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MD3002 > Lower GI tumours > Flashcards

Lower GI tumours Flashcards

1
Q

Benign tumours of small intestine

A
  • Adenoma

- Mesenchymal tumours (lipoma, angioma, leiomyoma)

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2
Q

Malignant tumours of small intestine

A
  • Adenocarcinomas and carcinoid

- Lymphomas and sarcomas

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3
Q

Benign tumours of colon/rectum

A
  • Non-neoplastic polyps

- Neoplastic-adenoma

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4
Q

Malignant tumours of colon/rectum

A
  • Adenocarcinoma
  • Anal zone carcinoma
  • Lymphoma
  • Leiomyosarcomas
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5
Q

Which part of the small intestine do adenomas usually affect

A

Ampulla of Vater

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6
Q

Malignant potentiel of small intestine adenomas

A

Can progress to adenocarcinoma

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7
Q

What do adenocarcinomas look like

A
  • Napkin ring encircling pattern

- Polypoid exophytic masses

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8
Q

Clinical presentation with adenocarcinomas

A
  • Intestinal obstruction
  • Cramping pain
  • Nausea
  • Vomiting/weight loss
  • May cause obstructive jaundice
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9
Q

What are the different types of non-neoplastic polyps

A
  • Hyperplastic

- Hamartomatous

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10
Q

What are the different types of neoplastic adenomas

A
  • Tubular
  • Villous
  • Tubulovillous
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11
Q

Histological features of hyper plastic polyps

A
  • Well-formed glands and crypts
  • Lined by non-neoplastic epithelial cells
  • Most of which show differentiation into mature goblet or absorptive cells
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12
Q

Macroscopic features of hyper plastic polyps

A
  • Nipple like
  • Hemispheric
  • Smooth
  • Moist protrusions of mucosa
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13
Q

Malignant potentiel of hyperplastic polyps

A

No malignant potential

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14
Q

Who is affected by hamartomatous polyps

A

Children younger than 5

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15
Q

Histological features of hamartomatous polyps

A
  • Abundant mystically dilated glands
  • Inflammation is common
  • Surface may be congested or ulcerated
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16
Q

Malignant potential of hamartomatous polyps

A

No malignant potential

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17
Q

What are the types of hamartomatous polyps

A
  • Juvenile

- Peutz-Jeghers

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18
Q

Describe Peutz-Jeghers polyps

A
  • Tend to be large and pedunculate

- Do not have malignant potential (but at increased risk of pancreatic, breast, lung and ovarian cancer)

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19
Q

What are the types of adenomas

A
  • Tubular (most common)
  • Villous
  • Tubulovillous
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20
Q

Why do adenomas arise

A

Result of epithelial proliferative dysplasia

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21
Q

What features suggest an adenoma may progress to be malignant

A
  • Polyp size (rare in tubular but high risk in sessile villous)
  • Histological architecture
  • Severity of epithelial dysplasia
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22
Q

Describe small tubular adenomas

A

Smooth-contoured and sessile

23
Q

Describe large tubular adenomas

A
  • Coarsely lobulated
  • Slender stalks
  • Raspberry like
24
Q

Histological features of tubular adenomas

A
  • Stalk is composed of fibromucular tissue and prominent blood vessels
  • Presence of dysplastic epithelium that may show mucin vacuoles
  • Carcinomatous invasion into the submucosal stalk of the polyp constitutes invasive adenocarcinoma
25
Q

Macroscopic features of villous adenoma

A

Velvety/cauliflower like masses projecting 1-3cm above the surrounding mucosa

26
Q

Histological features of villous adenomas

A
  • Frond like villiform extensions of the mucosa
  • Covered by dysplastic, sometimes very disorderly columnar epithelium
  • All degrees of dysplasia may be encountered
27
Q

Clinical features of villous adenomas

A

Often discovered because of overt rectal bleeding

28
Q

When is an endoscopic removal of a pedunculated adenoma considered adequate

A
  1. Adenocarcinoma is superficial and does not approach the margin of excision across base of stalk
  2. No vascular or lymphatic invasion
  3. Carcinoma is not poorly differentiated
29
Q

