MD4 Smorgasbord Flashcards
1
Q
Pheochromocytoma Clinical Presentation
A
Severe or episodic HTN, palpitations, tachycardia, anxiety, and excessive sweating
1
Q
A
Steatosis
1
Q
A
Chronic Cholecystitis
2
Q
What is the prognosis of hepatocellular carcinoma?
A
Poor
10% 5-year survival
3
Q
A
Adenomatous Polyps
4
Q
Progression of normal epithelium to adenocarcinoma
A
4
Q
A
Hemochromatosis
5
Q
A
Pancreatic Endocrine Neoplasm
(Islet Cell Tumor - cells are well-differentiated)
5
Q
A
Acute Hemorrhagic Gastritis
5
Q
What is acute cholecystitis and how is it characterized?
A
Acute onset of symptoms, 90% associated with gallstones
Gallbladder often enlarged, tense
Fibrinous serosal exudates
May be hemorrhagic, filled with pus, or health with calcification (porcelain GB)
6
Q
A
Pheochromocytoma
6
Q
A
Hypertrophic gastropathy
6
Q
A
Chronic Pancreatitis Pancreatic pseudocyst
7
Q
A
Medullary Carcinoma
7
Q
A
Normal Stomach
7
Q
A
Gastric Ulcer
8
Q
MEN-1 vs. MEN-2
A
9
Q
A
Ischemic Enteritis
10
Q
What is the most common cause of chronic gastritis?
A
Helicobacter pylori. Spiral bacteria may be found in gastric biopsies
11
Q
A
Cortex
Zona Glomerulosa
Zona Fasciculata
Zona Reticularis
Medulla
11
Q
A
Metastatic Carcinoma
11
Q
What are some complications of pancreatic adenocarcinoma?
A
Primary effects:
- Metastases (lung, liver, peritoneum)
- Pancreatic carcinoma
- Abdominal pain (peripheral lymphatic invasion)
Secondary effects:
- Trousseau syndrome: Migratory peripheral thrombophlebitis (10-25%)
- Courvosier gallbladder: painless jaundice, dilated gallbladder
- Weight loss
- Obstructive jaundice
12
Q
A
Acute Pancreatitis
White foci= fat necrosis due to fat digestion by lipase, releasing fatty acids that bind to calcium forming soaps (saponification)
13
Q
A
Grave’s Disease
13
Waterhouse-Friderichsen Syndrome purpura
Acute adrenal insufficiency due to DIC/hemorrhage caused by Neiserria meningititides infection.
13
Adrenal Cortical Carcinoma
13
Candida Esophagitis
13
Cirrhosis
13
What are predisposing factors for hepatocellular carcinoma (hepatoma)?
Cirrhosis
Hep B and C
Thorotrast (formerly used as radiographic contrast agent)
Alcohol
Radiation
Alpha-1 antitrypsin deficiency
Hemochromatosis
14
what is hereditary hemochromatosis?
Hereditary hemochromatosis (Bronze diabetes)
Autosomal recessive disorder of iron metabolism (HFE gene, chromosome 6p)
1-2/1,000 and M:F = 7:1 (men present earlier in life)
Prussian blue stain for iron shows granular staining in hepatocytes
14
What are some complications of acute pancreatitis?
Systemic organ failure, shock, ARDS, acute renal failure
DIC
Pancreatic abscess
Pancreatic pseudocyst
15
Adrenal Cortical Adenoma
17
Normal Thyroid
17
Carcinoid Tumor
17
Chronic Pancreatitis Pancreaticpseudocyst (no epithelial lining)
18
Parathyroid Hyperplasia
Sestamibi Scan
18
Layers of Adrenal Gland
Outer yellow cortex and red brown medulla (10:1)
Zona glomerulosa (10-15%): mineralocorticoids
Zona Fasciculata (60-70%): glucocorticoids
Zona Reticularis (20-30%): androgens
19
Gastric Lymphoma
19
Viral Hepatitis B
Ground glass change - cytoplasm turns into smooth ground glass appearance due to viral replication
20
Etiology of Hyperparathyroidism
20
Normal esophagus by endoscopy
20
Gastric Adenocarcinoma
20
Gross pathology of ischemic enteritis/colitis
Dusky discoloration of the bowel, blood in lumen
21
Squamous Cell Carcinoma of Esophagus
22
Reflux Esophagitis (increased eosinophils)
23
Metastatic Gastric Carcinoma
Virchow's node
23
Two hereditary colon cancer syndromes
1. Familial adenomatous polyposis
2. Hereditary non-polyposis colorectal cancer (Lynch syndrome):
a. Germline mutations in mismatch repair genes result in defective DNA repair, which is manifest as microsattelite instability
b. Increased risk for cancer of the colon/rectum, stomach, endometrium, ovary, etc.
c. Diagnosis of HNPCC: MSI by PCR, immunohitochemistry for mismatch repair proteins (MLH1, MSH2, MSH6, PMS2)
d. Stage for tage, patients with HNPCC have a better prognosis than sporadic colon cancers
24
Acute Pancreatitis
25
Colon Carcinoma
27
Pituitary Adenoma
27
What is the stalk effect?
| (in terms of excess prolactin)
Mildly elevated PRL is a common phenomenon, related to "stalk effect" rather than direct secretion by a pituitary adenoma. Any mass in the site can interfere mechanically with hypothalamic-hypophyseal connections and disrupt the steady-state inhibitory effect of the hypothalamus on PRL secretion by the AP gland. Does not justify a diagnosis of PRL-secreting pituitary adenoma.
27
Acute Pancreatitis
28
Hashimoto's Thyroiditis
Lymphoid follicle with germinal center
29
Hepatocellular Carcinoma
30
Papillary Carcinoma
Calcification - Somoma body
31
Medullary Carcinoma
32
Pancreatic carcinoma
33
Papillary Carcinoma
33
Esophageal Varices
34
Local complications of ulcerative colitis
35
Cholelithiasis
36
Cirrhosis
37
Gastric Ulcer
37
Acute Pancreatitis
38
Insulinoma
38
Esophageal Varices
38
Tubular Adenoma
39
Left: Zona Fasciculata
Right: Zona Reticularis
39
Normal
40
Medullary carcinoma
How common is it
Associations
Produces \_\_\_\_
Due to \_\_\_\_
Histo
Metastasis
5-10% of thyroid carcinomas, some associated with MEN2A/2B
Derived from parafollicular cells (neuroendocrine tumor)
Produce calcitonin (hypocalcemia uncommon)
Due to activating mutations of RET proto-oncogene (familial and some sporadic tumors)
Histo: Marked variation in appearances
Commonly has neuroendocrine appearance with nests & trabeculae of uniform cells
Amyloid within stoma common (calcitonin deposition)
Tumor cells stain from chromogranin and synaptophysin (neuroendocrine markers)
Spreads via lymphatics/blood to lymph nodes, lungs, liver, bones
42
Follicular Adenoma
43
Herpes Esophagitis
43
Lymphomas of the stomach
What is the most common form?
Most common site of extranodal lymphomas
5% of gastric malignancies, 20% of all extranodal lymphomas
Most common form: low-grade B-cell lymphoma of MALT (mucosa-associated lymphoid tissue)
Associated with H. pylori infection
Composed of dense infiltrate of small lymphoid cells, often showing plasma cell differentiation and invasion of gastric glands (lymphoepithelial lesions)
43
What is alcoholic hepatitis?
