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Pathology MD3002 > GI tumours upper tract > Flashcards

GI tumours upper tract Flashcards

1
Q

Benign oesophagus

A

5%
Mesenchymal tumours
squamous papillomas
(Leiomyomas, fibormas, lipomas, haemangiomas, neurofibromas, lymphangiomas, mucosal polyps)

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2
Q

Malignant tumours of the oesophagus:

A

Squamous cell carcinoma

Adenocarcinoma

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3
Q

Squamous cell carcinoma (90%)

A
  • Incidence: over 50 yo, 5 vs 1/100 000 male to female (Europe) (2:1 to 20:1), geographical variation (Iran, Central China, South Africa and Southern Brazil)
  • Dietary factors associated with SSC
    o Deficiency of vitamins A, C, riboflavin, thiamine, pyridoxine
    o Fungal contamination of foodstuffs
    o High content of nitrites/nitrosamines
  • Lifestyle factors: burning hot beverages and food; alcohol and tobacco
  • Oesophageal disorders associated: long-standing oesophagitis and Achalasia
  • Genetic predisposition
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4
Q

Morphology of SCC. Where is it? What does it look like?

A

20% upper third, 50% middle third, 30% lower third
Small, grey-white, plaque-like thickenings that become tumourous masses
Three patterns:
1. Protruded polypoid exophytic (60%)
2. Flat, diffuse, infiltrative (15%)
3. Excavated, ulcerated (25%)

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5
Q

histology of SCC

A

squamous epithelium, pleomorphism, hyperchromatism, mitotic figure, degree of atypia (low vs high grade of dysplasia

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6
Q

Clinical features of SCC (remember lymph nodes!)

A

sphagia

  • Extreme weight loss (cachexia)
  • Haemorrhage and sepsis
  • Cancerous tracheoesophageal fistula
  • Metastases (lymph nodes): cervical, mediastinal, paratracheal, tracheobronchial, gastric and celiac
  • Prognosis: 5% overall five-year survival
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7
Q

Adenocarcinoma

A
  • Lower thirds of oesophagus
  • Age 40, median age 60
  • Arises from Barrett mucosa (10%) – intestinal metaplasia caused by gastric reflux
  • Tobacco and obesity
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8
Q

Morphology of oesophageal adenocarcinoma, what does it look like?

A
  • Flat or raised patches or nodular masses

- Infiltrative or deeply ulcerative.

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9
Q

Histology of adenocarcinoma

A

mucin producing glandular tumours

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10
Q

Clinical features of adenocarcinoma:

A
  • Dysphagia
  • Progressive weight loss
  • Bleeding
  • Chest pain
  • Vomiting
  • Heart burn
  • Regurgitation
  • Prognosis: 20% over 5-year survival
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11
Q

Rare malignant oesophageal tumours

A

carcinoid tumour, malignant melanoma, lymphoma, sarcoma

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12
Q

Benign tumours of the stomach

A

Polyps: nodule or mass that projects above the level of the surrounding mucosa, usually in the antrum

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13
Q

Non-neoplastic polyps

A

(90%)
o Most small and sessile (without a stalk)
o Hyperplastic surface epithelium
o Cystically dilated glandular tissue

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14
Q

Neoplastic polyps

A

aka Adenomas (5-10%)
o Contain proliferative dysplastic epithelium
o Malignant potential
o Sessile (without stalk) or pedunculated (stalked)

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15
Q

Are there other common benign tumours of the stomach?

A

Leiomyomas and Schwannomas are rare

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16
Q

Malignant tumours of the stomach

A

Carcinoma
Lymphoma
Carcinoid
Mesenchymal

17
Q

Gastric carcinoma, prevalence

A
  • 90%-95% of malignant tumours of the stomach
  • FIfth most common tumour in the world
  • High in
    o Japan, Chile, Costa Rica, Colombia, China, Portugal, Russia, Bulgaria, Finland
    o Six-fold less common in USA, UK, Canada, Australia, New Zealand, France and Sweden
18
Q

Factors associated with gastric carcinoma

environmental, host, genetic

A 
-	Environmental
o	Infection by H. pylori
o	Diet
o	Low socioeconomic status
o	Cigarette smoking
-	Host
o	Chronic gastritis
o	Gastric adenomas
o	Barrett oesophagus
-	Genetic factors
o	Slightly increased risk with blood group A
o	Family history
o	Hereditary nonpolyposis colon cancer syndrome
o	Familial gastric carcinoma syndrome
19
Q

Morphology, location of gastric carcinoma

A
  • Pylorus and antrum 50-60%
  • Cardia 25%
  • The rest is body and fundus. Lesser curvature is involved in about 40% and the greater curvature in 12%
20
Q

Gastric carcinoma classified on the basis of:

A
  1. Depth/degree of invasion (early/advanced)
  2. Macroscopic growth pattern
    Exophytic
    Flat or depressed  Linitis plastic (leather bottle: diffuse infiltrative gastric carcin)
    Excavated
  3. Histological subtype
21
Q

Histopathology – adenocarcinoma, Lauren Classification: Intestinal type
What cells? Does it resemble other cells? What do the cells contain, where?

A

o neoplastic intestinal glands (resembling those of colonic adenocarcinoma)
o cells often contain apical mucin vacuoles
(therefore abundant mucin may be present in gland lumen)

22
Q

Histopathology – adenocarcinoma, Lauren Classification: Diffuse type
What cells? How do they lie? characteristic?

A

o gastric-type mucous cells (generally do not form glands)
these permeate the mucosa and wall
(as scattered individual cells or small clusters in an infiltrative growth patter)
o Mucin formation expands the malignant cells and pushes the nucleus to the periphery, creating a “signet ring”

23
Q

other in lauren classification

A

mixed type

24
Q

Morphology of gastric carcinoma – does it spread?

A

All gastric carcinomas eventually penetrate the wall and spread to regional and more distant lymph nodes

25
Q

sites of metastasis gastric carcinoma

A
  • Supraclavicular (Virchow) node
  • Local invasion of gastric carcinoma into the duodenum, pancreas, retroperitoneum
  • Metastases to liver and lungs common
  • Metastases to ovaries called Krukenberg tumour
26
Q

Clinical features gastric carcinoma

A
  • Asymptomatic until too late
  • Weight loss
  • Abdominal pain
  • Anorexia
  • Vomiting
  • Altered bowel habits
  • Dysphagia
  • Anaemic symptoms
  • Haemorrhage
27
Q

Prognosis of gastric carcinoma

A

five year survival

  • Early gastric cancer is 90-95%
  • Advanced gastric cancer is <15%
28
Q

Gastric lymphoma

A
  • 5% of all gastric malignancies
  • B-cell lymphomas of mucosa-associate lymphoid tissue (MALT lymphomas)
  • > 80% associated with chronic gastritis and H pylori infection
  • Prognosis: 50% five-year survival
29
Q

Morphology gastric lymphoma: where is it?

A

commonly occurs in mucosa or superficial submucosa.

30
Q

What do we mean by lymphoid epithelioid lesion

A

in gastric lymphoma: in lamina propria huge number of lymphocytes
Lymphocytic infiltrate of the lamina propria surrounds gastric glands (massively infiltrated with atypical lymphocytes and undergoing destruction)

Pathology MD3002 (3 decks)

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