GI tumours of the Lower Tract Flashcards
What percentage of GI tumours are present in the small intestine?
3 - 6%
What percentage of SI benign tumours are adenomas?
25%
What are the different types of SI benign mesenchymal tumours?
- Leiomyoma
- Lipoma
- Angioma
What are the different types of malignant SI tumours?
- Adenocarcinoma and carcinoid
- Lymphoma and sarcoma
What are the different types of benign colon and rectum tumours?
- Non-neoplastic polyps
- Neoplastic - Adenoma
What are the different types of malignant colon and rectum tumours?
- Adenocarcinoma (98%)
- Carcinoid
- Anal zone carcinoma
- Lymphoma
- Leiomyosarcomas
Who are likely to be affected by SI benign adenomas?
30 - 60 year old patients with occult blood loss
What is usually affected by SI benign tumours?
Ampulla of Vater (becomes enlarged and exhibits a velvety surface)
What can a SI adenoma become?
Has malignant potential to become an adenocarcinoma
Where do small intestine adenocarcinomas occur?
Duodenum
What age are patients usually affected by adenocarcinomas of the SI?
40 - 70 years old
What is the appearence of Adenocarcinomas of the SI?
- Napkin-ring encircling pattern
- Polypoid exophytic masses
What happen can happen as a result of SI adenocarcinomas?
- Intestinal obstruction
- Cramping pain, nausea, vomitting, weight loss
- may cause obstructive jaundice
What is the 5 year survival rate of SI adenocarcinomas?
70%
What can non-neoplastic polyps be divided into in the colon and rectum?
- Hyperplastic (90%)
- Hamartomatous
What can neoplastic ‘adenomas’ be divided into in the colon and rectum?
- Tubular
- Villous
- Tubulovillous
What age group are affected by hyperplastic polyps?
> 60
What is the appearence of hyperplastic polyps?
- <5mm
- Nipple-like, hemispheric, smooth, moist protrusions of the mucosa
Histologically: - Well-formed glands and crypts
- Lined by non-neoplastic epithelial cells
- Most of which show differentiation into mature goblet or absorptive cells
Do non-neoplastic polyps (hyperplastic or hamartomatous) have malignant potential?
No
Who are affected by Hamartomatous polyps?
Children < 5
Where are hamartous polyps found?
80% in the rectum
What are hamartomatous polyps?
- Beinign non-neoplastic tumours found mostly in rectum
- Malformations of the mucosal epithelium and lamina propria
Histologically: - Abundant cystically dilated glands
- Inflammation is common
- Surface may be congested or ulcerated
What are Peutz-Jeghers polyps caused by?
- Peutz-Jeghers autosomal dominant syndrome
- Mutation of the gene STK11 (LKB1) located on chromosome 19
Where is affected by Peutz-Jeghers hamartomatous polyps?
- Stomach 25%
- Colon 30%
- Small bowel
Involve the mucosal epithelium, lamina propria, and muscularis mucosa (tend to be large and pedunculated)
What peutz-jeghers syndrome increase the risk of?
- Pancreas
- Breast
- Lung
- Ovary
- Uterus carcinoma
Polpyps themselves are hamartomatous and do not have malignant potential
What can neoplastic polyps - adenomas appear like?
- Small, pedunculated lesions to large neoplasms that are usually sessile
Who are affected by neoplastic polyps - adenomas?
- 20 - 30% before 40
- Rising to 40 - 50% after age 60
- Equal male to female ratio
What do neoplastic polyps - adenomas arise as a result of?
Epithelial prolifrative dysplasia
What can neoplastic polyps - adenomas be classified as?
- Tubular adenomas (most common 75%)
- Vilous adenomas (1-10%)
- Tubulovillous adenoma (5-15%)
What are neoplastic adenomas a precursor lesion for?
Invasive colorectal adenocarcinomas
What is the risk of adenocarcinomas associated with in relation to adenomas?
Polyp size
- High risk (40%) in sessile villous adenomas > 4 cm
Histological architecture
Severity of epithelial dysplasia
- Severe dysplasia, when prsent, is often found in villous areas
IMPOSSIBLE FROM GROSS INSPECTION OF A POLYP TO DETERMINE ITS CLINICAL SIGNIFICANCE
What percentage of tubular adenomas are present in the colon?
90% also present in stomach and SI
How big are tubular adenomas?
Usually < 2.5 cm
What do tubular adenomas usually appear like?
- Small tubular adenomas are smooth-contoured and sessile
- Larger ones tend to be coarsely lobulated and have slender stalks raspberry - like