Develops in 20-25% of heavy drinks
Characterized by:
Inflammation and hepatocyte degeneration
Neutrophilic infiltrate
Steatosis
Mallory bodies (eosinophilic PAS +, corkscrew shaped intracytoplasmic stuctures made of intermediate filaments (keratin)
44
Papillary Carcinoma
Nuclear clearing - pale "orphan annie" nuclei
Blood vessels & cuboidal tumor cells
44
Esophageal Varices (ulceration + hemorrhage)
44
Cirrhosis
45
Celiac Disease
46
Normal Endocrine Pancreas
Antibody staining for insulin in beta-cells
46
Systemic complications of ulcerative colitis
47
48
Medullary Carcinoma
Dense secretory core granules
48
What are the associated metastases of stomach adenocarcinoma?
Left supraclavicular lymph node (Virchow's node) or both ovaries (Krukenberg tumor)
49
Chronic Pancreatitis
Concretions and atrophy replaced by chronic scar tissue
50
What is the Rule of 2s of Meckel's Diverticulum
1. Affects 2% of the population
2. Located within 2 ft of the ileocecal valve
3. Approximately 2 inches long
4. 2% are symptomatic
50
Acute cholecystitis
50
How do gallstones form
Secondary to supersaturation of bile
51
Adrenal Cortical Carcinoma
52
Multiple Endocrine Neoplasia 2B
53
Normal Stomach (Fundus)
54
Follicular Carcinoma
55
Adrenal Cortical Adenoma
Right: tumor, often with much lipid
55
Meckel's Diverticulum
56
Presentation of Gastrinoma
75% located in pancreas, peripancreatic region, 23% in duodenum, and rare in stomach
70-90% are malignant
Usually solitary and malignant if not associated with other endocrine abnormalities
Usually multiple and benign in a component of MEN
57
Adrenal Cortical Adenoma gross and microscopic findings
Gross: Bright yellow or yellow-brown tumors, usually
Microscopic: Usually composed of clear-pale cells resembling adrenal cortical cells, may have pleomorphism of cells, mitotic activity is usually low
57
Appendicitis
57
Adenocarcinoma of GB
58
Pancreatic Endocrine Neoplasm:
Epidemiology
Area of pancreas that is affected
Functional?
Histology
Epi: much less common than tumor of exocrine pancreas; adults primarily affected; single or multiple; benign or malignant
Area: Usually body or tail of pancreas
Functional: 60% secrete one or several peptide hormones
Histo: uniform cells with round/oval nuclei, fine chromatin, and pale granular cytoplasm
58
Adenocarcinoma of Esophagus
58
Celiac Disease
58
Alcoholic Hepatitis
Arrow: Mallory body
Aggregate of inflammatory cells \*largely neutrophils
59
What are the 2 main disorders of Hypertrophic Gastropathy?
Menetrier diseaes: hyperplasia of mucous neck cells due to elevated levels of TGF-alpha. Protein-losing enteropathy (diarrhea, edema). Associated with increased risk of gastric adenocarcinoma.
Zollinger Ellison Syndrome: Triad of gastrinoma (gastrin-secreting tumor usually in pancreas or duodenum due to hyperplasiz of oxyntic mucosa - parietal and chief cells), hypertrophic gastropathy and peptic ulcers due to hypersecretion of acid.
60
Hashimoto's Thyroiditis
Oncocytic Herthle cells
60
Thyroid nodular hyperplasia
no capsule, benign
61
Parathyroid Adenoma
61
Gastrointestinal stromal tumor
62
Neuroblastoma Epi
7-10% of all childhood malignancies
2nd most common childhood solid malignancy
80% occur in children
64
Graves' vs. Hashimoto's Pathogenesis
65
What genetic alteration can be found in papillary thyroid carcinoma?
Rearragement of the tyrosine kinase portion of RET proto-oncogene (chromosome 10) to put the tyr kin portion under the promotor of a gene that is constitutively expressed by follicular cells. Normally, tyr kin receptor is not normally expressed by thyrocytes.
[Causes high-level expression of tyrosine kinsase portion of the receptor as an unregulated growth signal)
66
Meckel's Diverticulum Complication
Intussusception
66
How do you distinguish hemochromatosis from secondary hemosiderosis?
Quantitative irone analysis
Secondary hemosiderosis = iron overload where iron accumulation typically affects Kupffer cells
68
Pituitary Adenoma
68
Ischemic Enteritis
69
RET Protooncogene mutations in MEN type 2
70
Acute Viral Hepatitis
71
Ulcerative Colitis
71
Villous Adenoma
72
Multiple Endocrine Neoplasia 2B
Mucosal neuromas
Have C cell hyperplasia nodules
72
Tubular Adenoma
73
S/Sx of thyroid hyperplasia
74
Barrett Esophagus
74
Squamous Cell Carcinoma of Esophagus
50% mid-esophagus, 30% distal, 20% proximal
74
What is hypertrophic gastropathy characterized by?
Giant, "cerebriform" enlargement of rugal folds of gastric mucosa due to hyperplasia of epithelial cells
75
Gastric Adenocarcinoma
75
Gross finidings in ulcerative colitis
1. Extends proximally from the rectum in a continuous fashion (without skip lesions)
2. Typically limited to the mucosa and submucosa, except in severe cases
3. Ulceration of mucosa
4. Pseudopolyps due to islands of mucosal regeneration
5. May result in megacolon
75
What are some complications of cirrhosis?
Portal HTN
Esophageal varices
Ascites
Splenomegaly
Hepatic encephalopathy
Hepatocellular carcinoma
76
Epi of colorectal adenocarcinoma?
Second leading cause of cancer death in U.S.
Adenocarcinoma accounts for 98% of all cancers of large intestine
77
Crohn's Disease
79
Normal Endocrine Pancreas
Antibody staining for glucagon in alpha-cells
79
Microscopic findings in DM pancreas (Types 1, 2)
Type 1: reduction in number and size of islets;
leukocytic infiltration of islets ("insulinitis")
Type 2: hyalinization/fibrosis of islets;
amyloid deposition (compose of amylin - cosecreted with insulin)
79
What are the types of gallstones
Gallstones occur secondary to supersaturation of bile
only 10% of gallstones are pure
1. cholesterol stones: pale, yellow, round/oval, single, radiolucent
2. pigment stones (Ca2+ bilirubinate): black/brown, oval, multiple
80
Etiology of Hypercortisolism
Cushing's Syndrome
Pituitary (Cushing's Disease): 60-70%
Adrenal: 20-25%
Ectopic: 10-15%
82
What are some S/Sx of Cushing's?
82
Herpes Esophagitis
82
Viral Hepatitis
84
Grave's Disease
Resorption vacuoles; Hypertrophic columnar follicular cells
84
Candida Esophagitis
Pseudomembranes
85
Adrenal Cortical Carcinoma
86
Hemochromatosis
87
What are esophageal varices?
Collateral, dilated veins which develop in response to portal hypertension. Tortuous dilated veins within submucosa that may cause massive upper GI bleeding
10-30% of upper GI hemorrhage
25-35% of cirrhotic patients
30% of initial bleeds fatal
88
Neuroblastoma
88
Normal Small Intestine
88
What is the clinical significance of adenomatous polyps?
Patients are at increased risk of developing colorectal adenocarcinoma
90
Describe Gross/Histo of Follicular adenoma
Euthyroid
Gross: Usually solitary, encapsulated nodule
Histo: Macro/micro follicular, appearance of cells differs from surroudning normal thyroid gland
Neither capsular invasion nor vascular invasion present
90
What drug can be given for a prolactinoma?
