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MD3002 - GI Disease/Pathology > GI Tumours (upper tract) > Flashcards

GI Tumours (upper tract) Flashcards

1
Q

What are the main types of benign oesophgeal tumour?

A
  • Mesenchymal tumours
  • Squamous papillomas
  • Leiomyomas
  • Fibromas
  • Lipomas
  • Haemangiomas
  • Neuorfibromas
  • Lymphangiomas
  • Mucosal polys
  • Squamous papillomas
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2
Q

What are the main types of malignant oesophgeal tumours?

A
  • Squamous cell carcinoma
  • Adenocarcinoma
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3
Q

What are the rare types of maligant oesophgeal tumours?

A
  • Carcinoid tumour
  • Malignant melanoma
  • Lymphoma
  • Sarcoma
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4
Q

What are the main types of benign tumour of the stomach?

A
  • Polyps
    • Non-neoplastic
    • Adenomas
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5
Q

What are the main types of malignant tumours of the stomach?

A
  • Carcinoma
  • Lymphoma
  • Carcinoid
  • Mesenchymal
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6
Q

What is the incidence of squamous cell carcinoma of the oeosphagus?

A
  • > age 50
  • 5 per 100,000 population in males and 1 per 100,000 in females (average in Europe)
  • Male = 2:1
  • Female = 20:1
  • Geographical variation
  • Iran, Central China, South Africa and Southern Brazil
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7
Q

What are the main factors assoicated with SSC of the oesophagus?

A
  • Dietary
    • Deficiency of vitamins (A, C, thiamine, pyridoxine)
    • Fungal contamination of food stuffs
    • High content of nitrites/nitrosamines
  • Lifestyle
    • Burning-hot beverages or food
  • Alcohol and tobacco
  • Oesophageal Disorders
    • Long-standing oesophagitis and achalasia
  • Genetic predisposition
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8
Q

What is the likelihood of SSC occuting in each third of the oesophagus?

A
  • 20% in the upper third
  • 50% in the middle third
  • 30% in the lower third of oesophagus
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9
Q

What is the gross morphology of SCC of the oesophagus?

A

Small, grey-white, plaque-like thickenings that become tumorous masses

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10
Q

What are the 3 main patterns of morphology of SCC of the oesophagus?

A
  • Protruded polypoid exophytic (60%)
  • Flat, diffuse, infiltrative
  • Excavated, ulcerated
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11
Q

Describe the histology of SCC

A
  • The squamous epithelium
  • Pleiomorphism
  • Hyperchromatism
  • Miotic figures
  • The degree of atypia:
    • Low grade dysplasia
    • High grade dysplasia
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12
Q

Describe the clinical features of SCC of the oesophagus

A
  • Dysphagia
  • Extreme weight loss (cachexia)
  • Haemorrhage and sepsis
  • Cancerous tracheoesophageal fistula
  • Metastases (lymph nodes):
    • Cervical
    • Mediastinal
    • Paratracheal
    • Tracheobronchial
    • Gastric and celiac
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13
Q

What is the prognosis of oesophageal SCC?

A

5% overall five-year survival

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14
Q

What part of the oesophagus does adenocarcinoma affect?

A

The lower third of the oesophagus

originates from the glandular tissue

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15
Q

What does adenocarcinoma of the oesophagus arise from?

A
  • Arise from Barrett Mucosa (10%)
    • Intestinal metaplasia caused by gastric reflux
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16
Q

What is the average age of onset of oesophgeal adenocarcinoma?

A

Age 40, with a median age of 60

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17
Q

What are two main causative factors assoicated with adenocarcinoma?

A

tobacco and obesity

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18
Q

Describe the morphology of oesophgeal adenocarcinoma

A
  • Flat or raised patched or nodular masses
  • May be infiltrative or deeply ulcerative
  • Histology:
    • Mucin-producing glandular tumours
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19
Q

Describe the T of TNM staging

A

T is carcinoma in situ

T1 = invasion of submucosa

T2 = invasion of muscularis propria

T3 = invasion of adventitia

T4 = invasion of adjacent structures

20
Q

Describe the N of TNM staging

A

N0 = no node spread

N1 = regional node metastases

21
Q

Describe the M of TNM staging

A

M0 = No distant metastases

M1 = Distant metastases

22
Q

What are the main clinical features of oesophgeal adenocarcinoma?

