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MOD (tumors, GI path) Flashcards

1
Q

Adenocarcinoma vs SCC risk factors?

A

Adeno–obesity, alc

SCC–HPV!

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2
Q

3 types/ ease of removal of esoph cancer?

A

Polyploid/ exophytic (most, golf ball, easy to excise)
Ulcerated/excavated (harder to remove)
Flat/diffuse (least)

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3
Q

What histo changes happen in Barretts?

A

intestinal metaplasia of esoph!
Non-ker stratified squamous epith of esoph is replaced with intestinal, non-cil columnar epith (with goblet cells!)
(BE comes from GERD, most ppl with BE will not get a carcinoma!)

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4
Q

What do goblet cells in esoph mean? what risk is it assoc with?

A

Indicate chronic mucosal injury/ metaplasia

Assoc with incr risk of adenocarc in esoph

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5
Q

4 types of esoph cancer invasion/spread? (eg where does it spread to)?

A

1 Intra esophageal (resect and bring up stomach)
2 Direct extensions (to lungs, aorta and nearby structures etc)
3 Lymphatic spread (to lymph nodes, drain to celiac trunk and can metast)
4 Distant disease (spread to retroperitoneal and celiac LNs, metast to liver and lung) (cant remove w surgery if spread to nodes)

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6
Q

3 most common locations for esoph cancer metastases?

A

Lungs
Liver
Retroperitoneal/Celiac lymph nodes

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7
Q

SCC vs adeno risk factors?

A

SCC: n-nitrous cpds (smoked meat), red meat
Adeno: GERD/ZE/H pylori, antichols, etc
both smoking and alc

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8
Q

TNM tumor staging?

A

T size
N nodal spread
M metastases

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9
Q

Major benign esoph tumors? sx?

A

Leiomyoma (soft tissue tumor), trouble swallowing can be resected (also papilloma, polyp, fibroma hemangioma etc)

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10
Q

Most “common” stomach cancers? (location?)

Pop for lymphomas?

A

Lymphomas (immunosuppr/HIV etc)
Carcinoids
Malig stromal tumor

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11
Q

Diffs between intestinal and diffuse gastric cancer classifications?
(Histo, differentiation, M:F, etc)

A

Intestinal gastric cancer– polypoid, elev, well diff, males

Diffuse gastric cancer– ulcerated/fung, poorly diff, SIGNET RING, = M:F

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12
Q

Grade vs stage?

A

Grade–differentiation

Stage–invasion/metastases

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13
Q

Early vs Advanced gastric cancer?

A

Early: confined to mucosa/submuc, good survival, removed with margin
Advanced: inflitrates into muscularis propria, lymph, nodes, poor px and low survival

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14
Q

Carcinoid tumor def?

Appearance gross/histo?

A

Epithelial neoplasm with neuroendocrine differentiation (grade 1 NET, grade 2, and NEC neuroendo carcinoma)

Gross: pedunculated, vascular/red
Histo: cells who organoid arrangements, uniform nuclei with salt and pepper chromatin

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15
Q

Most common tumors in stomach (3)
Esoph?
Duod? (which chemicals are produced?)

Sx? Most common?

A
  • Stomach: Type I NET (most common) with pernicious anemia and gastrinemia, autoimm), typie II net assoc with MEN-1 and ZE from gastrin-secreting tumor (elev gastrin), and type III NET (poor px, large)
  • Esoph: mostly carcinoid or NEC
  • Duod: Non-MEN-1 NET prod gastrin, or somatostatin, and MEN-1 which prod gastrin (NET)
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16
Q

Zollinger-Ellison syndrome?

A

Gastrin secreting tumor causes peptic ulcers! (sporadic or MEN-1) (can give Ca2+ stim to identify if gastrin doesnt show up as elev during dx)

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17
Q

Benign liver tumors? (3)

Which is most common?

A

Cavernous hemangioma (most common benign liver tumor!)
Focal nodula hyperplasia
Hepatocellular adenoma

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18
Q

Cavernous hemangioma

Pop? Histo/Gross? Px? *Complications?