Bromocriptine:
Dopamine agonist that inhibits PRL secretion and shrinks lactotrophs
90
Pseudomembranous Colitis
90
Immunology of Celiac Disease
Associated with HLA-DQ2 or HLA-DQ8
90
Metastatic Carcinoma
91
Pituitary Adenoma
91
Gross finidings in appendicitis
Swollen appendix with serosal exudates
92
Manifestations of Parathyroid Adenoma
92
Gastric Adenocarcinoma
Signet Ring Cell Morphology
With stain for cytokeratin (ensures that it's carcinoma, not macrophage)
93
What is the traditional classification of cirrhosis (and its associated diseases)?
Macronodular (\>3 mm)
* Viral hepatitis
* Alpha-1 antitrypisin deficiency
* Wilson's Disease
Micronodular (
* Alcoholism
* Hemochromatosis
* Primary biliary cirrhosis
* Wilson's Disease
94
Presentation of Waterhouse: Friderichsen Syndrome
Rapidly progressive hypotension leading to shock
DIC with purpura
Pathology: Bilateral adrenal hemorrhage and necrosis
94
Gastric Adenocarcinoma
95
What is diverticular disease?
Acquired outpouchings of the colonic mucosa and submucosa with an attenuated or absent muscularis propria.
Most common in the left colon, particularly sigmoid colon.
Most are asymptomatic; 20% have pain, constipation, abdominal distention, etc.
96
Types of necrosis in ischemic enteritis/colitis
1. Mucosal necrosis: usually results from hypoperfusion
2. Transmural necrosis: usually due to occlusion of a major mesenteric blood vessel (i.e. SMA or IMA)
97
Which is more common:
Primary tumors of the SI
Metastatic tumor involving SI
Metastatic.
Primary are relatively rare.
98
Gastric Carcinoma (Polyploid/ulcerated)
99
MEN-2B: Gorlin's Syndrome
Mutation in RET oncogene
Medullary carcinoma of thyroid
Pheochromocytoma of adrenal gland
Mucosal neuromas (oral cavity, GI tract, etc.)
Marfanoid appearance
99
Diverticulosis
100
Microscopic findings in Crohn's Disease
1. Mucosal ulceration with acute inflammation
2. Submucosal chronic inflammation with lymphoid aggregates and granulomas
3. Epithelioid granulomas in muscularis propria and subserosal tissue
4. Chronic mucosal damage (crypt architectural distortion)
101
What is the histology of gastritis?
Increased numbers of inflammatory cells within lamina propria, including lymphocytes, plasma cells, and neutrophils.
Neutrophils often infiltrate mucosal epithelium ("active" gastritis)
102
Parathyroid Adenoma
102
Carcinoid Tumor
104
Adrenal Cortical Carcinoma
104
What is the change that happens in Barrett's esophagus?
Intestinal metaplasia (goblet cell metaplasia) of distal esophagus in response to acid-reflux
106
Follicular Adenoma
Contained by fibrous capsule (top left is adenoma)
107
Normal Stomach (Antrum)
108
Describe a normal Esophagus
Gross: Pale esophageal mucosa (as compared with tan-brown gastric mucosa) and discrete gastro-esophageal junction
Histo: Squamous-lined mucosa of esophagus with submucosal glands and muscularis propria
110
Hashimoto's Thyroiditis
110
Cortex
Zona Glomerulosa
Zona Fasciculata
Zona Reticularis
Medulla
110
What is an erosion?
What is an ulcer?
Erosion: Partial thickness loss of mucosal tissue
Ulcer: Full-thickness loss of mucosa
111
What is ischemic enteritis/colitis?
Necrosis of the bowel due to insufficient blood supply
112
Ulcerative Colitis
112
Hemochromatosis
113
Adrenal Cortical Carcinoma
115
What form of hyperthyroidism shows exopthalmos?
Graves Disease. Only.
Treatment of graves focuses on reducing T4 secretion. This does not affect exophthalmos because it is an autoimmune problem (with TSI).
116
Adrenal Cortical Adenoma
Microscopic findings
Features of malignancy
Median survival
Microscopy: May be frankly anaplatic or resemble tumor cells of adrenal cortical adenoma
Malignancy: vascular invasion or metastasis
Survival: ~2 years
117
Candida Esophagitis
117
Gastric Adenocarcinoma
118
Normal Thyroid
Parafollicular cells only in lateral lobes (from neural crest)
119
Compare and contrast Menetrier Disease (adult) and Zollinger-Ellison Syndrome
Both are examples of Hypertrophic gastropathy
120
Gastric Ulcer
121
Waterhouse-Friderichsen Syndrome
Hemorrhagic necrosis of adrenal glands.
122
Celiac Disease
123
What are some complications of chronic pancreatitis?
Pseudocyst
Duct obstruction
Malabsorption, steatorrhea
Secondary diabetes
125
Normal Posterior Pituitary
126
Normal Endocrine Pancreas
128
What causes enlargement of the thyroid gland in Hashimoto's thyroiditis?
Infiltration by lymphoid cells.
129
Do medullary carcinomas arise in the thyroid isthmus or thyroglossal duct remnants?
No. C cells migrate from neural crest to lateral thyroid lobes.
130
Adrenal Cortical Adenoma
130
Malignant Gastrointestinal stromal tumor
131
What are the different parts of the stomach?
132
What are some copmlications of ulcers?
Bledding, performation, obstruction
134
Medullary Carcinoma
134
Adrenal Tuberculosis
Caseous Necrosis
135
Gastritis
135
Diverticulosis
136
What are some features that favor GIST malignancy?
Tumor size (\>5 cm)
Increased mitotic rate (\>5 mitotic figures/50 high power fields)
Presence of tumor necrosis
Mucosal invasion
138
MEN-1: Wermer's Syndrome
Mutation in MEN-1 gene (11q13)
Parathyroid hyperplasia/adenoma
Pituitary adenoma
Pancreatic (or duodenal) islet cell tumor (symptomatic tumors are commonly gastrinoma or insulinoma)
139
Gastrointestinal stromal tumor
141
Hashimoto's Thyroiditis
142
Pseudomembranous Colitis
143
What are the gross and histologic patterns of adenocarcinoma of the stomach?
Gross: 1) Exophytic or polypoid, ulcerated mass
2) Diffuse thickening of stomach (linitis plastica "leather bottle" stomach)
Histologic: 1) "intestinal" type: cohesive, gland-forming tumor cells
2) "Diffuse" type: discohesive "signet" ring cells w/ intracytoplasmic mucin
144
Hypertrophic gastropathy
144
What is the definition of cirrhosis?
Scarring of entire liver with 1) diffuse fibrosis 2) loss of lobular architecture 3) nodular regeneration
It is the end-stage of many chronic disorders, so it is difficult to determine precise etiology by histology alone
145
Diverticulosis
146
Describe (macro and micro) the normal gall bladder
Macro: sac-like with thin wall and green mucosal lining
Micro: columnar epithelial lining, lamina propria, muscularis propria (no muscularis mucosae or submucosa)
148
Neuroblastoma
150
Parathyroid Carcinoma.
Bands of fibrous tissue.
151
What is Hashimoto's thyroiditis?
