Lower GI Neoplasia (Quiz 2)

Question 1

what is the most common of malignant small bowel tumors

Answer 1

• carcinoid

Question 2

what is a carcinoid tumor

Answer 2

• rare, well-differentiated neuroendocrine tumor

Question 3

most common location for carcinoid tumor

Answer 3

• ileum

Question 4

symptoms if a carcinoid tumors obstructs the bowel

Answer 4

• desmoplasia - growth of fibrous or connective tissue

- intussusception

Question 5

what is carcinoid syndrome

Answer 5

• metastasis of carcinoid tumor to the liver

Question 6

symptoms of carcinoid syndrome

Answer 6

• flushing
• diaphoresis
• diarrhea
• wheezing
• hypotension

Question 7

appendices carcinoids usually occur where

Answer 7

• tip of appendix

Question 8

histology of carcinoid syndrome

Answer 8

• bland tumor cells
• salt and pepper chromatin
• no large nucleoli

Question 9

distinguishing factor of carcinoid tumor cells

Answer 9

• synaptophysin positive (stains red)

Question 10

what polyps have no malignant potential and no increased risk for CRC

Answer 10

• hyperplastic polyps

Question 11

what is the most common polyp in the large bowel

Answer 11

• hyperplastic polyp

Question 12

size of hyper plastic polyps

Answer 12

• most less than 3 mm in diameter

Question 13

gross pathology of hyperplastic polyps

Answer 13

• small sessile polyps

- slightly pale

Question 14

histopathology of hyperplastic polyps

Answer 14

• serrated crypts

- decreased goblet cells

Question 15

which cells are premalignant and all dysplastic

most colon cancers arise from this

Answer 15

• colonic adenomas

Question 16

two growth patterns of polyps

which is easier to clip

Answer 16

• sessile

- pedunculated - easier to clip because it’s basically on a a pedestal

Question 17

which architecture of an adenomatous polyp is the most common type with adenomatous epithelium arranged in closely-packed branching tubules having a cerebriform appearance at low power

Answer 17

• tubular

Question 18

which architecture of an adenomatous polyp is where adenomatous epithelium takes the form of straight, elongated finger-like fronds extending from the muscular mucosal to the luminal surface

Answer 18

• villous

Question 19

which architecture of an adenomatous polyp is a mixture of tubular and villous architecture

Answer 19

• tublovillous

Question 20

what makes epithelium adenomatous

Answer 20

• pleomorphic colonic epithelium
• nuclear pseudostratification
• loss of cytoplasmic mucin

Question 21

what is a polyp that grossly appears benign but is later found by histologic examination to contain cancer

Answer 21

• adenocarcinoma arising in a polyp

Question 22

symptoms of colon cancer

Answer 22

• asymptomatic
• obstruction
• bleeding
• weight loss
• pencil thin stool
• iron deficiency anemia

Question 23

what kind of lesion do we see with colon cancer

Answer 23

• apple core lesion

Question 24

in the setting of a newly recognized iron deficiency anemia, what is the biggest concern

what is the test to rule out?

Answer 24

• colorectal cancer

- colonoscopy

Question 25

tumors in the right colon are usually

Answer 25

• polypoid

- fumigating exophytic masses

Question 26

tumors involving the left colon are more

Answer 26

• annular lesions
• apple-core lesions
• bowel obstruction

Question 27

histology of colorectal carcinoma

Answer 27

• adenocarcinoma within desomoplastic stroma

- invades bowel wall

Question 28

nuclei of tumor cells in colorectal carcinoma

Answer 28

• oval or rounded nuclei

Question 29

chromatin of tumor cells in colorectal carcinoma

Answer 29

• clumped chromatin

- nuclear polymorphism

Question 30

nucleoli of tumor cells in colorectal carcinoma

Answer 30

• large or irregular

Question 31

mucin secretion of tumor cells in colorectal carcinoma

Answer 31

• minimal to abundant

- signet ring pattern occurs

Question 32

what happens if KRAS or BRAF mutations are present in colorectal carcinoma

Answer 32

• patient resistant to anti-EGFR therapies

Question 33

what happens if MSI-high in colorectal carcinoma

Answer 33

• patient resistant to 5-fluorouracil therapy

Question 34

genetics of familial adenomatous polyposis

mutation where

chance of cancer

Answer 34

• autosomal dominant
• mutation of APC gene

100% chance of cancer

Question 35

Peutz-Jehgers Syndrome symptoms

Answer 35

• multiple GI hamartomatous polyps

- pigmented spots on lips and buccal mucosa

Question 36

genetics of Peutz-Jehgers Syndrome

mutation where

Answer 36

• autosomal dominant

- mutation in STK11 gene