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MD4 Pathology > MD4 Smorgasbord > Flashcards

MD4 Smorgasbord Flashcards

1
Q

Pheochromocytoma Clinical Presentation

A

Severe or episodic HTN, palpitations, tachycardia, anxiety, and excessive sweating

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1
Q
A

Steatosis

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1
Q
A

Chronic Cholecystitis

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2
Q

What is the prognosis of hepatocellular carcinoma?

A

Poor

10% 5-year survival

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3
Q
A

Adenomatous Polyps

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4
Q

Progression of normal epithelium to adenocarcinoma

A
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4
Q
A

Hemochromatosis

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5
Q
A

Pancreatic Endocrine Neoplasm

(Islet Cell Tumor - cells are well-differentiated)

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5
Q
A

Acute Hemorrhagic Gastritis

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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)

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6
Q
A

Pheochromocytoma

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6
Q
A

Hypertrophic gastropathy

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6
Q
A

Chronic Pancreatitis Pancreatic pseudocyst

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7
Q
A

Medullary Carcinoma

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7
Q
A

Normal Stomach

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7
Q
A

Gastric Ulcer

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8
Q

MEN-1 vs. MEN-2

A
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9
Q
A

Ischemic Enteritis

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10
Q

What is the most common cause of chronic gastritis?

A

Helicobacter pylori. Spiral bacteria may be found in gastric biopsies

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11
Q
A

Cortex

Zona Glomerulosa

Zona Fasciculata

Zona Reticularis

Medulla

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11
Q
A

Metastatic Carcinoma

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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
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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)

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13
Q
A

Grave’s Disease

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13
Q
A

Waterhouse-Friderichsen Syndrome purpura

Acute adrenal insufficiency due to DIC/hemorrhage caused by Neiserria meningititides infection.

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13
Q
A

Adrenal Cortical Carcinoma

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13
Q
A

Candida Esophagitis

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13
Q
A

Cirrhosis

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13
Q

What are predisposing factors for hepatocellular carcinoma (hepatoma)?

A

Cirrhosis

Hep B and C

Thorotrast (formerly used as radiographic contrast agent)

Alcohol

Radiation

Alpha-1 antitrypsin deficiency

Hemochromatosis

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14
Q

what is hereditary hemochromatosis?

A

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

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14
Q

What are some complications of acute pancreatitis?

A

Systemic organ failure, shock, ARDS, acute renal failure

DIC

Pancreatic abscess

Pancreatic pseudocyst

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15
Q
A

Adrenal Cortical Adenoma

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17
Q
A

Normal Thyroid

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17
Q
A

Carcinoid Tumor

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17
Q
A

Chronic Pancreatitis Pancreaticpseudocyst (no epithelial lining)

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18
Q
A

Parathyroid Hyperplasia

Sestamibi Scan

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18
Q

Layers of Adrenal Gland

A

Outer yellow cortex and red brown medulla (10:1)

Zona glomerulosa (10-15%): mineralocorticoids

Zona Fasciculata (60-70%): glucocorticoids

Zona Reticularis (20-30%): androgens

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19
Q
A

Gastric Lymphoma

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19
Q
A

Viral Hepatitis B

Ground glass change - cytoplasm turns into smooth ground glass appearance due to viral replication

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20
Q

Etiology of Hyperparathyroidism

A
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20
Q
A

Normal esophagus by endoscopy

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20
Q
A

Gastric Adenocarcinoma

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20
Q

Gross pathology of ischemic enteritis/colitis

A

Dusky discoloration of the bowel, blood in lumen

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21
Q
A

Squamous Cell Carcinoma of Esophagus

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22
Q
A

Reflux Esophagitis (increased eosinophils)

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23
Q
A

Metastatic Gastric Carcinoma

Virchow’s node

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23
Q

Two hereditary colon cancer syndromes

A
  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
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24
Q
A

Acute Pancreatitis

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25
Q
A

Colon Carcinoma

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27
Q
A

Pituitary Adenoma

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27
Q

What is the stalk effect?

(in terms of excess prolactin)

A

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.

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27
Q
A

Acute Pancreatitis

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28
Q
A

Hashimoto’s Thyroiditis

Lymphoid follicle with germinal center

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29
Q
A

Hepatocellular Carcinoma

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30
Q
A

Papillary Carcinoma

Calcification - Somoma body

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31
Q
A

Medullary Carcinoma

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32
Q
A

Pancreatic carcinoma

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33
Q
A

Papillary Carcinoma

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33
Q
A

Esophageal Varices

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34
Q

Local complications of ulcerative colitis

A
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35
Q
A

Cholelithiasis

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36
Q
A

Cirrhosis

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37
Q
A

Gastric Ulcer

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37
Q
A

Acute Pancreatitis

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38
Q
A

Insulinoma

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38
Q
A

Esophageal Varices

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38
Q
A

Tubular Adenoma

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39
Q
A

Left: Zona Fasciculata

Right: Zona Reticularis

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39
Q
A

Normal

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40
Q

Medullary carcinoma

How common is it

Associations

Produces ____

Due to ____

Histo

Metastasis

A

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

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42
Q
A

Follicular Adenoma

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43
Q
A

Herpes Esophagitis

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43
Q

Lymphomas of the stomach

What is the most common form?

A

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)

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43
Q

What is alcoholic hepatitis?

A

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)

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44
Q
A

Papillary Carcinoma

Nuclear clearing - pale “orphan annie” nuclei

Blood vessels & cuboidal tumor cells

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44
Q
A

Esophageal Varices (ulceration + hemorrhage)

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44
Q
A

Cirrhosis

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45
Q
A

Celiac Disease

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46
Q
A

Normal Endocrine Pancreas

Antibody staining for insulin in beta-cells

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46
Q

Systemic complications of ulcerative colitis

A
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47
Q
A
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48
Q
A

Medullary Carcinoma

Dense secretory core granules

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48
Q

What are the associated metastases of stomach adenocarcinoma?

