Histopathology 11: Upper G.I pathology

Question 1

In which part of the stomach does H.Pylori tend to reside ?

Answer 1

Pyloric antrum and pyloric canal

Question 2

List the 3 layers of tissue seen on histology of the antrum and body of the stomach ?

Answer 2

• gastric mucos collomnar epithelium at the top
• Lamina propria in the middle (with specialised acid secreting glands)
• Muscularis mucosa at the bottom

Question 3

What is the normal villous: Crypt ratio in the duodenum ?

Answer 3

villous: crypt > 2:1

Question 4

What do goblet cells in the stomach suggest ?

Answer 4

Metaplasia - should not be any goblet cells in the stomach

Question 5

Which risk factors are associated with squamous cell carcinoma of the oesophagus ?

Answer 5

• -Smoking and alcohol
• -More common in afro-carribeans

Question 6

Which risk factors are associated with adenocarcinoma of the oesophagus ?

Answer 6

• Barret’s oesophagus
• GORD
• smoking
• obesity

Question 7

Which cancer is more common in the distal 1/3 of the oesophagus ?

Answer 7

Adenocarcinoma

Question 8

Which cancer is more common in the middle 1/3 of the oesophagus ?

Answer 8

Squamous cell carcinoma

Question 9

List 3 causes of acute gastritis (inflammation of gastric mucosa)?

Answer 9

• NSAIDS
• Alcohol
• H.Pylori

Question 10

List 3 causes of chronic gastritis ?

Answer 10

ABC of gastritis:

• Autoimmune: anti-parietal autoantibodies
• Bacterial: H. pylori
• Chemical: NSAIDs, bile reflux

Key cells in chronic = lymphocytes

Question 11

What does the presence of lymphoid follicles (MALT) in the stomach suggest ?

Answer 11

• H.Pylori infection
• Increased risk of lymphoma (gastric MALToma)

Question 12

Which type of cancer is most common in the stomach ?

Answer 12

Adenocarcinoma

Question 13

what is the z-line in the oesophagus

Answer 13

point at which epithelium transitions from squamous to columnar (squamo-columnar junction)

Oesophagus = squamous, stomach = columnar

Question 14

important feature of the oesophageal mucosa

Answer 14

submucosal glands

Question 15

marker for intestinal type epithelium

Answer 15

glandular epithelium with goblet cells

Question 16

hallmark of acute inflammation in general

Answer 16

Neutrophil polymorphs

Question 17

Commonest cause of oesophagitis

Answer 17

Reflux Oesophagitis/ GORD

Question 18

Aetiology of Barrett’s oesophagus

Two types

Answer 18

• NORMAL squamous epithelium of the lower oesophagus is REPLACED by metaplastic columnar epithelium (usually with goblet cells)
• Due to GORD/reflux

1. WITHOUT goblet cells - gastric metaplasia
2. WITH goblet cells – intestinal type metaplasia (NB since no goblet cells in gastric/stomach, but there are in intestine)

Question 19

Is cancer more likely in gastric metaplasia (without goblet cells) or intestinal metaplasia (with goblet cells) in Barrett’s oesophagus?

Answer 19

MUCH HIGHER in intestinal metaplasia

Question 20

Premalignant stages before cancer

Answer 20

Metaplasia (reversible) > dysplasia > cancer

Question 21

How do cells in Barrett’s look during screening for the disease?

Answer 21

hyperchromatic

Question 22

Most common type of oesophageal cancer in developed countries

Most common WW

Answer 22

• Adenocarcinoma of the Oesophagus (associated with reflux)
• Adenocarcinomas form glands and secrete mucus
• Found in lower oesophagus

WW: Squamous Cell Carcinoma (mid-lower oesophagus)

Question 23

Most damaging form of H pylori

Answer 23

• Cag-A +ve H. pylori
• Cag A is a toxin
• Switches off apoptosis in gastric cells and so damaged cells are not killed, so DNA damage in cells persists

Question 24

commonest opportunistic viral infection to cause gastritis

Answer 24

CMV

Question 25

Which IBD can cause gastritis

Answer 25

Crohn's

Question 26

What is metaplasia and is it reversible?

Answer 26

Metaplasia is a change from one cell type to another and by definition is reversible - NOT precancerous

Question 27

What is dysplasia?

Answer 27

Some of the cytological and histological features of malignancy are present, but NO invasion through the basement membrane, so no chance of metastasis Features of malignancy: * Big nuclei * Raised nucleocytoplasmic ratio * Increased mitoses * Abnormal mitoses

Question 28

Infection that is major RF of gastric cancer

Answer 28

H. pylori

Question 29

\>95% of all malignant tumours in the stomach are what type?

Answer 29

ADENOCARCINOMAS * Can get well differentiated * or poorly differentiated: Linitis plastica, signet ring cell carcinoma

Question 30

Signet ring cells seen in which type of GI cancer?

Answer 30

poorly differentiated adenocarcinoma of gastric cancer

Question 31

Cause of ALMOST ALL duodenal ulcers

Answer 31

* H. pylori * NB also cause of half gastric cancers * stimulates increased acid secretion which spills over the stomach and into the duodenum and induces acute duodenitis

Question 32

Pain in duodenal ulcer made worse/relieved by food?

Answer 32

Relieved NB most of these ulcrs due to H pylori

Question 33

Very common parasite which exists in immunocompetent people and can affect duodenum Another disease affecting duodenum

Answer 33

Giardia lablia infection Whipple’s disease

Question 34

Histological changes in Malabsorption Partial Villous Atrophy (like in Coeliac)

Answer 34

* Villous atrophy- become smaller * Crypt hyperplasia- become bigger * **Increased intraepithelial lymphocytes**

Question 35

Rule on food if wanting to do duodenal biopsy for Coeliac

Answer 35

Stay on gluten diet otherwise won't see villous atrophy with increased intraepithelial lymphocytes

Question 36

Those with coeliac are more likely to develop which malignancy?

Answer 36

increased risk of GIT cancers: MALToma AKA Enteropathy associated T-cell Lymphoma (EATL) NB lymphomas in the stomach due to H. pylori are B cell lymphomas

Question 37

Does food help/worsen Sx of gastric ulcer?

Answer 37

WORSEN

Question 38

How invasive is gastric ulcer? Link between gastric ulcer and cancer

Answer 38

defect goes THROUGH the muscularis mucosae (through the full thickness of the mucosa and into the submucosa) * Ulcers may become malignant, but cancers may also ulcerate * ALL ULCERS SHOULD BE BIOPSIED TO EXCLUDE MALIGNANCY