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More GI Flashcards

1
Q

Types of esophageal cysts

A

Simple

Bronchogenic cysts: anterior mediastinum, ciliated

Duplicaiton: foregut derived, attache dor within esophagus, muscular layer, variable types (esophagus, GI, stomach)

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2
Q

Assoc. with achalasia?

H and E?

Cancer risk?

A

Secondary to scleroderma, chagas, amyloidosis, Parkinsons, Pseudoachalasia from tumor

See progessive inflammatory destruction of gangion cells with chronic ganglionitits or aganglionosis.

SCC!!! 33x

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3
Q

SCC in esophagous associated with?

Some genes associated?

A

Black, China, Iran, France, Africa: Nitrosamines, moldy food, smoking, alcholol, HISTORY OF CAUSTIC INGESION, Plummer-Vinson (FE, glossitis, webs)

p53, p16, heterozygosity

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4
Q

Key to differentiate regenerative (florid) Squamous Epithelium in Esophagus from SCC?

Histology of reflux?

A

Preserved architecture even though cells/groups can be atypical but fairly preserved; bridges can be more pronounced

<8 intraep eosin/HPF with neutrophils/lymphocytes, basal cell hyper plasia, elongated papilla, vascular lakes of dilated vessels, spongiosis

100% have mucosal damage

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5
Q

Mucosal finding of Barrett’s esophagus?

H and E?

RIsk of adeno?

If gastric mucosa in upper or mid third consider?

A

Pink/salmon tongues of columnar mucosa: Short 3 cm; long >3cm

Glandular mucosa with intestinal metaplasia; Goblet cells, inflammed LP, disrupted muscularis mucosa, erosion

Risk 0.5-1.0% needs repreat; need to grade dysplasia

Islet patch

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6
Q

What is basal crypt dysplasia?

IHC and Gene?

Barrett’s low grade vs high grade?

A

Rare entity, Deep crypts with dysplastic chagnes with MATURE SURFACE. Other areas of dysplasia common

P53+, 17p LOH

Low; gland budding, lumina infolding, psedovillous groups; loss of polarity, nuclear crowing, elongated

High: Gland complexity, cribiforming, villous groupth, Full thickness stratification, hyperchromasia, loss polarity, enlarge nuclei

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7
Q

If struggling with adeno in esopogous consider what testing?

Surviability?

A

Loss of heterozygosist of p53, c-erB-2 (HER2) expression (15%), DNA mismatch repari mutations and adenomatous polyposis coli gene (rare)

T1 65-90% at 5 years

T4: 15% at 5 years

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8
Q

Classic endo finding of Eosinophilic esophagitis?

H and E?

Tx?

A

Feline esophagous with rings/webs, vertial lines/furrows with white spots: more common in men

>15 eosinophils/HPF ; Eosinophilic microabscesses and degranulation, basal cell proliferation, intercellular edema, Upper and lower esophagus

Tx: eliminate food allergens and steroids

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9
Q

Foveolar and parietal cells and chief cells are present?

H. P gastritis associated with?

A

In the body!

Parietal cells; Middle to deep

Chief cells: Admixed in lower 1/3rd

Gram - sea gull bacilus; ANTRUM (90%) and Multifocal atrophic (75%); MALT lymphoma and Adenocarcinoa (70-90%); intestinal type.

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10
Q

Features of autoimmune atrophic gastritis, labs, H. Pylori?

Where is it?

IHC?

Features of Multifocal atrophic gastritis?

A

AAG: Diffuse body gastritis, Immune mediate (antiparietal and anti intrinsic factor)

HIGH GASTRIN; F>M; Low Vit B12. H. pylori <20%

BODY CONFIED!!!; Lymphoplasmocytic infilatre in LP, loss of parital cells and antral glands and intestinal metaplasia

GASTRIN STAIN to confirm body. (Positive in antrum and negative in body)

Multifocal atrophic gastritis: Multiforcal atrophy and gastris, not immune mediated, Normal/low gastrin, Normal B12, H. Pylori ~90-100%.

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11
Q

Lymphocytic gastritis is assocaited with, definition, associations?

Eosinophlic gastritis is assocaited with, definition, associations?

Granulomatous gastritis is assocaited with, definition, associations?

Collagenmous gastritis is assocaited with, definition, associations?

A

Lymph gastrits >25 intraepithelial lymphs (CD8+)/100 epithelial cells, Celiac, H. Pylori, Crohn’s, HIV, edge of cancer/lymphoma.

Eos: >20 eos/HPS, deep into LP and muscularis mucosae, ALLERGIC SYNDROMS, connective tisue disease

Gran: Crohn’s, TB, Sarcoid, Foreign body, isolated gran gastritis

Collagenous: RARE; thick band

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12
Q

Features of reactive gastropathy, associations?

DDx?

PPI effect?

A

NSAIDs/steroids, Alcohol, bile, radiation

Foveolar hyeprplasia, serrated gastric pics (corkscrew), mucin depletion, splaying muscularis, no H. P

DDx: hyperplastic polyp, gastric antral vascular ectasia, protal hypertensive gastropathy (need history)

PPI: Dilatation of glands lined by parietal cells (Pink, granular cytoplasm, fried egg) and narrowing of surface epithelium

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13
Q

Menetrier disease features?