A

Left supraclavicular lymph node (Virchow’s node) or both ovaries (Krukenberg tumor)

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49
Q
A

Chronic Pancreatitis

Concretions and atrophy replaced by chronic scar tissue

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50
Q

What is the Rule of 2s of Meckel’s Diverticulum

A
  1. Affects 2% of the population
  2. Located within 2 ft of the ileocecal valve
  3. Approximately 2 inches long
  4. 2% are symptomatic
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50
Q
A

Acute cholecystitis

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50
Q

How do gallstones form

A

Secondary to supersaturation of bile

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51
Q
A

Adrenal Cortical Carcinoma

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52
Q
A

Multiple Endocrine Neoplasia 2B

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53
Q
A

Normal Stomach (Fundus)

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54
Q
A

Follicular Carcinoma

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55
Q
A

Adrenal Cortical Adenoma

Right: tumor, often with much lipid

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55
Q
A

Meckel’s Diverticulum

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56
Q

Presentation of Gastrinoma

A

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

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57
Q

Adrenal Cortical Adenoma gross and microscopic findings

A

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

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57
Q
A

Appendicitis

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57
Q
A

Adenocarcinoma of GB

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58
Q

Pancreatic Endocrine Neoplasm:

Epidemiology

Area of pancreas that is affected

Functional?

Histology

A

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

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58
Q
A

Adenocarcinoma of Esophagus

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58
Q
A

Celiac Disease

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58
Q
A

Alcoholic Hepatitis

Arrow: Mallory body

Aggregate of inflammatory cells *largely neutrophils

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59
Q

What are the 2 main disorders of Hypertrophic Gastropathy?

A

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.

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60
Q
A

Hashimoto’s Thyroiditis

Oncocytic Herthle cells

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60
Q
A

Thyroid nodular hyperplasia

no capsule, benign

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61
Q
A

Parathyroid Adenoma

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61
Q
A

Gastrointestinal stromal tumor

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62
Q

Neuroblastoma Epi

A

7-10% of all childhood malignancies

2nd most common childhood solid malignancy

80% occur in children

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64
Q

Graves’ vs. Hashimoto’s Pathogenesis

A
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65
Q

What genetic alteration can be found in papillary thyroid carcinoma?

A

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)

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66
Q
A

Meckel’s Diverticulum Complication

Intussusception

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66
Q

How do you distinguish hemochromatosis from secondary hemosiderosis?

A

Quantitative irone analysis

Secondary hemosiderosis = iron overload where iron accumulation typically affects Kupffer cells

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68
Q
A

Pituitary Adenoma

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68
Q
A

Ischemic Enteritis

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69
Q

RET Protooncogene mutations in MEN type 2

A
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70
Q
A

Acute Viral Hepatitis

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71
Q
A

Ulcerative Colitis

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71
Q
A

Villous Adenoma

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72
Q
A

Multiple Endocrine Neoplasia 2B

Mucosal neuromas

Have C cell hyperplasia nodules

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72
Q
A

Tubular Adenoma

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73
Q

S/Sx of thyroid hyperplasia

A
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74
Q
A

Barrett Esophagus

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74
Q
A

Squamous Cell Carcinoma of Esophagus

50% mid-esophagus, 30% distal, 20% proximal

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74
Q

What is hypertrophic gastropathy characterized by?

A

Giant, “cerebriform” enlargement of rugal folds of gastric mucosa due to hyperplasia of epithelial cells

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75
Q
A

Gastric Adenocarcinoma

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75
Q

Gross finidings in ulcerative colitis

A
  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
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75
Q

What are some complications of cirrhosis?

A

Portal HTN

Esophageal varices

Ascites

Splenomegaly

Hepatic encephalopathy

Hepatocellular carcinoma

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76
Q

Epi of colorectal adenocarcinoma?

A

Second leading cause of cancer death in U.S.

Adenocarcinoma accounts for 98% of all cancers of large intestine

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77
Q
A

Crohn’s Disease

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79
Q
A

Normal Endocrine Pancreas

Antibody staining for glucagon in alpha-cells

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79
Q

Microscopic findings in DM pancreas (Types 1, 2)

A

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)

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79
Q

What are the types of gallstones

A

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
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80
Q

Etiology of Hypercortisolism

A

Cushing’s Syndrome

Pituitary (Cushing’s Disease): 60-70%

Adrenal: 20-25%

Ectopic: 10-15%

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82
Q

What are some S/Sx of Cushing’s?

A
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82
Q
A

Herpes Esophagitis

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82
Q
A

Viral Hepatitis

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84
Q
A

Grave’s Disease

Resorption vacuoles; Hypertrophic columnar follicular cells

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84
Q
A

Candida Esophagitis

Pseudomembranes

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85
Q
A

Adrenal Cortical Carcinoma

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86
Q
A

Hemochromatosis

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87
Q

What are esophageal varices?

A

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

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88
Q
A

Neuroblastoma

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88
Q
A

Normal Small Intestine

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88
Q

What is the clinical significance of adenomatous polyps?

A

Patients are at increased risk of developing colorectal adenocarcinoma

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90
Q

Describe Gross/Histo of Follicular adenoma

A

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

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90
Q

What drug can be given for a prolactinoma?

A

Bromocriptine:

Dopamine agonist that inhibits PRL secretion and shrinks lactotrophs

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90
Q
A

Pseudomembranous Colitis

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90
Q

Immunology of Celiac Disease

A

Associated with HLA-DQ2 or HLA-DQ8

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90
Q
A

Metastatic Carcinoma

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91
Q
A

Pituitary Adenoma

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91
Q

Gross finidings in appendicitis

A

Swollen appendix with serosal exudates

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92
Q

Manifestations of Parathyroid Adenoma

A
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92
Q
A

Gastric Adenocarcinoma

Signet Ring Cell Morphology

With stain for cytokeratin (ensures that it’s carcinoma, not macrophage)

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93
Q

What is the traditional classification of cirrhosis (and its associated diseases)?