Chronic lymphocytic thyroiditis
Predominantly affects women, usually middle aged-elderly
Anti-TSH receptor Ab (inhibitory), anti-thyroglobulin, anti-thyroid peroxidase Ab
Initially may be thyrotoxic, then become hypothyroid
Increased risk for malignancy, lymphoma, and possibly carcinoma
152
Multiple Endocrine Neoplasia
152
Are celiacs at increased risk for malignancy?
Yes: lymphoma and carcinoma
153
Gastric Lymphoma
153
Celiac Disease
154
Medullary Carcinoma
Amyloid composed of pro-calcitonin
155
Pancreatic Endocrine Neoplasm
(Islet Cell Tumor - arranged in groups)
156
Describe a normal stomach
Gross: Tan brown mucosa and gastric rugae (folds)
Microscopic: gastric pits lined by mucous neck cells with glands lined by parietal (red-pink) and chief (pale) cells. Little/no inflammatory cells normally present in gastric mucosa.
158
Thyroid Nodular hyperplasia
Due to iodine deficiency, diet, meds/genetics
159
Colorectal adenocarcinoma malignant tumors
160
Gross findings in Crohn's Disease
1. Sharp demarcation with segmental intestinal involvement (skip lesions)
2. Thickened bowel wall with luminal narrowing (string sign by imaging)
3. Serpentine mucosal ulcers or a cobblestone appearance to the involved mucosa
4. Tendency toward fistual formation or bowel perforation
160
Viral Hepatitis
160
Risk factors for cholesterol stones
Female, fat, \>40, fertile
Drugs
GI disorders
162
Normal Pituitary Gland
163
What is the prognosis of stomach adenocarcinoma?
Depends on stage, overall 5 year survival about 30%
165
Hashimoto's Thyroiditis
"Fish-flesh" and infiltrated by lymphocytes
167
4 major and 2 minor cells types of endocrine pancreas and their hormones
1. Beta cell: insulin
2. Alpha cell: glucagon
3. delta cell: somatostain
4. PP cell: pancreatic polypeptide
5. D1 cell: vasoactive intestinal polypeptide
6. Enterochromafiin cell: serotonin
168
Gastric Ulcer (Malignant)
169
What skin condition is associated with celiacs?
Dermatitis herpetiformis: blistering skin disorder with IgA deposits
170
Crohn's Disease
172
Neuroblastoma
Left: area of necrosis
172
Hypertrophic gastropathy
173
Diverticulosis
174
Reflux Esophagitis
175
Microscopic findings in appendicitis
Acute inflammation (neutrophils) infiltrating muscularis propria, often with mucosal inflammation/ulceration
176
Diabetes Mellitus Type 1
Congo red stain of amyloid
177
Pseudomembranous Colitis
178
Adenocarcinoma of Esophagus
178
Carcinoid Tumor
179
Where do adenocarcinomas of the esophagus occur?
What are some other risk factors?
What are adenocarcinomas?
What is it associated with?
Prognosis?
Majortiy arise in distal esophagus in association with Barrett esophagus
Risk Factors: smoking tobacco, obesity
Adenocarcinoma = gland-forming malignancy
Associated with dysplasia of adjacent glandular epithelium
Prognosis: Varies depending on stage, but overall 5yr survival
180
Chronic Cholecystitis
181
Immunohistochemistry for mismatch repair proteins
Immunohistochemistry for mismatch repair proteins
182
How do you distinguish chronic from acute hepatitis?
Distinction from acute made clinically, not pathologically
Usually requires elevation of liver enzymes for \>6 months (or persistently elevated viral load)
183
Complications of Meckel's Diverticulum
1. Peptic ulcer (if gastric mucosa present)
2. Infection - may mimic acute appendicitis
3. Volvulus
4. Intussusception
185
Adrenal Tuberculosis
Acid Fast Bacilli
186
Ulcerative Colitis
186
What is acute hepatitis characterized by?
Inflammation (mostly lymphocytic, with some neutrophils and eosinophils)
Lobular disarray
Ballooning degeneration
Acidophil (Councilman) bodies
May see bridging necrosis (severe cases)
188
What is the grosss and microscopic pathology of Hashimoto's thyroiditis?
Gross: diffuse firm enlargement of thyroid, well demarcated from adjacent tissue
Microscopic: lymphocytic infiltrate with germinal centers
Oncocytic (Hurthle cell) metaplasia of follicular epithelium
Destruction of follicles, leading to fibrosis in late stages
188
What is acute pancreatitis characterized by?
Diffuse edema, acute inflammation, hemorrhage, fat necrosis, fibrosis, calcification
20% mortality
189
Pancreatic carcinoma
191
Barrett Esophagus
191
What is the clinical relevance of Barrett's esophagus?
Increased risk of adenocarcinoma (dysplasia --\> carcinoma)
192
Adenocarcinoma of GB
194
Gastritis
195
Gastrointestinal stromal tumor
197
Thyroid nodular hyperplasia
Can compress trachea or recurrent laryngeal -\> hoarse voice
199
Normal Adrenal Gland
Cortex is yellowish.
Medulla is reddish-brown.
201
What mutagenic agent increase the incidence of papillary thyroid carcinoma?
Radiation
202
Normal anterior pituitary
Red = acidophils
Purple = basophils
Clear = chromophobes
202
Medullary Carcinoma
203
Adenomatous Polyps
204
Distinctive Features of Crohn's Disease and Ulcerative Colitis (table)
206
Squamous Cell Carcinoma of Esophagus
207
What is ulcerative colitis?
A form of idiopathic inflammatory bowel disease which is limited to the colon and rectum.
209
Necrolytic Migratory Erythema
| (Glucagonoma)
210
Adrenal Cortical Carcinoma
211
Meckel's Diverticulum
213
What cells give rise to medullary carcinoma of the thryoid?
C cells
214
Neuroblastoma
Tumor cells form rosettes around a central anucleated zone.
215
Waterhouse-Friderichsen Syndrome
Hemorrhage in adrenal glands.
Acute adrenal insufficiency due to DIC/hemorrhage caused by Neiserria meningititides infection.
217
Parathyroid Adenoma
Solid sheets of cells.
Adenomas have compressed non-neoplastic tissue at edges.
219
Normal Esophagus and stomach
220
Candida Esophagitis
221
Papillary Carcinoma
221
Metastatic Gastric Carcinoma in liver
222
Metastatic Carcinoma
223
Normal Pituitary gland
224
Porcelain gallbladder
226
MEN-2A: Sipple's Syndrome
Mutation in RET oncogene (10q11)
Medullary carcinoma of thyroid
Pheochromocytoma of adrenal medulla
Parathyroid hyperplasia
227
Left: Follicular adenoma
Middle: Follicular carcinoma
Right: Papillary carcinoma
227
What HLA types are associated with Hashimoto's?
HLA-DR5
HLA-DR3
228
Presentation of Conn's Syndrome
Primary hyperaldosteronism due to adrenal cortical adenoma.
HTN, neuromuscular symptoms (weakness, paresthesias), potassium wasting, increased aldosterone with typically decreased renin levels.
Almost invariabley caused by an adrenocortical adenoma.
229
Gastrinoma Triangle
231
Herpes Esophagitis
232
Follicular Carcinoma
Widely invasive
233
Pathogenesis of acute pancreatitis
234
Adrenal Cortical Adenoma
Uniform, arranged in nests.
235
Barrett's esophagus
236
What are the functional classification of pituitary adenomas?
Classification of pituitary tumors based on serum hormone levels and/or immunohistochemical staining.