A

Most common!
Appearance: see on a CT scan commonly, large squishy cherry spot, histo is reddish hemorrhage of vasc
-Complications: DIC coag in extreme sports/ KAsabach Merrit (tumor sucks up platelets), and Rupture

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19
Q

Focal Nodular Hyperplasia etiology?

Appearance?

A
  • From localized hyperperfusion due to presence of anomalous artery, fibrosis of liver tissue can cause central scar, intact arc but abnormal vasc
  • females (like prev), most asmp, X on scan
20
Q 
HEPATOCELLULAR ADENOMA 
Pop?
Risks?
Sx?
Px/size?
Results/ compl?
Histopath/layers?
Subtypes?
A
  • women (sex hormones, contraceptives, glycogen storage dis)
  • solitary lesion
  • sx: abd pain, referred pain bc liver doesn’t have nerve endings
  • can rupture (ESP if pregnant and HTN) center can get necrotic (high risk at >5cm), can lead to HELLP (hemolysis/elev liver enz/low platelets), can turn into hepatocell carc
  • histopath: absence of portal triads/bile ducts, hepatocytes everywhere instead (but normal nucl), 2 or fewer layers, aberrant arteries
  • subtypes: Beta-catenin activated HCA has HIGHEST risk for malig!
21
Q

Types of malig liver tumors? (4 + metast)

A

Hepatocellular carcinoma (incl fibrolamellar)
Choliangiocarcinoma
Hepatoblastoma (bbys)
Angiosarcoma

22
Q

Hepatocellular carcinoma
risks?
Histopath/layers?

A
  • risks: HEP B!!!, virus can cause scarring, (other causes like aflatoxin, NASH steatohep, type II DM, alc/smoking, A1-AT herid dis etc)
  • histo: scarring with large atypical cells with mitosis, 3+ layers!
23
Q 
Hepatocell carc (cont)
Gross
Dx
Tx
Invazn
Mutation
A
  • gross: nodular brown firm liver, with golden tumor in center
  • dx: hypervasc masses on imaging (big and white), glypican-3, elev AFP
  • tx: resect (can resect a lot if small, transplant or ablation if big)
  • invazn: portal vein
  • mut: TERT telomere stability, p53, beta-catenin
24
Q

Fibrolamellar HCC?

Pop? gross/histo? px?