A

Macronodular (>3 mm)

  • Viral hepatitis
  • Alpha-1 antitrypisin deficiency
  • Wilson’s Disease

Micronodular (

  • Alcoholism
  • Hemochromatosis
  • Primary biliary cirrhosis
  • Wilson’s Disease
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94
Q

Presentation of Waterhouse: Friderichsen Syndrome

A

Rapidly progressive hypotension leading to shock

DIC with purpura

Pathology: Bilateral adrenal hemorrhage and necrosis

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94
Q
A

Gastric Adenocarcinoma

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95
Q

What is diverticular disease?

A

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.

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96
Q

Types of necrosis in ischemic enteritis/colitis

A
  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)
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97
Q

Which is more common:

Primary tumors of the SI

Metastatic tumor involving SI

A

Metastatic.

Primary are relatively rare.

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98
Q
A

Gastric Carcinoma (Polyploid/ulcerated)

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99
Q

MEN-2B: Gorlin’s Syndrome

A

Mutation in RET oncogene

Medullary carcinoma of thyroid

Pheochromocytoma of adrenal gland

Mucosal neuromas (oral cavity, GI tract, etc.)

Marfanoid appearance

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99
Q
A

Diverticulosis

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100
Q

Microscopic findings in Crohn’s Disease

A
  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)
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101
Q

What is the histology of gastritis?

A

Increased numbers of inflammatory cells within lamina propria, including lymphocytes, plasma cells, and neutrophils.

Neutrophils often infiltrate mucosal epithelium (“active” gastritis)

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102
Q
A

Parathyroid Adenoma

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102
Q
A

Carcinoid Tumor

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104
Q
A

Adrenal Cortical Carcinoma

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104
Q

What is the change that happens in Barrett’s esophagus?

A

Intestinal metaplasia (goblet cell metaplasia) of distal esophagus in response to acid-reflux

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106
Q
A

Follicular Adenoma

Contained by fibrous capsule (top left is adenoma)

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107
Q
A

Normal Stomach (Antrum)

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108
Q

Describe a normal Esophagus

A

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

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110
Q
A

Hashimoto’s Thyroiditis

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110
Q
A

Cortex

Zona Glomerulosa

Zona Fasciculata

Zona Reticularis

Medulla

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110
Q

What is an erosion?

What is an ulcer?

A

Erosion: Partial thickness loss of mucosal tissue

Ulcer: Full-thickness loss of mucosa

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111
Q

What is ischemic enteritis/colitis?

A

Necrosis of the bowel due to insufficient blood supply

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112
Q
A

Ulcerative Colitis

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112
Q
A

Hemochromatosis

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113
Q
A

Adrenal Cortical Carcinoma

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115
Q

What form of hyperthyroidism shows exopthalmos?

A

Graves Disease. Only.

Treatment of graves focuses on reducing T4 secretion. This does not affect exophthalmos because it is an autoimmune problem (with TSI).

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116
Q

Adrenal Cortical Adenoma

Microscopic findings

Features of malignancy

Median survival

A

Microscopy: May be frankly anaplatic or resemble tumor cells of adrenal cortical adenoma

Malignancy: vascular invasion or metastasis

Survival: ~2 years

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117
Q
A

Candida Esophagitis

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117
Q
A

Gastric Adenocarcinoma

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118
Q
A

Normal Thyroid

Parafollicular cells only in lateral lobes (from neural crest)

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119
Q

Compare and contrast Menetrier Disease (adult) and Zollinger-Ellison Syndrome

A

Both are examples of Hypertrophic gastropathy

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120
Q
A

Gastric Ulcer

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121
Q
A

Waterhouse-Friderichsen Syndrome

Hemorrhagic necrosis of adrenal glands.

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122
Q
A

Celiac Disease

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123
Q

What are some complications of chronic pancreatitis?

A

Pseudocyst

Duct obstruction

Malabsorption, steatorrhea

Secondary diabetes

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125
Q
A

Normal Posterior Pituitary

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126
Q
A

Normal Endocrine Pancreas

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128
Q

What causes enlargement of the thyroid gland in Hashimoto’s thyroiditis?

A

Infiltration by lymphoid cells.

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129
Q

Do medullary carcinomas arise in the thyroid isthmus or thyroglossal duct remnants?

A

No. C cells migrate from neural crest to lateral thyroid lobes.

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130
Q
A

Adrenal Cortical Adenoma

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130
Q
A

Malignant Gastrointestinal stromal tumor

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131
Q

What are the different parts of the stomach?

A
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132
Q

What are some copmlications of ulcers?

A

Bledding, performation, obstruction

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134
Q
A

Medullary Carcinoma

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134
Q
A

Adrenal Tuberculosis

Caseous Necrosis

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135
Q
A

Gastritis

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135
Q
A

Diverticulosis

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136
Q

What are some features that favor GIST malignancy?

A

Tumor size (>5 cm)

Increased mitotic rate (>5 mitotic figures/50 high power fields)

Presence of tumor necrosis

Mucosal invasion

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138
Q

MEN-1: Wermer’s Syndrome

A

Mutation in MEN-1 gene (11q13)

Parathyroid hyperplasia/adenoma

Pituitary adenoma

Pancreatic (or duodenal) islet cell tumor (symptomatic tumors are commonly gastrinoma or insulinoma)

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139
Q
A

Gastrointestinal stromal tumor

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141
Q
A

Hashimoto’s Thyroiditis

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142
Q
A

Pseudomembranous Colitis

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143
Q

What are the gross and histologic patterns of adenocarcinoma of the stomach?

A

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

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144
Q
A

Hypertrophic gastropathy

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144
Q

What is the definition of cirrhosis?

A

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

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145
Q
A

Diverticulosis

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146
Q

Describe (macro and micro) the normal gall bladder

A

Macro: sac-like with thin wall and green mucosal lining

Micro: columnar epithelial lining, lamina propria, muscularis propria (no muscularis mucosae or submucosa)

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148
Q
A

Neuroblastoma

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150
Q
A

Parathyroid Carcinoma.

Bands of fibrous tissue.

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151
Q

What is Hashimoto’s thyroiditis?

A

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

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152
Q
A

Multiple Endocrine Neoplasia

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152
Q

Are celiacs at increased risk for malignancy?

