Miscellaneous

Question 1

What are these genes associated with?

LKB1
SMAD4
HLA-DR1
NOD2

Answer 1

LKB1: Peutz jegher
SMAD4: juvenile polyposis
HLA-DR1: extra intestinal manifestation of IBD
NOD2: pouchitis

Question 2

What is Heyde syndrome?

Answer 2

Aortic stenosis breaks platelets due to shear force and results in von willebrand type of situation. Bleeds from small bowel angioectasias.

Treatment is aortic valve replacement

Question 3

BMPR1A?

Answer 3

juvenile polyposis

Question 4

P16 and ki 67?

Answer 4

Hpv

Question 5

Endoglin (CD105)

Answer 5

Hemorrhoids

Question 6

Periodic acid-Schiff stain (+)?

Answer 6

Perianal pagets

Question 7

SMAD4

Answer 7

Juvenile polyposis

Question 8

Scimitar sign

Answer 8

sacral defect through which the dura protrudes

Meningocele

Question 9

Chromosome 5

Answer 9

APC. Fap

5q21

Question 10

CHRPE

Answer 10

congenital hyperplasia of the retinal pigment epithelium (CHRPE)

Associated with FAP. Not pathognomonic but if four or more then most likely FAP

Question 11

When should you repeat cscope?

< 10 mm hyperplastic polyps in rectum/sigmoid

1-2 tubular adenomas, < 10 mm

3-10 tubular adenomas

> 10 tubular adenomas

1 or more tubular adenomas >10 mm

1 or more villous adenomas

Adenomas with high grade dysplasia

Answer 11

< 10 mm hyperplastic polyps in rectum/sigmoid
10 yrs

1-2 tubular adenomas, < 10 mm
5 yrs

3-10 tubular adenomas
3 yrs

> 10 tubular adenomas
< 3 yrs

1 or more tubular adenomas >10 mm
3 yrs

1 or more villous adenomas
3 years

Adenomas with high grade dysplasia

Question 12

What is a favorable ki67 index?

Answer 12

<3%

Question 13

How many mitosis are acceptable for local excision of rectal NET?

Answer 13

<2

G1 (low-grade tumors) have less than 2 mitoses per hpf and less than 3% Ki-67 index;

G2 (intermediate grade) tumors have 2 to 20 mitoses per hpf or 3% to 20% Ki-67 index;

G3 (high grade) tumors have more than 20 mitoses per hpf or more than 20% Ki67 index

Question 14

chromogranin and synaptophysin

Answer 14

Gold standard for carcinoid

Question 15

When should you repeat colonoscopy?

Sessile serrated polyp(s) < 10 mm with no dysplasia

Sessile serrated polyp(s) ≥10 mm

Sessile serrated polyp with dysplasia

Traditional serrated adenoma

Serrated polyposis syndrome

Answer 15

Sessile serrated polyp(s) < 10 mm with no dysplasia
5 yrs

Sessile serrated polyp(s) ≥10 mm
3 yrs

Sessile serrated polyp with dysplasia
3 yrs

Traditional serrated adenoma
3 yrs

Serrated polyposis syndrome
1 yr

Question 16

KRAS wildtype vs KRAS mutation

Effectiveness of cetuximab vs bevacizumab?

Answer 16

The use of bevacizumab is not limited by KRAS or other mutations

Cetuximab is INEFFECTIVE in patients with the KRAS/NRAS/BRAF mutation

Right-sided cancers have worse overall survival and derive less benefit from cetuximab even without KRAS mutations

Combination therapy with cetuximab and bevacizumab is not recommended due to increased toxicity and poor oncologic outcomes such as progression-free survival and overall survival.

Question 17

What surgery to do for anal melanoma?

Answer 17

thicknesses of less than 1 mm, WLE with a 1-cm margin is appropriate.

For tumor thickness between 1 and 4 mm, WLE with a 2-cm margin should be performed if the anal sphincter complex in not affected.

In lesions greater than 4 mm, APR is suggested.

Question 18

Lymphatic drainage of the rectum

Upper

Middle

Lower 1/3

Answer 18

Upper: IMA, para aortic

Middle: IMA, para aortic

Lower 1/3: superior rectal, middle rectal, internal iliac

Question 19

Cytokeratin 7

Answer 19

Perianal pagets

Question 20

Lymphatic drainage of anal canal

Above the dentate line

Below the dentate line

Answer 20

Above the dentate line: mesorectal and internal iliac nodes

Below the dentate line: superficial and external iliac (deep) inguinal nodes

Question 21

HMB45

Answer 21

melanoma

Question 22

CDX2

TTF1

ISL-1

Answer 22

CDX2: Midgut primary NET.

TTF1: Lung primary

ISL-1: Pancreas primary

Question 23

OCTN1/OCTN2

Answer 23

IBD5 locus on chromosome 5. Defects lead to UC

Question 24

Which chromosome is Ibd1 found on?

IBD3?

Answer 24

16

IBD 3 is found on chromosome 6.

Question 25

CARD12/NOD2

Answer 25

Fibrostenosing Crohn’s in SB but not colon