10% Corticotroph adenoma - secrete ACTH and POMC -\> Cushing's syndrome
20% Somatotroph adenoma - secrete GH -\> Acromegaly, gigantism
1-3% Thyrotroph adenoma (rare) - secrete TSH -\> thyrotoxicosis, usu. asymptomatic
10-15% Gonatotroph adenoma - secrete LH, FSH, & subunits -\> usu. asymp.
25% Lactotroph adenoma (prolactinoma) most common - secrete PRL -\> galactorrhea, hypogonadism, amenorrhea, infertility, loss of libido & impotence in men
20-30% Null cell adenomas - do not secrete hormones
237
Ischemic Enteritis
239
Pheochromocytoma
Secretory granules with catecholamines
Present with HTN intermittently
Can measure urinary metanephrines/VMA
240
Meckel's Diverticulum
242
Pancreatic Endocrine Neoplasm
(Islet Cell Tumor - on the left)
Circumscribed/encapuslated.
In pancreas or region around pancreas.
243
What is celiac disease?
Gluten-sensitive enteropathy
A disorder resulting from hypersensitivity to gluten (protein component of wheat and other grains), which primarily affects the SI, leading to diarrhea and malabsorption (defective absorption of fats, vitamins, proteins, carbohydrates, and water).
244
Adrenal Cortical Adenoma
246
Parathyroid Hyperplasia
247
Alcoholic Liver Disease
248
Waterhouse-Friderichsen Syndrome
Acute adrenal insufficiency due to DIC/hemorrhage caused by Neiserria meningititides infection.
250
Gastrointestinal stromal tumor
Can arise anywhere in GI tract, thought to be due to Cajal cells
251
Appendicitis
253
Adrenal Cortical Adenoma
254
Normal Parathyroid Gland
Four glands (variable)
Mixture of chief cells (pale cytoplasm) and oxyphil cells (eosinophilic cytoplasm)
Variable amounts of adipose tissue (increases with age)
254
H. Pylori
256
Esophagitis (acute)
-Intercellular edema (spongiosis) and inflammatory cells in lamina propria
257
Hashimoto's Thyroiditis
Metaplasia
257
What are the most common primary sites for metastatic carcinoma?
GI tract, breast, and lung
259
Papillary thyroid carcinoma
How common is it?
Who is affect?
How does it present? (Gross/Histo)
Prognosis?
Most common type of thyroid carcinoma (75-85% of thyroid carcinoma)
Women more commonly affects, presents with cold thyroid nodule
Gross: solid/cystic, firm, fibrous, often infiltrative appearance
Histo: Papillae lined by cuboidal to columnar cells
Nuclear features characteristic (intranuclear pseudoinclusions; nuclear clearing/grooves)
Psammoma bodies (laminated calcifications)
Prognosis: 95% 10 year survival, commonly metastasize to regional lymph nodes
261
Diabetes Mellitus Type 1
Deposits of extracellular amyloid composed of amylin, which is co-secreted with insulin
261
Gastric Lymphoma
262
Pathologic findings in familial adenomatous polyposis
By young adulthood, (mean age = 16 years), the entire colon is typicalliy covered in a carpet of adenomatous polyps. Adenocarcinoma develops after an average of 10-15 years.
264
Papillary Carcinoma
Finger-like projections
264
Celiac Disease Pathogenesis Diagram
265
Chronic Gastritis
Loss of glands + fibrosis
266
Comparison of Type 1 and Type 2 Diabetes Mellitus
267
Neuroblastoma
268
What is steatosis?
Increased storage of lipid in liver, resulting in yellow appearance (macroscopic) and cytoplasmic vacuoles (microscopic)
May be due to variety of causes (alcohol, DM, obesity, protein malnutrition, metabolic disorders)
270
What is Waterhouse-Friderichsen Syndrome?
Hemorrhagic destruction of adrenals related to severe bacterial infection: Meningococcus, pneumococci, Staphylococci, Pseudomonas, Haemophilus
271
Two growth patterns of colorectal adenocarcinoma
1. Left colon: annular, apple-core lesions which often cause obstruction
2. Right colon: polypoid, fungating mass often causing bleeding
272
Serology of Celiac Disease
Antibodies:
Anti-transglutaminase
Anti-gluten
Anti-endomysial
273
Metastatic Carcinoma
273
Chronic Pancreatitis
274
Colonic Adenocarcinoma
275
What is a GIST?
Gastrointestinal stromal tumor of stomach
Major of mesenchymal tumors of GI tract now classified as GISTs.
Thought to be dervied from interstitial cells of Cajal (pacemaker cells of GI tract).
Histo: Spindled (elongated) tumor cells
275
Villous Adenoma
276
Steatosis
277
Follicular Adenoma
Confined by capsule, no vascular invasion
279
Adenocarcinoma arising in Barrett Esophagus
280
What is appendicitis?
Inflammation of the appendix, usually associated with obstruction (i.e fecalith)
281
Patient has Hashimoto's.
Patient takes oral contraceptives.
Patient has slightly elevated total T4 (with decreased free T4).
Why?
OCPs can increase the quantitiy of binding proteins and drive up the total T4 without changing the free fraction.
283
Papillary Carcinoma
Intra-nuclear pseudo-inclusions (invagination of cytoplasms)
284
Normal Small Intestine
286
Gross findings of DM pancreas
Pancreas may be small, atropic
287
Ischemic Enteritis
288
Presentation of Parathyroid Adenoma
Women \> men, 3:1
Usually too small to be palpated
Presentation related to hypercalcemia due to PTH secretion (80% asymptomatic)
Encapsulated, cellular neoplasm
Usually chief cells predominate, other cell types may be present
289
Cirrhosis
Blue collagen bands in trichome stain
290
Acute cholecystitis
PMNs infiltrating mucosa
291
What is Crohn's Disease?
A transmural granulomatous inflammatory disease that usually affects the terminal ileum or colon, but may involve any portion of the GI tract from mouth to anus.
292
Villous Adenoma
293
Gastric Ulcer
294
Appendicitis
296
-omas
297
Follicular Carcinoma
Vascular invasion
298
Pheochromocytoma
Adrenal medulla turns dark brown in a solution of chromium salts (oxidizes cathecholamines)
299
Alcoholic Hepatitis
Mallory Hyaline Body
300
What are the different causes of gastritis?
Alcohol, drugs (NSAIDS), bile reflux, stress, radiation, chemotherapy
300
What is Adenocarcinoma of the stomach associated with?
H. pylori infection
302
Normal Colon
304
Gastrointestinal stromal tumor
306
What is the most important screening test to determine functional status of the thyroid gland?
TSH assay: elevated in hypo, close to zero in hyperthroidism.
307
Gastric Adenocarcinoma
308
Microscopic findings in ulcerative colitis
1. Ulceration with acute and chronic inflammation
2. Crypt abscess formation
3. Crypt architectural distortion with branched crypts
4. Basal plasmacytosis
309
What are some differences between H. pylori and autoimmune gastritis?
Location, inflammatory infiltrate, acid production, gastrin, other lesions, serology, sequelae, and associations
310
Describe the anterior lobe of the pituitary gland
adenohypophysis: Origin from Rathke's pouch. Produces GH, FSH, LH, ACTH, TSH
Somatotrophs (30%) and Lactotrophs (20%) - lateral regions
Corticotrophs (15%) and thyrotrophs (10%) - central regions
Gonadotrophs (20%) - diffusely distributed
Histology: Mixed population of epithelial cells arranged in acini
Portal blood supply from hypothalamus to anterior pit.