A

Yes: lymphoma and carcinoma

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153
Q
A

Gastric Lymphoma

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153
Q
A

Celiac Disease

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154
Q
A

Medullary Carcinoma

Amyloid composed of pro-calcitonin

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155
Q
A

Pancreatic Endocrine Neoplasm

(Islet Cell Tumor - arranged in groups)

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156
Q

Describe a normal stomach

A

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.

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158
Q
A

Thyroid Nodular hyperplasia

Due to iodine deficiency, diet, meds/genetics

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159
Q

Colorectal adenocarcinoma malignant tumors

A
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160
Q

Gross findings in Crohn’s Disease

A
  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
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160
Q
A

Viral Hepatitis

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160
Q

Risk factors for cholesterol stones

A

Female, fat, >40, fertile

Drugs

GI disorders

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162
Q
A

Normal Pituitary Gland

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163
Q

What is the prognosis of stomach adenocarcinoma?

A

Depends on stage, overall 5 year survival about 30%

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165
Q
A

Hashimoto’s Thyroiditis

“Fish-flesh” and infiltrated by lymphocytes

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167
Q

4 major and 2 minor cells types of endocrine pancreas and their hormones

A
  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
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168
Q
A

Gastric Ulcer (Malignant)

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169
Q

What skin condition is associated with celiacs?

A

Dermatitis herpetiformis: blistering skin disorder with IgA deposits

170
Q
A

Crohn’s Disease

172
Q
A

Neuroblastoma

Left: area of necrosis

172
Q
A

Hypertrophic gastropathy

173
Q
A

Diverticulosis

174
Q
A

Reflux Esophagitis

175
Q

Microscopic findings in appendicitis

A

Acute inflammation (neutrophils) infiltrating muscularis propria, often with mucosal inflammation/ulceration

176
Q
A

Diabetes Mellitus Type 1

Congo red stain of amyloid

177
Q
A

Pseudomembranous Colitis

178
Q
A

Adenocarcinoma of Esophagus

178
Q
A

Carcinoid Tumor

179
Q

Where do adenocarcinomas of the esophagus occur?

What are some other risk factors?

What are adenocarcinomas?

What is it associated with?

Prognosis?

A

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
Q
A

Chronic Cholecystitis

181
Q

Immunohistochemistry for mismatch repair proteins

A

Immunohistochemistry for mismatch repair proteins

182
Q

How do you distinguish chronic from acute hepatitis?

A

Distinction from acute made clinically, not pathologically

Usually requires elevation of liver enzymes for >6 months (or persistently elevated viral load)

183
Q

Complications of Meckel’s Diverticulum

A
  1. Peptic ulcer (if gastric mucosa present)
  2. Infection - may mimic acute appendicitis
  3. Volvulus
  4. Intussusception
185
Q
A

Adrenal Tuberculosis

Acid Fast Bacilli

186
Q
A

Ulcerative Colitis

186
Q

What is acute hepatitis characterized by?

A

Inflammation (mostly lymphocytic, with some neutrophils and eosinophils)

Lobular disarray

Ballooning degeneration

Acidophil (Councilman) bodies

May see bridging necrosis (severe cases)

188
Q

What is the grosss and microscopic pathology of Hashimoto’s thyroiditis?

A

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
Q

What is acute pancreatitis characterized by?

A

Diffuse edema, acute inflammation, hemorrhage, fat necrosis, fibrosis, calcification

20% mortality

189
Q
A

Pancreatic carcinoma

191
Q
A

Barrett Esophagus

191
Q

What is the clinical relevance of Barrett’s esophagus?

A

Increased risk of adenocarcinoma (dysplasia –> carcinoma)

192
Q
A

Adenocarcinoma of GB

194
Q
A

Gastritis

195
Q
A

Gastrointestinal stromal tumor

197
Q
A

Thyroid nodular hyperplasia

Can compress trachea or recurrent laryngeal -> hoarse voice

199
Q
A

Normal Adrenal Gland

Cortex is yellowish.

Medulla is reddish-brown.

201
Q

What mutagenic agent increase the incidence of papillary thyroid carcinoma?

A

Radiation

202
Q
A

Normal anterior pituitary

Red = acidophils

Purple = basophils

Clear = chromophobes

202
Q
A

Medullary Carcinoma

203
Q
A

Adenomatous Polyps

204
Q

Distinctive Features of Crohn’s Disease and Ulcerative Colitis (table)

A
206
Q
A

Squamous Cell Carcinoma of Esophagus

207
Q

What is ulcerative colitis?

A

A form of idiopathic inflammatory bowel disease which is limited to the colon and rectum.

209
Q
A

Necrolytic Migratory Erythema

(Glucagonoma)

210
Q
A

Adrenal Cortical Carcinoma

211
Q
A

Meckel’s Diverticulum

213
Q

What cells give rise to medullary carcinoma of the thryoid?

A

C cells

214
Q
A

Neuroblastoma

Tumor cells form rosettes around a central anucleated zone.

215
Q
A

Waterhouse-Friderichsen Syndrome

Hemorrhage in adrenal glands.

Acute adrenal insufficiency due to DIC/hemorrhage caused by Neiserria meningititides infection.

217
Q
A

Parathyroid Adenoma

Solid sheets of cells.

Adenomas have compressed non-neoplastic tissue at edges.

219
Q
A

Normal Esophagus and stomach

220
Q
A

Candida Esophagitis

221
Q
A

Papillary Carcinoma

221
Q
A

Metastatic Gastric Carcinoma in liver

222
Q
A

Metastatic Carcinoma

223
Q
A

Normal Pituitary gland

224
Q
A

Porcelain gallbladder

226
Q

MEN-2A: Sipple’s Syndrome

A

Mutation in RET oncogene (10q11)

Medullary carcinoma of thyroid

Pheochromocytoma of adrenal medulla

Parathyroid hyperplasia

227
Q
A

Left: Follicular adenoma

Middle: Follicular carcinoma

Right: Papillary carcinoma

227
Q

What HLA types are associated with Hashimoto’s?

