GIT Path: Intestinal Tumors Flashcards
colon adenocarcinoma can systemically metastasize to _____, _____, _____ and _____
liver, peritoneum, lungs, and bones
the sporadic form of MSI cancers is associated with what mutation
methylation of MLH1 promoter
serrations intraluminally on histology is indicative of ______
sessile serrated adenoma/polyp
it has a “saw tooth” appearance
______ is a precursor lesion fo the MSI pathway colorectal cancer
sessile serrated adenoma
_________ pathway for developing colorectal cancer arise from the adenoma-carcinoma sequence
chromosomal instability pathway
adenomas are confined to the _______
lamina propria (INTACT MUSCULARIS PROPRIA)
describe the accumulation of mutations that can lead to adenomas in the colon (FAP)
- start with an APC gene mutation
- accumulation of β catenin mutation
- accumulate KRAS mutation
- later: p53, telomerase, etc
_____ grade neuroendocrine tumors are usually aggressive
high
what are two major pathways for developing colon cancer? what is the more common pathway?
- chromosomal instability pathway: APC gene mutations, FAP/Gardner/ Turcot’s
- MSI pathway: defect in DNA mismatch repair genes MLH1 MSH2, most of these are sporadic and the familial form in HNPCC
chromosomal instability pathway is more common
If an elderly man patient presents with iron deficiency anemia, what are you thinking?
Iron deficiency anemia in an elderly man is due to GI malignancy unless proven otherwise
neuroendocrine tumors can occur in the stomach in what 3 settings?
- type I: autoimmune gastritis
- type II: Gastrinoma (rillinger Ellison) in which there is ↑ gastrin secretion
- Type III: sporadic (more aggressive)
PJ polyps (Peutz Jegher) have a germline mutation and are at risk for developing cancers of ______, ____, ___, ___, and ____
pancreas, breast, lung, ovary and uterus
histologic patterns that indicate low grade dysplasia as that seen in adenomas
- enlargement of nuclei
- stratification of basal layer
- loss of mucin / goblet cells
patients with celiac disease are at risk for what of tumors?
- T cell lymphoma (enteropathy associated including ulcerative jejunitis)
CEA is used to monitor ______ carcinoma
colorectal carcinoma
the tumor marker for colorectal cancers is ______
CEA
what are some features of adenoma with high grade dysplasia
- cribiform glands (fusion of crypts)
- dyspolarity of nuclei
(all of this occurs in the lamina propria)
FAP (familial adenomatous polyposis) has associated with a genetic defect in __________
APC gene (5q21)
the most common site of primary GI lymphomas is the ____
stomach
what are the 3 types of adenomas associated with adenomas and which one has the highest risk to undergo malignant transformation
3 types: tubular, villous, and tubulovillous
villous type has ↑ chance for malignancy
what syndromes are associated with FAP (tubular adenomas)
- gardner syndrome: FAP (tubular adenomas) + osteomas, desmoid tumors and epidermal cysts
- Turcot syndrome: tubular adenomas with malignant CNS gliomas (TURcot = TURban)
what is the treatment regimen for gastric lymphomas (MALToma)
- eradication of H. pylori with antibiotics
- 90% remission
- high stage and unresponsive cases treated with chemotherapy: ritixumab + chemo
how can you tell the difference between juvenile polyp and PJ polyp
- juvenile has cystically dilated crypts
- the crypt in PJ is tightly packed, irregular and has little space for inflammatory infiltrates
- PJ has arborizing SM bundles
describe the number and type of adenomas seen in FAP
100+ tubular adenomas and must do a prophylactic total colectomy due to high risk of colorectal cancer
what are risk factors for colorectal carcinomas?
- obesity, decreased physical activity
- diet LOW in fiber and rich in animal fat
what are the types of colonic polyps?
- hyperplastic
- hamartomatous
- adenomatous
GI neuroendocrine tumors most commonly affects ______ and ______ and can metastasize to _______
small intestine and appendix;
liver leading to carcinoid system with wheezing, diarrhea, flushing and ↑ 5HT can lead to right sided heart fibrosis
sessile serrated adenomas are lesions seen in the _____ pathway for the cause of colon cancer
- MSI (microsatellite)
are adenomas precancerous?
YES; they have low grade dysplasia
a 3 year old boy has blood in hi story and has brown black discoloration on his lips, palm and genitals. His father had similar complaints. What is the most likely cause?
PJ polyps because he has the melanotic pigments but also his father has it
juvenile usually only found in the rectum
invasion into the ________ is indicative of invasive adenocarcinoma instead of high grade dysplasia
submucosa
______ will have glands lined by non dysplastic eptihlum rich in goblet cells and have arborizing network of smooth muscle between glands
PJ syndrome (Peutz Jegher)
primary gastrointestinal lymphomas person with _____
lymphoma in the GIT with or without continuous lymph nodes and there is NO liver, spleen or bone marrow involvement at the time of diagnosis
fibrosis of the _____ side of the heart is associated with neuroendocrine tumors
right side
- expanded lamina propria
- abundantly cystically dilated glands
- can potentially see inflammatory cells
the above two are hsitological findings in ______
juvenile polyps
what is the main difference between lymphocytic and collagenous colitis?
- thickness of collagenous band that supports the enterocytes: THICK = COLALGENOUS
NO collagen band = lymphocytic
the most common site of juvenile polyps (hamartomatous polyp) is the ______
rectum