311
What are complications of hereditary hemochromatosis?
Cirrhosis
Hepatocellular carcinoma
Hypopituitarism, skin pigmentation, cardiac failure, DM, arthropathy, testicular atrophy
312
PancreaticCarcinoma
313
Metastatic Carcinoma
315
Normal Stomach (fundus)
Chief cells - purple (Pepsinogen)
Parietal cells - pink (HCl, IF)
316
Acute Pancreatitis
317
How common are ductal adenocarcinomas?
Where in the pancreas do most of these malignancies occur?
Pretty common
85% of all pancreatic malignancies
2/3 occur in head of pancreas
318
Describe metastatic carcinoma
Usually multiple circumscribed nodules
319
Microscopic findings in pseudomembranous colitis?
Necrotic debris on mucosal surface consisting of necrotic epithelial cells, degenerating inflammatory cells, mucus, and fibrinous material
321
Adrenal Tuberculosis
Histiocytes or macrophages
322
Follicular Carcinoma
323
Diverticulosis
324
Acute Pancreatitis
325
Hashimoto's Thyroiditis
326
Acute Pancreatitis
327
Adenomatou Polyps diagram
328
Herpes Esophagitis
| (sharply demarcated lesions)
329
Pancreatic carcinoma
330
What is the gross and microscopic pathology of a pituitary adenoma?
Gross: Enlarged pituitary gland with mass effect (macroadenoma \>1cm) or circumscribed nodule within pituitary gland (micro
Microscopic: Disruption of normal pituitary architecture (sheets, expanded nests, trabeculae), monomorphous population of cells
331
Gross pathology of Celiac Disease
Flattening or loss (atrophy) of villi of the SI mucosa
332
Histology of ischemic enteritis/colitis
Necrosis and hemorrhage within affected regions
333
Pancreatic Carcinoma
334
What is the difference between a malignant and benign ulcer?
Can't absolutely distinguish between benign and malignant ulcers by macroscopic exam alone.
Benign: small, regular smooth edges
Malginant: large, irregular with "rolled" or "heaped up" borders
334
Crohn's Disease vs. Ulcerative Colitis (picture)
335
Steatosis
337
Parathyroid Adenoma
338
Choledocholithiasis
340
Normal Stomach
341
What is Meckel's Diverticulum
Persistence (failure of involution) of the intestinal end of the omphalomesenteric duct (connects the lumen of the lumen of the developing gut to the yolk sac)
True diverticulum having all 3 layers of the normal bowel
Located on anti-mesenteric side of the SI
May have gastric or pancreatic heterotopia
344
Ulcerative Colitis
346
Pituitary Adenoma
Expansion of gland into sella turcica
347
Pancreatic carcinoma
348
Viral Hepatitis
Balloon hepatocytes that are degrading
350
Pathogenesis of Hashimoto's Thyroiditis
351
Pheochromoctyoma Rule of 10
10% extra-adrenal (paraganglioma)
10% multiple (sporadic cases)
10% malignant
10% occur in children
10% familial (MEN2A/2B, NF-1, VHL)
352
Pancreatic Carcinoma
353
Steatosis
355
Describe the normal thyroid gland
15-25 gm in adults, but variable
Right & left lobes connected by isthmus, may have pyramidal lobe
Follicles lined by follicular epithelial cells (cuboidal/low columnar)
Colloid (stored thyroid hormone, thyroglobulin) appears eosinophilic, acellular material
Parafollicular "C" cells located between follicles
355
Crohn's Disease
356
Gastrinoma Triangle
357
Viral Hepatitis
359
Acini of cheif cells; granular cells = oxyphil cells
360
Gross findings in pseudomembranous colitis?
Pseudomembrane formation appearing as dirty green-yellow plaques
362
Gastric Lymphoma
363
What is chronic cholecystitis and how is it characterized?
Recurrent biliary colic or absence of prior acute cholecystitis, virtually always associated with gallstones
Wall thickened and fibrotic
Chronic inflammation
Entrapped epithelial crypts (Rokitansky-Aschoff sinuses)
364
Hepatocellular Carcinoma
366
Gastric Adenocarcinoma
367
Diabetes Complications (Picture 2)
369
What are some S/sx of Acromegaly?
371
Ischemic Enteritis
372
What is metaplasia?
Reversible change from one mature cell type into another. May represent adaptive (protective) change in response to injury
374
Herpes Esophagitis
Ground glass appearance
375
What are some of the mutations associated wth pancreatico adenocarcinoma?
K-Ras, p16, p53, BRCA2, DPC4/SMAD4
376
What is the most common malignant tumor of the liver?
Metastatic carcinoma
378
Gastrointestinal stromal tumor
380
Ischemic Enteritis
381
Multiple Endocrine Neoplasia (MEN) Syndromes
382
Metastatic Carcinoma
383
Viral Hepatitis (Hemorrhagic)
385
What explains visual defecits in AP adenomas?
Compression of the optic chiasm causes bitemporal loss of peripheral vision.
387
Diabetes Mellitus Type 1
Autoimmune destruction of islets.
Inflammation and infiltration by T lymphocytes (dark cells) = insulinitis
389
Barrett Esophagus
Low grade dsyplasia
390
What is the most common malignancy of th esophagus?
What are risk factors?
Where does it occur?
What is the prognosis?
What is the histology?
Squamous cell carcinoma
Risk factors: Alcohol, tobacco, consumption of hot beverages, dietary foods
Location: Upper 1/3 - 20%, Middle 1/3 - 50%, Lower 1/3 - 30%
Prognosis: usually advanced stage at time of Dx, poor prognosis, overall 5yr survival 20%
Histo: polygonal tumor cells with prominent intercellular bridges and foci and keratinization (Squamous pearls)
391
What are the common causes of hypoadrenalism?
Autoimmune adrenalitis
Granulomatous infections of the adrenal gland
Anterior Pituitary failure
392
How is Barrett's esophagus diagnosed?
Combination of clinical & pathologic criteria
Clinical: Endoscopic presence of salmon-colored mucosa above GE junction
Pathologic: Histologic evidence of intestinal metaplasia (presence of goblet cells) within columnar epithelium biopsied
394
Barrett Esophagus
High grade dysplasia
395
Gastric Ulcer
396
Esophageal Varices
397
Gastric Carcinoma
Signet Ring Cell Morphology
398
Gastric Adenocarcinoma
Signet ring cell morphology
400
Gastric Adenocarcinoma
401
What serum marker may be elevated in hepatocellular carcinoma?
Alpha feto-protein
403
What is a goiter?
Enlargement of the thyroid gland
Nodular vs. diffuse
Hyper vs. hypofunctioning
403
What is reflux esophagitis?
What is it characterized by?
Due to acid reflux; characterized by intra-epithelial inflammatory cells (esp. eosinophils), basal layer hyperplasia, spongiosis, and elongation of papillae of lamina propria
404
Alcoholic Hepatitis
Typically involves neutrophils that infiltrate lobules
406
Normal anterior pituitary
GH Antibody staining
407
Barrett Esophagus
409
Adrenal Tuberculosis
410
Appendicitis
411
What is the macroscopic and microscopic description of hepatocellular carcinoma?
Macro: single/multiple, may have bile staining
Micro: Atypical hepatocytes with nuclear pleomorphisms, thickened trabeculae (several layers thick), absent portal tracts
412
Cholelithiasis
414
What is dysplasia?