A

HLA-DR5

HLA-DR3

228
Q

Presentation of Conn’s Syndrome

A

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
Q

Gastrinoma Triangle

A
231
Q
A

Herpes Esophagitis

232
Q
A

Follicular Carcinoma

Widely invasive

233
Q

Pathogenesis of acute pancreatitis

A
234
Q
A

Adrenal Cortical Adenoma

Uniform, arranged in nests.

235
Q
A

Barrett’s esophagus

236
Q

What are the functional classification of pituitary adenomas?

A

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
Q
A

Ischemic Enteritis

239
Q
A

Pheochromocytoma

Secretory granules with catecholamines

Present with HTN intermittently

Can measure urinary metanephrines/VMA

240
Q
A

Meckel’s Diverticulum

242
Q
A

Pancreatic Endocrine Neoplasm

(Islet Cell Tumor - on the left)

Circumscribed/encapuslated.

In pancreas or region around pancreas.

243
Q

What is celiac disease?

A

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
Q
A

Adrenal Cortical Adenoma

246
Q
A

Parathyroid Hyperplasia

247
Q
A

Alcoholic Liver Disease

248
Q
A

Waterhouse-Friderichsen Syndrome

Acute adrenal insufficiency due to DIC/hemorrhage caused by Neiserria meningititides infection.

250
Q
A

Gastrointestinal stromal tumor

Can arise anywhere in GI tract, thought to be due to Cajal cells

251
Q
A

Appendicitis

253
Q
A

Adrenal Cortical Adenoma

254
Q

Normal Parathyroid Gland

A

Four glands (variable)

Mixture of chief cells (pale cytoplasm) and oxyphil cells (eosinophilic cytoplasm)

Variable amounts of adipose tissue (increases with age)

254
Q
A

H. Pylori

256
Q
A

Esophagitis (acute)

-Intercellular edema (spongiosis) and inflammatory cells in lamina propria

257
Q
A

Hashimoto’s Thyroiditis

Metaplasia

257
Q

What are the most common primary sites for metastatic carcinoma?

A

GI tract, breast, and lung

259
Q

Papillary thyroid carcinoma

How common is it?

Who is affect?

How does it present? (Gross/Histo)

Prognosis?

A

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
Q
A

Diabetes Mellitus Type 1

Deposits of extracellular amyloid composed of amylin, which is co-secreted with insulin

261
Q
A

Gastric Lymphoma

262
Q

Pathologic findings in familial adenomatous polyposis

A

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
Q
A

Papillary Carcinoma

Finger-like projections

264
Q

Celiac Disease Pathogenesis Diagram

A
265
Q
A

Chronic Gastritis

Loss of glands + fibrosis

266
Q

Comparison of Type 1 and Type 2 Diabetes Mellitus

A
267
Q
A

Neuroblastoma

268
Q

What is steatosis?

A

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
Q

What is Waterhouse-Friderichsen Syndrome?

A

Hemorrhagic destruction of adrenals related to severe bacterial infection: Meningococcus, pneumococci, Staphylococci, Pseudomonas, Haemophilus

271
Q

Two growth patterns of colorectal adenocarcinoma

A
  1. Left colon: annular, apple-core lesions which often cause obstruction
  2. Right colon: polypoid, fungating mass often causing bleeding
272
Q

Serology of Celiac Disease

A

Antibodies:

Anti-transglutaminase

Anti-gluten

Anti-endomysial

273
Q
A

Metastatic Carcinoma

273
Q
A

Chronic Pancreatitis

274
Q
A

Colonic Adenocarcinoma

275
Q

What is a GIST?

A

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
Q
A

Villous Adenoma

276
Q
A

Steatosis

277
Q
A

Follicular Adenoma

Confined by capsule, no vascular invasion

279
Q
A

Adenocarcinoma arising in Barrett Esophagus

280
Q

What is appendicitis?

A

Inflammation of the appendix, usually associated with obstruction (i.e fecalith)

281
Q

Patient has Hashimoto’s.

Patient takes oral contraceptives.

Patient has slightly elevated total T4 (with decreased free T4).

Why?

A

OCPs can increase the quantitiy of binding proteins and drive up the total T4 without changing the free fraction.

283
Q
A

Papillary Carcinoma

Intra-nuclear pseudo-inclusions (invagination of cytoplasms)

284
Q
A

Normal Small Intestine

286
Q

Gross findings of DM pancreas

A

Pancreas may be small, atropic

287
Q
A

Ischemic Enteritis

288
Q

Presentation of Parathyroid Adenoma

A

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
Q
A

Cirrhosis

Blue collagen bands in trichome stain

290
Q
A

Acute cholecystitis

PMNs infiltrating mucosa

291
Q

What is Crohn’s Disease?

A

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
Q
A

Villous Adenoma

293
Q
A

Gastric Ulcer

294
Q
A

Appendicitis

296
Q

-omas

A
297
Q
A

Follicular Carcinoma

Vascular invasion

298
Q
A

Pheochromocytoma

Adrenal medulla turns dark brown in a solution of chromium salts (oxidizes cathecholamines)

299
Q
A

Alcoholic Hepatitis

Mallory Hyaline Body

300
Q

What are the different causes of gastritis?

A

Alcohol, drugs (NSAIDS), bile reflux, stress, radiation, chemotherapy

300
Q

What is Adenocarcinoma of the stomach associated with?

A

H. pylori infection

302
Q
A

Normal Colon

304
Q
A

Gastrointestinal stromal tumor

306
Q

What is the most important screening test to determine functional status of the thyroid gland?

A

TSH assay: elevated in hypo, close to zero in hyperthroidism.

307
Q
A

Gastric Adenocarcinoma

308
Q

Microscopic findings in ulcerative colitis

A
  1. Ulceration with acute and chronic inflammation
  2. Crypt abscess formation
  3. Crypt architectural distortion with branched crypts
  4. Basal plasmacytosis
309
Q

What are some differences between H. pylori and autoimmune gastritis?

Location, inflammatory infiltrate, acid production, gastrin, other lesions, serology, sequelae, and associations

A
310
Q

Describe the anterior lobe of the pituitary gland

A

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
Q

What are complications of hereditary hemochromatosis?

