Fundic Gland Polyp

bic cystically liked clanned (chief and parietal cells)

31
Q

What is shown in the provided image?

A

Gastric hyperplastic polyp

lining of glands is mucin type cells

typically see in backdrop of chronic gastritis

32
Q

What is shown in the provided image?

A

Gastric Adenoma

33
Q

What are the major gastric malignancy types?

A
  • Adenocarcinoma >90%
    • intestinal type
    • diffuse type
  • Also
    • lymphoma ~5%
    • Neuroendocrine (carcinoid) tumor ~3%
    • gastrointestinal stromal tumor (GIST) ~2%
34
Q
  • Symptoms of gastric adenocarcinoma?
  • prognosis?
  • Where are incidence most common?
A
  • Symptoms
    • often mimic chronic gastriris and PUD
    • often not discovered unil advanced
      • weight loss
      • anorexia
      • early satiety
      • bleeding
      • mets
  • Prognosis
    • early gastric ca: ~90% 5 year survival
    • Avoid gastric va: <20% 5 year survival
  • Incidence
    • very common in Japan
    • incidence is steadily falling in US since ’30s
      • intestinal adenocarcinoma is decreasing
  • Risk factors
    • dietary: nitrates & cmoked, salty, or pickled foods, lack of fresh fruits/vegetables
    • gastric atrophy and intestinal metaplasia
      • H. pylori
        • produce urease
        • gastritis –> mucosal atrophy –>intestinal metaplasia –> dysplasia
      • autoimmune gastritis
      • FAP (germline APC mutations)
35
Q

What is shown in the provided image?

A

Sharing gland walls & invading into muscle

36
Q

Important features of gastric adenocarcinoma, diffuse type

A
  • ~50% us gastric adenocarcinomas
  • world-wide incidence stable and uniform across countries
  • environmental/dietary risk factors not well established
    • relationship to H. Pylori not well established
  • Familial gastric cancer is strongly associated with this type of carcinoma
  • Mutations in CDH1(encodes E-cadherins- responsible for holding glands together) or silencing (methylation) of the CDH1 promoter present in almost all cases (familial or sporadic)
37
Q

What is shown in the provided photo?

A

Linitis plastica = leather bottle

spread diffulsely & make whole stomach wall hard

38
Q

What is shown in the provided image?

A

not making good glands b/c E-cadherin expression is inappropriate

39
Q

What is a MALT lympona?

Describe the pathogenesis.

A
  • B-Cell lymphoma
  • most common type to occur in stomach (DLBL also occur)
  • Pathogenesis
    • Tend to arise at sites of chronic inflammation
      • gastric MALTs often coexist with H. pylori gastritis
      • symptoms similar to H. pylori gastritis
      • H. pylori infection induces a polyclonal lymphoid inflammatory response
      • Monoclonal B cell clone emerges, still dependent on antigen-stimulated T helper cells for growth
        • at this stage, antibiotic prescription for H. pyori leads to tumor regression
      • with time, tumor may acquire 1 of 3 known chromoslmal translocations. At this point, elimination of H. pylori wiht antiotic is inneffective.
        • *t(11;18)/API2-MALT1 fusion protein
          • Fusion of apoptosis inhibitor gene with MLT gene
          • May be ptorective against high grade transformation
        • T(14;18)
          • increased expression of MALT1 protein
        • T(1;14)
          • increased expression of BCL-10
40
Q

Describe the provided image

A

glands are gone

lymphomas in general are cohesive cells

tumors of hematopietic cells tend not to stick together

41
Q

Features of Gastrointestinal Stromal Tumor?

Where do they arise?

Common features of the tumor?

A
  • most common primary non-epithelial neoplasm of the stomach
    • stomach the most common site for this rare mesenchmal tumor
  • aveage age at diagnosis is 60 (<40 is uncommon)
  • tumors arise from interstitial cells of Cajal
    • “pacemaker cells” in muscularis propria
      • control GI peristalsis
  • Varying micro patterns:spindled/epithelioid
  • ~95% have one of two mutually exclusive Tyrosine kinase receptor family mutations
    • marjority oncogenic gain-of-function mutations of gene encoding tyrosine kinase, c-KIT, the receptor for stem cell factor
    • minority, mutations in PDGFRA, however:
      • more common in the stomach than elsewhere
42
Q

What is the Carney’s triad?

Other associations with gastrointestinal stromal tumors?

treatments?

Prognosis?

A
  • Carney’s triad- YOUNG females
    • gastric GIST
    • extra-adrenal paraganglioma
  • also seen in association with
    • NF1, with paragangliomas, familial syndrome with germline KIT mutations
  • Treatment
    • primary - complete surgical resection
    • In patients with unresectable or metastatic disease, effective therapy for tumors with KIT/PDGFRA mutations
      • tyrosine kinase inhibitor imatinib mesylate (Gleevec)
  • Prognosis linked to tumor size/mitotic rate/location
    • stomach generally behave better than elsewhere
    • mets can occur 30 years after removal of the primary tumor
      • liver, lung, peritoneum
43
Q

What is shown in the provided images?

A

Gastrointestinal Stromal Tumor

S2B1: Pathology (9 decks)

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