A 
younger pts (30 etc)
-large tumor, better px than HCC, but metast, fibrosis
25
Cholangiocarcinoma - Types (3) and most common - sx - risks - histo - px - tx
Cancer of bile ducts! - types: intrahepatic, hilar, extra hep (last 2 cause jaundice bc obstruct bile duct) - sx: jaundice - risk factors: sclerosing of ducts, ulcerative colitis/flukes/cysts/nitrosamines in diet - histo: cells prolif/fibrosis, klastskin tumor (hilar CCA), skip lesions - px is better with intrahep (can also be mixed CCA and HCC which is worse px), resect, transplant (but can be bad)
26
``` Hepatoblastoma Pop? Assoc/sx? Causes? Lvls? Histo? Tx? Px? ```
- babies within first 5 yr - assoc with anemia, and thrombo - elev AFP! - histo: tumor cells look like fetal hepatocytes, epith, sometimes pink mesenchymal bone, or small cell pattern - Tx: neoadjuvent hemo then operate, decent survival
27
Angiosarcoma Px? Appearance? Cause?
-bad px -v vascular, red and black; hemorrhage w diffuse enlargement of liver w nodular appearance, malig prolif of endoth cells -cause: from polyvinyl chloride eg tires, males (liver and bile duct cancers have increased mortality)
28
Which hepatic malig is most common? Metast from? Tx? Mutations?
Metastatic disease! Can come from colorectal cancer Tx with surg ablation neoadj chemo KRAS mutation (need more chemo, but too much can cause fatty liver cirrhosis)
29
Diaphragmatic hiatal hernia compl?
can be from incompl during dev, compli is pulm hypoplasia
30
Pyloric stenosis and congen assocs/sx?
Hyperplasia of pyloris that obstructs gastric outlfow Sx: nonbiliary vomiting newborn with distended stomach Assoc with Trisomy 18 and Turners
31
Gastric heterotopia and assocs?
displaced tissue in GI, large/red, normal mucosa with oxyntic glands, inlet patch -assoc with barrets, adenocarc (acid release), even ectopic pancr tissue
32
If gastric mucos makes way into colon this cause?
occult blood loss
33
What are the cells/secretions in the body vs antrum of stomach?
Body--parietal cells secr HCl (and intrinsic factor) | Antrum--G cells secrete gastrin (which stim par cells to secr more HCl)
34
Protective mechs of stomach from acid?
``` Tight junctions Mucin Bicarb Turnover PGs! (help w. all of above! NSAIDS inhibit this!) ```
35
Acute gastritis causes/mechs? | Mild acute?
Transient inflam mucosa Can be from NSAIDS which inhibit PGs sx pain nausea vomit bleed -Mild acute: Lamina prop congested but BM ok, transient mucosal but no hemorr, surface epith intact
36
Which cells infiltrate in acute vs chronic gastritis?
Acute-- NEUTROS! | Chronic--LYMPHOS! (and plasma cells)
37
Erosive hemorrhagic gastritis? | appearance?
erosion (superficial epith lost, prululent exudate with fibrin) and hemorr (ulcer where entire mucosa is gone, can extend into submucosa), -darker black spots in bright red mucosa on gross
38
Chronic gastritis and most common cause
- Most common cause is H pylori - gland atrophy w/ lymphos - nausea/vomiting/pain
39
``` H pylori appearance results cells and features complications MALT ```
- Most common cause of CHRONIC GASTRITIS - spiral shaped gram neg, lil dark rods on GIEMSA - assoc with poverty, foreign etc - lymphocytic and neutrophilic bc bact, interstit metaplasia (looks columnar and has goblet cells!), poorly diff glands, MALT lymphoma (neoplastic B cell lymphoma in mucosa) - compl include gland atrophy
40
Antral vs pangastritis? leads to?
antral gast- high acid, (can lead to ulcers) | pan gast-decr acid bc mucosal atrophy (can lead to adeno)
41
Tests for H pylori? | Tx?
GOLD STD: histo! GIEMSA stain -do if pt has dyspepsia w/o alarm sx, can also use serologic test for IgG against pylori for current/past, stool antigen test for active infxn, urea breath test, can have false negatives (esp if antibios PPIs etc)
42
``` Autoimmune gastritis Def Sx Causes/ assoc Cx Etiology Compl Histo Tx ```
- sx smooth beefy RED TONGUE, atrophic glossitis of tongue - assoc with folate/B12 deficiency (pernicious/ megaloblastic anemia) always - not in antrum, cx is loss of parietal cells (so no HCl and IF decr B12 abs in ileum causing megalob anemia) - women, autoimmune conds - compl: periph neurop, spinal cord, cerebral etc - tx: IM so b12 can get in - histo: lympho/macro infilt, glandular atrophy
43
Other uncommon gastritis?
IgE allergic eosinophilic gastritis Lympho gastritis assoc with celiacs Granulomatous
44
Acute ulcer types? Tx? diff between acute and chronic ulcer appearance?
ulcer breaches mucosa - acute: from acute erosive gastritis, ICU, stress, curling/cushing etc; small round, many, with marked borders, no scarring (chronic has scarring) - tx acute with PPI and H2 blocker - chronic PUD: H pylori or NSAIDS (smoking, steroids etc), gastric hyperacid from H pylori, gastrin, ZE assoc, benign near lower, elev borders, bleeding/perfor, various tx
45
Ulcerated gastric carcinoma and diff with benign ulcers? | Sx/alarm features and location?
Ba px, assoc with iron def anemia and wt loss (alarm features that indicate cancer) -larger ulcers with heaped up margins (Benign are smaller with raised margins), antrum
46
Types of polyps and diffs? | Pop? assocs? appearance?
- Hyperplastic/inflam polyps: assoc with chronic gastritis, rxn causes polyp growth (can elim by elim pylori) - Fundic gland polyps, women, assoc with PPI tx, decr acid secr increases gastrin secr by G cells, G/gland prolif (collectionof polyps), not malig, increased risk for gastric adenoma

T2 GI (6 decks)

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