A

Cirrhosis

Hepatocellular carcinoma

Hypopituitarism, skin pigmentation, cardiac failure, DM, arthropathy, testicular atrophy

312
Q
A

PancreaticCarcinoma

313
Q
A

Metastatic Carcinoma

315
Q
A

Normal Stomach (fundus)

Chief cells - purple (Pepsinogen)

Parietal cells - pink (HCl, IF)

316
Q
A

Acute Pancreatitis

317
Q

How common are ductal adenocarcinomas?

Where in the pancreas do most of these malignancies occur?

A

Pretty common

85% of all pancreatic malignancies

2/3 occur in head of pancreas

318
Q

Describe metastatic carcinoma

A

Usually multiple circumscribed nodules

319
Q

Microscopic findings in pseudomembranous colitis?

A

Necrotic debris on mucosal surface consisting of necrotic epithelial cells, degenerating inflammatory cells, mucus, and fibrinous material

321
Q
A

Adrenal Tuberculosis

Histiocytes or macrophages

322
Q
A

Follicular Carcinoma

323
Q
A

Diverticulosis

324
Q
A

Acute Pancreatitis

325
Q
A

Hashimoto’s Thyroiditis

326
Q
A

Acute Pancreatitis

327
Q

Adenomatou Polyps diagram

A
328
Q
A

Herpes Esophagitis

(sharply demarcated lesions)

329
Q
A

Pancreatic carcinoma

330
Q

What is the gross and microscopic pathology of a pituitary adenoma?

A

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
Q

Gross pathology of Celiac Disease

A

Flattening or loss (atrophy) of villi of the SI mucosa

332
Q

Histology of ischemic enteritis/colitis

A

Necrosis and hemorrhage within affected regions

333
Q
A

Pancreatic Carcinoma

334
Q

What is the difference between a malignant and benign ulcer?

A

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
Q

Crohn’s Disease vs. Ulcerative Colitis (picture)

A
335
Q
A

Steatosis

337
Q
A

Parathyroid Adenoma

338
Q
A

Choledocholithiasis

340
Q
A

Normal Stomach

341
Q

What is Meckel’s Diverticulum

A

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
Q
A

Ulcerative Colitis

346
Q
A

Pituitary Adenoma

Expansion of gland into sella turcica

347
Q
A

Pancreatic carcinoma

348
Q
A

Viral Hepatitis

Balloon hepatocytes that are degrading

350
Q

Pathogenesis of Hashimoto’s Thyroiditis

A
351
Q

Pheochromoctyoma Rule of 10

A

10% extra-adrenal (paraganglioma)

10% multiple (sporadic cases)

10% malignant

10% occur in children

10% familial (MEN2A/2B, NF-1, VHL)

352
Q
A

Pancreatic Carcinoma

353
Q
A

Steatosis

355
Q

Describe the normal thyroid gland

A

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
Q
A

Crohn’s Disease

356
Q
A

Gastrinoma Triangle

357
Q
A

Viral Hepatitis

359
Q
A

Acini of cheif cells; granular cells = oxyphil cells

360
Q

Gross findings in pseudomembranous colitis?

A

Pseudomembrane formation appearing as dirty green-yellow plaques

362
Q
A

Gastric Lymphoma

363
Q

What is chronic cholecystitis and how is it characterized?

A

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
Q
A

Hepatocellular Carcinoma

366
Q
A

Gastric Adenocarcinoma

367
Q

Diabetes Complications (Picture 2)

A
369
Q

What are some S/sx of Acromegaly?

A
371
Q
A

Ischemic Enteritis

372
Q

What is metaplasia?

A

Reversible change from one mature cell type into another. May represent adaptive (protective) change in response to injury

374
Q
A

Herpes Esophagitis

Ground glass appearance

375
Q

What are some of the mutations associated wth pancreatico adenocarcinoma?

A

K-Ras, p16, p53, BRCA2, DPC4/SMAD4

376
Q

What is the most common malignant tumor of the liver?

A

Metastatic carcinoma

378
Q
A

Gastrointestinal stromal tumor

380
Q
A

Ischemic Enteritis

381
Q

Multiple Endocrine Neoplasia (MEN) Syndromes

A
382
Q
A

Metastatic Carcinoma

383
Q
A

Viral Hepatitis (Hemorrhagic)

385
Q

What explains visual defecits in AP adenomas?

A

Compression of the optic chiasm causes bitemporal loss of peripheral vision.

387
Q
A

Diabetes Mellitus Type 1

Autoimmune destruction of islets.

Inflammation and infiltration by T lymphocytes (dark cells) = insulinitis

389
Q
A

Barrett Esophagus

Low grade dsyplasia

390
Q

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?

A

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
Q

What are the common causes of hypoadrenalism?

A

Autoimmune adrenalitis

Granulomatous infections of the adrenal gland

Anterior Pituitary failure

392
Q

How is Barrett’s esophagus diagnosed?

A

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
Q
A

Barrett Esophagus

High grade dysplasia

395
Q
A

Gastric Ulcer

396
Q
A

Esophageal Varices

397
Q
A

Gastric Carcinoma

Signet Ring Cell Morphology

398
Q
A

Gastric Adenocarcinoma

Signet ring cell morphology

400
Q
A

Gastric Adenocarcinoma

401
Q

What serum marker may be elevated in hepatocellular carcinoma?

A

Alpha feto-protein

403
Q

What is a goiter?

A

Enlargement of the thyroid gland

Nodular vs. diffuse

Hyper vs. hypofunctioning

403
Q

What is reflux esophagitis?

What is it characterized by?

A

Due to acid reflux; characterized by intra-epithelial inflammatory cells (esp. eosinophils), basal layer hyperplasia, spongiosis, and elongation of papillae of lamina propria

404
Q
A

Alcoholic Hepatitis

Typically involves neutrophils that infiltrate lobules

406
Q
A

Normal anterior pituitary

GH Antibody staining

407
Q
A

Barrett Esophagus

409
Q
A

Adrenal Tuberculosis

410
Q
A

Appendicitis

411
Q

What is the macroscopic and microscopic description of hepatocellular carcinoma?