Pre-malignant change involving abnormalities in nuclear size, shape, and (lack of) maturation
416
Follicular Carcinoma
Capsule invasion
417
Ulcerative Colitis
418
Cholelithiasis
420
What hormone does medullary thyroid carcinoma most commonly secrete?
Calcitonin
| (ACTH also possible)
421
Squamous Cell Carcinoma of Esophagus with keratin pearls
422
Describe Carcinoid Syndrome
- Only seen in the presence of hepatic metastasis (liver normally inactivates 5-HT secreted by tumor)
- Sx include abdominal cramps, diarrhea, bronchospasm, episodic facial flushing (due to vasodilation), cardiac valve fibrosis
Carcinoid tumors have roughly equal incidence as carcinomas.
Carcinoid tumors (neuroendocrine tumors) may produce bioactive substances (ie. serotonin or 5-HT).
All carcinoid tumors are potentially malignant (although appendicieal and rectal carcinoids rarely metastasize).
423
Papillary Carcinoma
Calcification
424
Zollinger-Ellison syndrome
Gastrinoma, acid hypersecretion, peptic ulcers
Associated with gastrinoma
425
Pituitary Adenoma
426
Adrenal Cortical Carcinoma
Vascular invasion, metastasis = malignancy
427
Function of calcitonin?
Help lower serum calcium
428
Pheochromocytoma
429
Etiology of Hypoadrenalism
Adrenocortical Insufficiency
Primary: chronic (Addison's) or acute (Waterhouse-Friderichsen)
Secondary: Pituitary insufficiency or exogenous corticosteroids
430
Diabetes Complications (Picture 1)
431
Celiac Disease
432
Colonic Adenocarcinoma
433
Radionuclide scan
Top left: Normal, moderate homogeneous uptake
Top right: Grave's, diffuse increased uptake
Bottom Left: Multi-nodular goiter, heterogeneous uptake
Bottom right: Thyroid neoplasm/cyst; Cold nodule
434
Gastric Ulcer
435
What is chronic pancreatitis?
Usually not associated with acute pancreatitis
Chronic inflammation, ductal ectasia, squamous metaplasia of ducts, calcification, fibrosis, stone formation, pseudocysts
436
Adenocarcinoma of Esophagus
437
Alcoholic Hepatitis Mallory Body
Eosinophilic inclusion, composed mostly of filaments caused by damage to filaments to form cytokeratin
\*EXAM\*
439
Pheochromocytoma Gross and Microscopic findings
Indicator of malignancy
Gross: well demarcated, very vascular, pale grey to light brown tumors; tumor turns dark brown in chromium salt solution (Zenker's solution); "pheochrome" refers to affinity for chromium salts
Microscopy: Large cells with basophilic granular cytoplasm, arranged in small nests separated by capillaries; may have nuclear pleomorphism and mitotic activty
Malignancy: metastatis
441
Adenocarcinoma of Esophagus
442
Gastric Lymphoma
443
Papillary Carcinoma
Nuclear groove "Coffee beans"
445
Crohn's Disease
447
What HLA types are strongly associated with Graves disease?
HLA-B8
HLA-DR3
448
Familial Adenomatous Polyposis
449
What are some associated findings of gastritis?
Erosion/ulceration
Intestinal metaplasia
Atrophy & fibrosis
451
Esophageal Varices
451
Gastric Adenocarcinoma
452
Genetics of familial adenomatous polyposis
Mutation in the adenomatous polyposis coli tumor-suppressor gene on Ch 5q21
453
Hypertrophic Gastropathy
455
Pituitary MacroAdenoma
456
Pseudomembranous Colitis
457
Adrenal Tuberculosis
Activated T cells
Langhans nucleated cells
458
Presentation of Insulinoma
Most common functioning islet cell tumor.
Presents with episodic hypoglycemic attacks, low blood glucose, symptoms precipitated by fasting or exercise, symptoms relieved by glucose.
High plasma insulin levels, increased insulin:glucose.
90% are solitary tumors, may be small and require special imaging.
Only 10% are malignant.
459
Neuroblastoma Gross and Microscopic Findings
Gross: Large tumors (6-8cm avg.), sof, white, with areas of hemorrhage, necrosis, or calcification
Microscopic: Small blue cell tumor arranged in diffuse sheets (may see Homer Wright rosettes)
90% produce catecholamines (urinary metanephrines/VMA elevated)
460
Cholelithiasis
461
Diverticulosis
462
Villous Adenoma
464
Tubular Adenoma
465
Gastric Ulcer
466
Malignant Gastrointestinal stromal tumor
467
Normal Parathyroid Gland
468
Ulcerative Colitis
469
What is familial adenomatous polyposis?
An inhertied, autosomal dominant condition in which affected patients develop innumerable adenomatous polyps of the colon and subsequently, invasive adenocarcinoma.
470
Colon Carcinoma
471
What is the Whipple triad?
1. Sx of hypoglycemia are present (esp. confusion, stupor, loss of consciousness)
2. Hypoglycemia is present, typically glucose less than 50 mg/dL
3. Attacks are precipitated by fasting or exercise and are promptly relieved by administration of glucose
473
Pancreatic Endocrine Neoplasm
(Islet Cell Tumor)
Circumscribed/encapuslated.
In pancreas or region around pancreas.
474
Gastric Adenocarcinoma
476
Gastric Ulcer
478
How is GIST treated?
Majority of GIST express CD117 ("c-kit") which is the molecular target of tyrosine kinase inhibitor (Imatinib)
479
Colon Carcinoma
482
Crohn's Disease diagram
483
Viral Hepatitis
484
Cholelithiasis (Pigment Gallstones)
Indicative of chronic hemolysis
485
Hepatocellular Carcinoma
Small tumors at periphery
486
Viral Hepatitis
Acidophilic (Councilman) body (arrow)
A hepatocyte undergoing apoptosis
487
Chronic cholecystitis
488
Diabetes Mellitus Type 1
Amyloid deposits
489
What is the origin of amyloid in medullary thyroid carcinoma?
Excess procalcitonin deposition
490
Normal Thyroid
491
PT Hyperplasia
492
Follicular carcinoma
Who does this affect?
Gross/Histo
Metastasizes to \_\_\_
Prognosis
15-20% of thyroid carcinomas
Women predominantly affected, older age group
Gross: Widely invasive or encapsulated nodule
Histo: Widely invasive-extensive infiltration of normal thyroid or vascular invasion
"Minimally invasive"-capsuclar or vascular invasion present
Hematogenous metastasis to lungs/bones
Prognosis: Widely invasive (50% 10yr survival); minimally invasive (90% 10yr survival)
493
Hepatocellular Carcinoma
495
Gastric Ulcer
496
Diffuse Hyperplasia
Who, Pathogenesis, Gross/Histo
Grave's Disease Classic triad: hyperthyroidism, ophthalmopathy (exophthalmos), pretibial myxedema
Who: Young women (20-40 y.o)
Pathogenesis: TSI, anti-TSH Ab, Thyroid growth-stimulating immunoglobulins
Gross: symmetric enlargement of thyroid gland
Histo: Follicular hyperplasia with papillary infoldings, tall/columnar cells, scallping of margins of colloid within follicles
497
Grave's Disease
Resorption vacuoles
498
Describe a pancreatic adenocarinoma (macro/microscopically)
Macro: Infiltrative, firm, tan-white tumor
Micro: irregular ducts/glands lined by atypical cuboidal to columnar cells, desmoplastic stromal response
499
What are adenomatous polyps?
