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PCM Exam 4 > GIT Path: Intestinal Tumors > Flashcards

GIT Path: Intestinal Tumors Flashcards

1
Q

colon adenocarcinoma can systemically metastasize to _____, _____, _____ and _____

A

liver, peritoneum, lungs, and bones

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2
Q

the sporadic form of MSI cancers is associated with what mutation

A

methylation of MLH1 promoter

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3
Q

serrations intraluminally on histology is indicative of ______

A

sessile serrated adenoma/polyp

it has a “saw tooth” appearance

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4
Q

______ is a precursor lesion fo the MSI pathway colorectal cancer

A

sessile serrated adenoma

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5
Q

_________ pathway for developing colorectal cancer arise from the adenoma-carcinoma sequence

A

chromosomal instability pathway

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6
Q

adenomas are confined to the _______

A

lamina propria (INTACT MUSCULARIS PROPRIA)

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7
Q

describe the accumulation of mutations that can lead to adenomas in the colon (FAP)

A
  • start with an APC gene mutation
  • accumulation of β catenin mutation
  • accumulate KRAS mutation
  • later: p53, telomerase, etc
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8
Q

_____ grade neuroendocrine tumors are usually aggressive

A

high

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9
Q

what are two major pathways for developing colon cancer? what is the more common pathway?

A
  • 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

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10
Q

If an elderly man patient presents with iron deficiency anemia, what are you thinking?

A

Iron deficiency anemia in an elderly man is due to GI malignancy unless proven otherwise

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11
Q

neuroendocrine tumors can occur in the stomach in what 3 settings?

A
  1. type I: autoimmune gastritis
  2. type II: Gastrinoma (rillinger Ellison) in which there is ↑ gastrin secretion
  3. Type III: sporadic (more aggressive)
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12
Q

PJ polyps (Peutz Jegher) have a germline mutation and are at risk for developing cancers of ______, ____, ___, ___, and ____

A

pancreas, breast, lung, ovary and uterus

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13
Q

histologic patterns that indicate low grade dysplasia as that seen in adenomas

A
  • enlargement of nuclei
  • stratification of basal layer
  • loss of mucin / goblet cells
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14
Q

patients with celiac disease are at risk for what of tumors?

A
  • T cell lymphoma (enteropathy associated including ulcerative jejunitis)
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15
Q

CEA is used to monitor ______ carcinoma

A

colorectal carcinoma

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16
Q

the tumor marker for colorectal cancers is ______

A

CEA

17
Q

what are some features of adenoma with high grade dysplasia

A
  • cribiform glands (fusion of crypts)
  • dyspolarity of nuclei

(all of this occurs in the lamina propria)

18
Q

FAP (familial adenomatous polyposis) has associated with a genetic defect in __________

A

APC gene (5q21)

19
Q

the most common site of primary GI lymphomas is the ____

A

stomach

20
Q

what are the 3 types of adenomas associated with adenomas and which one has the highest risk to undergo malignant transformation

A

3 types: tubular, villous, and tubulovillous

villous type has ↑ chance for malignancy

21
Q

what syndromes are associated with FAP (tubular adenomas)

A
  • gardner syndrome: FAP (tubular adenomas) + osteomas, desmoid tumors and epidermal cysts
  • Turcot syndrome: tubular adenomas with malignant CNS gliomas (TURcot = TURban)
22
Q

what is the treatment regimen for gastric lymphomas (MALToma)

A
  • eradication of H. pylori with antibiotics
  • 90% remission
  • high stage and unresponsive cases treated with chemotherapy: ritixumab + chemo
23
Q

how can you tell the difference between juvenile polyp and PJ polyp

A
  • 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
24
Q

describe the number and type of adenomas seen in FAP

A

100+ tubular adenomas and must do a prophylactic total colectomy due to high risk of colorectal cancer

25
Q

what are risk factors for colorectal carcinomas?

A
  • obesity, decreased physical activity

- diet LOW in fiber and rich in animal fat

26
Q

what are the types of colonic polyps?

A
  • hyperplastic
  • hamartomatous
  • adenomatous
27
Q

GI neuroendocrine tumors most commonly affects ______ and ______ and can metastasize to _______

A

small intestine and appendix;

liver leading to carcinoid system with wheezing, diarrhea, flushing and ↑ 5HT can lead to right sided heart fibrosis

28
Q

sessile serrated adenomas are lesions seen in the _____ pathway for the cause of colon cancer

A
  • MSI (microsatellite)
29
Q

are adenomas precancerous?

A

YES; they have low grade dysplasia

30
Q

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?

A

PJ polyps because he has the melanotic pigments but also his father has it

juvenile usually only found in the rectum

31
Q

invasion into the ________ is indicative of invasive adenocarcinoma instead of high grade dysplasia

A

submucosa

32
Q

______ will have glands lined by non dysplastic eptihlum rich in goblet cells and have arborizing network of smooth muscle between glands

A

PJ syndrome (Peutz Jegher)

33
Q

primary gastrointestinal lymphomas person with _____

A

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

34
Q

fibrosis of the _____ side of the heart is associated with neuroendocrine tumors

A

right side

35
Q
  • expanded lamina propria
  • abundantly cystically dilated glands
  • can potentially see inflammatory cells

the above two are hsitological findings in ______

A

juvenile polyps

36
Q

what is the main difference between lymphocytic and collagenous colitis?

A
  • thickness of collagenous band that supports the enterocytes: THICK = COLALGENOUS

NO collagen band = lymphocytic

37
Q

the most common site of juvenile polyps (hamartomatous polyp) is the ______

A

rectum

PCM Exam 4 (44 decks)

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