A

Macro: single/multiple, may have bile staining

Micro: Atypical hepatocytes with nuclear pleomorphisms, thickened trabeculae (several layers thick), absent portal tracts

412
Q
A

Cholelithiasis

414
Q

What is dysplasia?

A

Pre-malignant change involving abnormalities in nuclear size, shape, and (lack of) maturation

416
Q
A

Follicular Carcinoma

Capsule invasion

417
Q
A

Ulcerative Colitis

418
Q
A

Cholelithiasis

420
Q

What hormone does medullary thyroid carcinoma most commonly secrete?

A

Calcitonin

(ACTH also possible)

421
Q
A

Squamous Cell Carcinoma of Esophagus with keratin pearls

422
Q

Describe Carcinoid Syndrome

A
  • 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
Q
A

Papillary Carcinoma

Calcification

424
Q

Zollinger-Ellison syndrome

A

Gastrinoma, acid hypersecretion, peptic ulcers

Associated with gastrinoma

425
Q
A

Pituitary Adenoma

426
Q
A

Adrenal Cortical Carcinoma

Vascular invasion, metastasis = malignancy

427
Q

Function of calcitonin?

A

Help lower serum calcium

428
Q
A

Pheochromocytoma

429
Q

Etiology of Hypoadrenalism

A

Adrenocortical Insufficiency

Primary: chronic (Addison’s) or acute (Waterhouse-Friderichsen)

Secondary: Pituitary insufficiency or exogenous corticosteroids

430
Q

Diabetes Complications (Picture 1)

A
431
Q
A

Celiac Disease

432
Q
A

Colonic Adenocarcinoma

433
Q
A

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
Q
A

Gastric Ulcer

435
Q

What is chronic pancreatitis?

A

Usually not associated with acute pancreatitis

Chronic inflammation, ductal ectasia, squamous metaplasia of ducts, calcification, fibrosis, stone formation, pseudocysts

436
Q
A

Adenocarcinoma of Esophagus

437
Q
A

Alcoholic Hepatitis Mallory Body

Eosinophilic inclusion, composed mostly of filaments caused by damage to filaments to form cytokeratin

*EXAM*

439
Q

Pheochromocytoma Gross and Microscopic findings

Indicator of malignancy

A

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
Q
A

Adenocarcinoma of Esophagus

442
Q
A

Gastric Lymphoma

443
Q
A

Papillary Carcinoma

Nuclear groove “Coffee beans”

445
Q
A

Crohn’s Disease

447
Q

What HLA types are strongly associated with Graves disease?

A

HLA-B8

HLA-DR3

448
Q
A

Familial Adenomatous Polyposis

449
Q

What are some associated findings of gastritis?

A

Erosion/ulceration

Intestinal metaplasia

Atrophy & fibrosis

451
Q
A

Esophageal Varices

451
Q
A

Gastric Adenocarcinoma

452
Q

Genetics of familial adenomatous polyposis

A

Mutation in the adenomatous polyposis coli tumor-suppressor gene on Ch 5q21

453
Q
A

Hypertrophic Gastropathy

455
Q
A

Pituitary MacroAdenoma

456
Q
A

Pseudomembranous Colitis

457
Q
A

Adrenal Tuberculosis

Activated T cells

Langhans nucleated cells

458
Q

Presentation of Insulinoma

A

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
Q

Neuroblastoma Gross and Microscopic Findings

A

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
Q
A

Cholelithiasis

461
Q
A

Diverticulosis

462
Q
A

Villous Adenoma

464
Q
A

Tubular Adenoma

465
Q
A

Gastric Ulcer

466
Q
A

Malignant Gastrointestinal stromal tumor

467
Q
A

Normal Parathyroid Gland

468
Q
A

Ulcerative Colitis

469
Q

What is familial adenomatous polyposis?

A

An inhertied, autosomal dominant condition in which affected patients develop innumerable adenomatous polyps of the colon and subsequently, invasive adenocarcinoma.

470
Q
A

Colon Carcinoma

471
Q

What is the Whipple triad?

A
  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
Q
A

Pancreatic Endocrine Neoplasm

(Islet Cell Tumor)

Circumscribed/encapuslated.

In pancreas or region around pancreas.

474
Q
A

Gastric Adenocarcinoma

476
Q
A

Gastric Ulcer

478
Q

How is GIST treated?

A

Majority of GIST express CD117 (“c-kit”) which is the molecular target of tyrosine kinase inhibitor (Imatinib)

479
Q
A

Colon Carcinoma

482
Q

Crohn’s Disease diagram

A
483
Q
A

Viral Hepatitis

484
Q
A

Cholelithiasis (Pigment Gallstones)

Indicative of chronic hemolysis

485
Q
A

Hepatocellular Carcinoma

Small tumors at periphery

486
Q
A

Viral Hepatitis

Acidophilic (Councilman) body (arrow)

A hepatocyte undergoing apoptosis

487
Q
A

Chronic cholecystitis

488
Q
A

Diabetes Mellitus Type 1

Amyloid deposits

489
Q

What is the origin of amyloid in medullary thyroid carcinoma?

A

Excess procalcitonin deposition

490
Q
A

Normal Thyroid

491
Q
A

PT Hyperplasia

492
Q

Follicular carcinoma

Who does this affect?

Gross/Histo

Metastasizes to ___

Prognosis

A

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
Q
A

Hepatocellular Carcinoma

495
Q
A

Gastric Ulcer

496
Q

Diffuse Hyperplasia

Who, Pathogenesis, Gross/Histo

A

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
Q
A

Grave’s Disease

Resorption vacuoles

498
Q

Describe a pancreatic adenocarinoma (macro/microscopically)

A

Macro: Infiltrative, firm, tan-white tumor

Micro: irregular ducts/glands lined by atypical cuboidal to columnar cells, desmoplastic stromal response

499
Q

What are adenomatous polyps?

A

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
Q

What is autoimmune gastritis?

What are some symptoms?