A
  • Dysphagia
  • Progressive weight loss
  • Bleeding
  • Chest pain
  • Vomiting
  • Heartburn
  • Regurgitation
  • Prognosis: 20% overall five-year survival
23
Q

What is a polyp?

A

Nodule or mass that projects above the level of the surrounding mucosa, usually in the antrum

24
Q

Describe non-neoplastic polyps

A
  • Most are small and sessile (without a stalk)
  • Hyperplastic surface epithelium
  • Cystically dilated glandular tissue

90% of polyps

25
Q

Describe neoplastic polyps

A

Contains proliferative dysplastic epithelium

Malignant potential

Sessile (without stalk) or pedunculated (stalked)

26
Q

What are the three main types of polyp found in the stomach?

A
  • non-neoplastic
  • neoplastic - adenomas
  • Leiomyomas and Schwannomas
27
Q

What contributes 90-95% of malignant tumours of the stomach

A

gastric carcinoma

28
Q

What are the environmental factors assoicated with gastric carcinoma?

A
  • Infection by H.pylori
  • Diet
  • Low socioeconomic status
  • Cigarette smoking
29
Q

What are the host factors assoicated with gastric carcinoma?

A
  • Chronic gastritis
  • Gastric adenomas
  • Barrett Oesophagus
30
Q

What are the genetic factors assoicated with gastric carcinoma?

A
  • Slightly increased risk with blood group A
  • Family History
  • Hereditary nonpolyposis colon cancer syndrome
  • Familial gastric carcinoma
31
Q

What is the morphology of the location of gastric carcinoma?

A
  • Pylorus and antrum; 50% to 60%
  • Cardia; 25%
  • With the remainder in the body and fundus
    • The lesser curvature is involved in about 40% and the greater curvature in 12%
32
Q

What are gastric carcinomas classified by?

A
  1. Depth of invasion
    1. Early and advanced
  2. Macroscopic growth pattern
  3. Histological subtype
33
Q

What are the three main types of macroscopic growth patterns?

A

Exophytic - into lumen

Flat or depressed

Excavated - into mucosa

34
Q

What is Linitis plastica “(leather bottle)”?

A
  • Diffuse infiltrative gastric carcinoma
  • Mucosal erosion
  • Markedly thickened gastric wall
35
Q

What are the three types of histopathology of adenicarcinoma (Lauren Classification)

A
  • Intestinal type
  • Diffuse type mixed type
36
Q

Describe the intestinal type of adenocarcinoma

A
  • Composed of neoplastic intestinal glands resembling those of colonic adenocarcinoma
  • Cells often contain apical mucin vacuoles and abundant mucin may be present in gland lumens
37
Q

Describe the difuse type of adenocarcinoma

A
  • Composed of gastric-type mucous cells, which generally do not form glands, but rather permeate the mucosa and wall as scattered individual cells or small clusters in an “infiltrative” growth oattern
  • Mucin formation expands the malignant cells and pushes the nucleus to the periphery, creating a ‘signet ring’
38
Q
A
39
Q
A
40
Q

What is the expected spread of gastric carcinoma?

A
  • All gastric carcinomas eventually penetrate the wall and spread to regional and more distant lymph nodes
    • Supraclavicular (Virchow) node
    • Local invasion of gastric carcinoma into the duodenum, pancreas and retroperitoneum
    • Metastases to the liver and lungs are common
    • Metastases to the ovaries called Krukenburg Tumour
41
Q

What are the clinical features of gastric carcinoma?

A
  • Asymptomatic until late
  • Weight loss
  • Abdominal pain
  • Anorexia
  • Vomiting
  • Altered bowel habits
  • Dysphagia
  • Anaemic symptoms
  • Haemorrhage
42
Q

What is the prognosis of gastric carcinoma?

A
  • PROGNOSIS five-year survival:
    • Early gastric cancer is 90%-95%
    • Advanced gastric cancer < 15%
43
Q

What is gastric lymphoma?

A
  • 5% of all gastric malignancies
  • B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphomas)
  • >80% are associated with chronic gastritis and H. pylori infection
  • Prognosis: 50% five-year survival
44
Q

What is the morphology of gastric lymphoma?

A
  • Commonly occurs in the mucosa or superficial submucosa
  • Lymphocytic infiltrate of the lamina propria surrounds gastric glands massively infiltrated with atypical lymphocytes and undergoing destruction
  • The “lymphoid epithelioid” lesion
45
Q
A

MD3002 - GI Disease/Pathology (11 decks)

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