Common, benign neoplasms of the colorectal mucosa which are associated with increased risk of developing carcinoma, either within the polyp or at other colorectal sites.
500
What is autoimmune gastritis?
What are some symptoms?
Autoantibodies against parietal cells, H/K ATPase, or IF
Chronic inflammation leads to mucosal injury and eventual atrophy.
Achlorhydria (low acid production) and hypergastrinemia
Pernicious anemia (B12 deficiency)
Increased risk for gastric cancer
502
Metastatic Gastric Carcinoma in Lung
503
Herpes Esophagitis
Loss of mucosa + exudate forming
505
Crohn's Disease
506
Medullary Carcinoma
Apple-green birefringence
508
Pituitary Adenoma
Monomorphic & arranged in sheets, not acini
509
Adrenal Cortical Carcinoma
More mitotically active.
510
Adrenal Cortical Adeonoma
Left: tumor
Right: Residual normal adrenal tissue
512
Familial Adenomatous Polyposis
513
Colonic Adenocarcinoma
514
What are the damaging and defensive forces of the stomach?
What causes each?
Damaging: gastric acid, peptic enzymes
Caused by: H. pylori, NSAIDS, aspirin, cigarettes, alcohol, gastric hyperacidity, duodenal gastric reflux
Defensive: surface mucus secretion, HCO3 secretion into mucus, mucosal blood flow, apical surface membrane transport, epithelial regenerative capacity, elaboration of prostaglandins
Caused by: Ischemia, shock, delayed gastric emptying, and host factors
516
Pheochromocytoma
517
Diagnosis of Adrenal Cortical Carcinoma
May have hemorrhage and necrosis
May appear encapsulated or circumscribed
519
Parathyroid Adenoma
519
Molecular pathogenesis of familial adenomatous polyposis
APC protine has normal functions within the cytoskeleton and in the intercellular adhesion. APC binds to the cytoskeletal protein beta-catenin in a complex with the cell adhesion molecule E-cadherin. When not bount to E-cadherin, beta-catenin also binds T-cell factor/lymphoid enhancer factor, which is a transcriptional activator of various genes involved in cell proliferation and inhibition of apoptosis. By binding to beta-catenin, APC promotes beta-catenin degradation. A mutation in the APC gene leads to decreased affinity for beta-catenin, thereby leading to a state of increased cell proliferation that predisposes to the development of carcinoma.
520
Crohn's Disease Pathogenesis
521
What is acute pancreatitis associated with?
80% of cases associated with gallstones or alcoholism
522
Squamous Cell Carcinoma of Esophagus
523
Gastric Adenocarcinoma
Signet ring cell morphology
524
Cirrhosis
525
Gastric Ulcer
526
Pheochromocytoma
527
Islets of Langerhans
Clusters of uniform cells scattred within exorine pancreas
528
Presentation of Glucagonoma
Mainly adult females (perimenopausal or postmenopausal).
Associated with glucagonoma synrome: mild glucose intolerance, anemia, skin rash "necrolytic migratory erythema", weight loss, glossitis/stomatitis
High plasma glucagon levels
Overall 60-70% malignant
Usually malignant if associated with glucagonoma syndrome, otherwise benign
529
Hemochromatosis
Excessive hemosiderin stores
530
Adenocarcinoma of Esophagus
532
Waterhouse-Friderichsen Syndrome
Hemorrhagic necrosis of adrenal glands.
Acute adrenal insufficiency due to DIC/hemorrhage caused by Neiserria meningititides infection.
533
Meckel's Diverticulum Complication
Volvulus
534
How can you differentiate between hypoglycemia caused by beta-cell tumors and self-induction by insulin/sulfonylureas?
Beta-cell tumors are accompanied by high serum levels of C peptide.
535
Ischemic Enteritis
536
Nodular hyperplasia
Multinodular goiter
Idiopathic, usually clinicaly euthyroid
Mutliple nodules, often with one dominant nodule
Variable appearances: large/cellular/hyperplastic nodules, hemorrhage, cystic degeneration
537
Ulcerative Colitis
538
Pheochromocytoma Diagnosis
Elevated urine metanephrines and vanillylmandelic acid (VMA), which are metabolites of cathecholamines
539
Follicular Adenoma
540
Presentation of Adrenal Tuberculosis
Infection of adrenal glands by Mycobacterium tuberculosis
Formely the most comon cause of chronic adrenal insufficiency
Granulomatous inflammation: epitheliod histiocytes, giant cells, and acid-fast bacilli
541
S/Sx of Hashimoto's Thyroiditis
542
Gastric Lymphoma
543
Pseudomembranous Colitis
544
Parathyroid Carcinoma
Very uncommon.
Tend to have higher Ca++ levels because they're larger.
Invasive to soft tissues of the neck.
545
Cirrhosis
547
Adenomatous Polyps:
Two main Growth patterns
Three histologic subtypes
1. Pedunculated
2. sessile
1. Tubular adenoma (\>90%): exhibit more than 75% tubular pattern
2. Tubulovillous adenoma (5-10%): exhibit 25-50% villous pattern
3. Villous adenoma (1%): exhibit more than 50% villous pattern
548
Histology of Celiac Disease
Diffuse inflammation within lamina propria and epithelium, along with partial or complete loss of villi (villous:crypt ratio is reversed)
549
Acute Pancreatitis
550
Adenocarcinoma of GB
551
Gastric Adenocarcinoma
552
What is pseudomembranous colitis?
Iatrogenic disease due to antibiotic therapy (classically clindamycin), which alters the normal intestinal flora and allows overgrowth of *Clostridium difficile*. Certain strains of *C. difficile* produce a cytotoxin (toxin A and/or B), which results in epithelial necrosis.
553
Pituitary Adenoma
Salt & Pepper chromatin
554
Hemochromatosis
555
Porcelain Gallbladder
556
Normal Appendix
557
What are 2 types of infectious esophagitis?
Describe them.
Herpes esophagitis: Sharply "punched out" ulcers with multinucleated giant cells and intranuclear "ground glass" inclusions
Candida esophagitis: Gray-yellow exudates with yeast/pseudohyphae
558
Hypertrophic gastropathy
Hyperplasia of mucus-secreting cells
559
Describe the posterior lobe of the pituitary gland
Neurohypophysis: origin-floor of 3rd ventricle
Releases vasopressin (ADH) and oxytocin - hormones produced in hypothalamus and travel in axons to posterior lobe)
560
Gastric Polyploid Carcinoma
561
What are some risk factors for pigment stones?
Chronic hemolysis
Certain infections (Bacteria - E. coli; Parasites - Clonorchis)
GI disorders
562
Barrett Esophagus
Left side replaced by columnar glandular mucosa
563
Esophageal Varices (ulceration that became thrombosed)
564
What is an adenocarcinoma of the Gallbladder?
- How often does it occur?
- Who does it occur in most?
- Association with gallstones?
Rare malignancy that is more common in females
80-90% associated with gallstones
Most have invaded liver by time of diagnosis
Uniformly fatal
565
Crohn's Disease
566
Cirrhosis
Shrunken, atrophic liver (scarring then liver tries to regenerate, forming nodules)
567
Pathogenesis of various carcinomas
568
Presentation of Cushing's Syndrome
569
Gastritis with erosions
570
What is the prognosis of pancreatic adenocarcinoma?
Overall poor prognosis: 10% 1-year survival; 2% 5-year survival
571
Squamous Cell Carcinoma of Esophagus
572
Crohn's Disease
573
Adrenal Gland