A

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
Q
A

Metastatic Gastric Carcinoma in Lung

503
Q
A

Herpes Esophagitis

Loss of mucosa + exudate forming

505
Q
A

Crohn’s Disease

506
Q
A

Medullary Carcinoma

Apple-green birefringence

508
Q
A

Pituitary Adenoma

Monomorphic & arranged in sheets, not acini

509
Q
A

Adrenal Cortical Carcinoma

More mitotically active.

510
Q
A

Adrenal Cortical Adeonoma

Left: tumor

Right: Residual normal adrenal tissue

512
Q
A

Familial Adenomatous Polyposis

513
Q
A

Colonic Adenocarcinoma

514
Q

What are the damaging and defensive forces of the stomach?

What causes each?

A

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
Q
A

Pheochromocytoma

517
Q

Diagnosis of Adrenal Cortical Carcinoma

A

May have hemorrhage and necrosis

May appear encapsulated or circumscribed

519
Q
A

Parathyroid Adenoma

519
Q

Molecular pathogenesis of familial adenomatous polyposis

A

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
Q

Crohn’s Disease Pathogenesis

A
521
Q

What is acute pancreatitis associated with?

A

80% of cases associated with gallstones or alcoholism

522
Q
A

Squamous Cell Carcinoma of Esophagus

523
Q
A

Gastric Adenocarcinoma

Signet ring cell morphology

524
Q
A

Cirrhosis

525
Q
A

Gastric Ulcer

526
Q
A

Pheochromocytoma

527
Q

Islets of Langerhans

A

Clusters of uniform cells scattred within exorine pancreas

528
Q

Presentation of Glucagonoma

A

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
Q
A

Hemochromatosis

Excessive hemosiderin stores

530
Q
A

Adenocarcinoma of Esophagus

532
Q
A

Waterhouse-Friderichsen Syndrome

Hemorrhagic necrosis of adrenal glands.

Acute adrenal insufficiency due to DIC/hemorrhage caused by Neiserria meningititides infection.

533
Q
A

Meckel’s Diverticulum Complication

Volvulus

534
Q

How can you differentiate between hypoglycemia caused by beta-cell tumors and self-induction by insulin/sulfonylureas?

A

Beta-cell tumors are accompanied by high serum levels of C peptide.

535
Q
A

Ischemic Enteritis

536
Q

Nodular hyperplasia

A

Multinodular goiter

Idiopathic, usually clinicaly euthyroid

Mutliple nodules, often with one dominant nodule

Variable appearances: large/cellular/hyperplastic nodules, hemorrhage, cystic degeneration

537
Q
A

Ulcerative Colitis

538
Q

Pheochromocytoma Diagnosis

A

Elevated urine metanephrines and vanillylmandelic acid (VMA), which are metabolites of cathecholamines

539
Q
A

Follicular Adenoma

540
Q

Presentation of Adrenal Tuberculosis

A

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
Q

S/Sx of Hashimoto’s Thyroiditis

A
542
Q
A

Gastric Lymphoma

543
Q
A

Pseudomembranous Colitis

544
Q
A

Parathyroid Carcinoma

Very uncommon.

Tend to have higher Ca++ levels because they’re larger.

Invasive to soft tissues of the neck.

545
Q
A

Cirrhosis

547
Q

Adenomatous Polyps:

Two main Growth patterns

Three histologic subtypes

A
  1. Pedunculated
  2. sessile
  3. Tubular adenoma (>90%): exhibit more than 75% tubular pattern
  4. Tubulovillous adenoma (5-10%): exhibit 25-50% villous pattern
  5. Villous adenoma (1%): exhibit more than 50% villous pattern
548
Q

Histology of Celiac Disease

A

Diffuse inflammation within lamina propria and epithelium, along with partial or complete loss of villi (villous:crypt ratio is reversed)

549
Q
A

Acute Pancreatitis

550
Q
A

Adenocarcinoma of GB

551
Q
A

Gastric Adenocarcinoma

552
Q

What is pseudomembranous colitis?

A

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
Q
A

Pituitary Adenoma

Salt & Pepper chromatin

554
Q
A

Hemochromatosis

555
Q
A

Porcelain Gallbladder

556
Q
A

Normal Appendix

557
Q

What are 2 types of infectious esophagitis?

Describe them.

A

Herpes esophagitis: Sharply “punched out” ulcers with multinucleated giant cells and intranuclear “ground glass” inclusions

Candida esophagitis: Gray-yellow exudates with yeast/pseudohyphae

558
Q
A

Hypertrophic gastropathy

Hyperplasia of mucus-secreting cells

559
Q

Describe the posterior lobe of the pituitary gland

A

Neurohypophysis: origin-floor of 3rd ventricle

Releases vasopressin (ADH) and oxytocin - hormones produced in hypothalamus and travel in axons to posterior lobe)

560
Q
A

Gastric Polyploid Carcinoma

561
Q

What are some risk factors for pigment stones?

A

Chronic hemolysis

Certain infections (Bacteria - E. coli; Parasites - Clonorchis)

GI disorders

562
Q
A

Barrett Esophagus

Left side replaced by columnar glandular mucosa

563
Q
A

Esophageal Varices (ulceration that became thrombosed)

564
Q

What is an adenocarcinoma of the Gallbladder?

  • How often does it occur?
  • Who does it occur in most?
  • Association with gallstones?
A

Rare malignancy that is more common in females

80-90% associated with gallstones

Most have invaded liver by time of diagnosis

Uniformly fatal

565
Q
A

Crohn’s Disease

566
Q
A

Cirrhosis

Shrunken, atrophic liver (scarring then liver tries to regenerate, forming nodules)

567
Q

Pathogenesis of various carcinomas

A
568
Q

Presentation of Cushing’s Syndrome

A
569
Q
A

Gastritis with erosions

570
Q

What is the prognosis of pancreatic adenocarcinoma?

A

Overall poor prognosis: 10% 1-year survival; 2% 5-year survival

571
Q
A

Squamous Cell Carcinoma of Esophagus

572
Q
A

Crohn’s Disease

573
Q
A

Adrenal Gland

MD4 Pathology (6 decks)

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