Most common cancer in the large intestine

A

Adenocarcinoma

30
Q

Dietary factors for colorectal cancer

A
  1. Excess dietary caloric intake relative to requirements
  2. Low content of vegetable fibres
  3. High content of refined carbohydrates
  4. Intake of red meat
  5. Decreased intake of protective micornutrients
31
Q

Features of tumours in proximal colon

A
  • Polypoid, exophytic masses
  • Obstruction is uncommon
  • Penetrate the bowel wall as subserosal and serial white, firm masses
32
Q

Features of tumours in distal colon

A
  • Annular, encircling lesions (napkin-ring lesions)
  • Margins are classically heaped up, beaded and firm and mid-region remains ulcerated
  • Lumen narrowed and proximal bowel may be distended
  • Penetrate the bowel wall as subserosal and serosal white, firm masses
33
Q

What lesion is found with colorectal adenocarcinoma

A

Apple-core lesion

34
Q

Histological features of adenocarcinomas

A
  • Undifferentiated, anaplastic masses

- Many produce mucin

35
Q

Clinical features for cancer of caecum/right colon

A
  • Fatigue
  • Weakness
  • Iron-defieincy anaemia
36
Q

Clinical features for left-sided lesions

A
  • Occult bleeding
  • Changes in bowel habits
  • Crampy LLQ discomfort
37
Q

Where do colorectal tumours spread

A
  • Direct extension into adjacent structures

- Metastasis through lymphatics/blood vessels

38
Q

Dukes’ staging for colorectal cancer

A

A) confined to submucosa layer
B) Spread through muscle layer but doesn’t involve lymph nodes
C) Involving lymph nodes

39
Q

How to identify carcinoid tumours

A
  • No reliable histological difference between benign and malignant tumours
  • Aggressive behaviour correlates with site of origin, depth of penetration, size of tumour and histological features of necrosis/mitosis
40
Q

Macroscopic features of carcinoid tumours

A
  • Intramural or submucosal masses that create small polypoid or plateau-like elevations
  • Solid, yellow tan appearance on transection
41
Q

Most common site of carcinoid tumours

A

Appendix

42
Q

Histology of carcinoid tumours

A
  • Neoplastic cells may form discrete islands, trabeculae, glands
  • Tumour cells are monotonously similar, having scant pink granular cytoplasm and a round/oval stippled nucleus
43
Q

Features of carcinoid syndrome

A
  • Caused by excess of serotonin
  • Cutaneous flushes and apparent cyanosis
  • Diarrhoea, cramps, nausea, vomiting
  • Cough, wheezing, dyspnoea
44
Q

What are the types of GI lymphoma

A
  • B cell

- T cell

45
Q

Give examples of B cell lymphomas

A
  • MALT
  • Immunoproliferative small-intestine disease
  • Burkitt lymphoma
46
Q

Describe T cell lymphoma

A
  • Associated with long standing malabsorption syndrome

- Prognosis is poor

47
Q

Give examples of mesenchymal tumours

A
  • Lipomas
  • Leiomyomas
  • Leiomyosarcomas
48
Q

Describe lipomas

A

Well-demarcated, firm nodules, arising within the submucosa or muscularis propria

49
Q

Describe leiomyosarcomas

A

Large, bulky intramural masses that eventually fungal and ulcerate into the lumen or project subserosally into the abdominal space

50
Q

Most common benign tumour of anus

A

Warts (condyloma acuminata)

51
Q

Give the malignant tumours of anus

A
  • Basaloid pattern
  • Squamous cell carcinoma
  • Adenocarcinoma
  • Malignant melanoma
52
Q

Describe basaxoid pattern

A

Immune proliferative cells derived from basal layer of stratified squamous epithelium

53
Q

Describe squamous cell carcinoma

A

Closely associated with chronic HPV infection

MD3002 (14 decks)

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