H and E?

Association?

ZE syndrome?

Association?

A

Rare males>50 yrs. Gross: Giant polypoid body/fondus

H and E: Foveolar hyperplasia (surface) with atrophy of oxyntic cells,

Associated with H. P, CMV. TGF-A immunostain +

ZE: Gastrin and hypersection, MEN1 (gastrinoma) and <5% G-cell hyperplasia

Gross: Hypertrophy of rugal body and fu ndus fold, ANTREM SPARED/Atrophic

Parietal hypertrophy and hyperplasia (Chief and Mucus cells)

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14
Q

Most common gastric polyp?
H and E?

Genes?

A

Fundic

Small <2mm

Cystially dilated glands lined foveolar, chief, and parietal cells; if only foveolar it is Hyperplastic polyp (pits, branching, dilated foveolar epithelium)

APC (like FAP) and B-catenin (sporatic)

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15
Q

Hyperplastic polyp H and E?

What do 0.6-0.9% of HP’s have?

A

Solitary; only fundic mucosa, branching and pits common

Signet Adeno

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16
Q

Hamartomatous polyps, H and E?

Syndrome/gene?

Inflammatory fibroid polyp H and E?

Associated with what gene/IHC?

A

Arborizing bundles of smooth muscle derived from mscularis mucosae and foveolar hyperplasia

STK11/LKB1 chr 19p13.3; Peutz-Jegher

IFP: Benign, submucosa, myxoid stroma, bland spindle cells, prominent blood vessels and eosinophils

PDGFR (>50%) and CD34+

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17
Q

Gastric xanthoma H and E?

Gastric adenoma types?

Genes mutated?

Associated with

A

Lipid laden machrophages in LP; M:F 3:1; Oil Red O, Sudan black, CD68+, KERATIN -

GA:10% polyps in elderly; Intestinal (goblet or paneth), gastric (foveolar)
KRAS, p53, APC, MSI

35-100% FAP and Gardner’s

18
Q

Gastric adenocarcinoma associations?

Hereditary diffuse/signet ring carcnoma gene?

A

More common in Japan

H. P with 100% itestinal type and less with diffuse type

Premalignant: adenomas, Hyperplastic polyps, chronic atrophic gastritis, BLOOD GROUP A,

Hereditary signet ring cell: Auto dominant E Cadhering (CDH1)

19
Q

Gastric adenocarcinoma genes?

A

Intestinal: APC (30-40%); c-met p54 (25-40%), Her2 (5-15%)

Diffuse: APC (2%), c-met (20-40%), Her2 (1%), CDH1

20
Q

2 types of GIST?

5% associated with?

Which one is malignant?

GIST Risk features?

A

Spindle (short fasicles with cells with vaculoes) and epithelioid (Halo of pale cytoplasm and clear space; can be focal keratin +)

Carney’s triad (GIST, Paraganglioma, Pulmonary chondroma), and NF1

Spindle: 20-25% of gastric spindle are malignant; C-kit and PDGFRA

Risk: Size, mits, location

21
Q

What is a Meckle diverticulum?

A

2% population, 2 feet form IC valve, 2 inches, symptomatic before 2 years:
Gastric mucosa or pancreatic tissue;from failure of obliteration of mophalo-mesenteric duct

22
Q

Acute duodenitis H and E?

Most common organism?

Other organisms?

A

Neutrophils in LP, lymphs and plasma cells, erosions and **foveolar metaplasia

H. Pylori most common from antral gastrits**

Immunocompetent: G. Lamblia, Strongyloides

Immunosuppressed, Cryptosporidium, microsporidium, MAI, Isospora belli

23
Q

Cryptosporidium H and E?

Cryptococcus H and E?

Giardia H and E?

A

Small blue balls on apical border of enterocytes; 2-5 microns

See white space; capsule doe snot stain; GMS+ and Mucicarmine +; 4-10 microns

Teardrop shapped; 12-15 microns with eye on surface of duodenum; can look like junk

24
Q

Whipple disease organism?

Patient population?
H and E?

A

T. Whippelii

Men ~40 yrs

Broadening of villi by foamy macrophages with PASD+ bacilli (DDx MAI: AFB+); swiss cheese look on H and E

25
Q

Circumferential stritures in terminal ileum related to?

Celiac related to what diatry thing?

Age peaks?
Labs?

HLAs?

Complicatons?

A

Chronic slow release NSAID usage; called iaphragm disease

Gliadin, Gluten

0-3-and 20-40

IgA anti transglutaminase (90% specific) IgA anti-endomysial and IgA antigliandid (not sensitive or specific)

HLA-DQ2 (95%); HLA-DQ8 (5%)

Enteropathy associated T-cell lymphoma, small intestin adeno

26
Q

Celiac disease, see what cells in LP?

What can cause false negative serologies in kids with Celiac?

A

>30 IEL/100 enterocytes or >40 IEL/enterocytes in jejunum, CD3+, CD8+

IgA deficency

27
Q

Tropical sprue caused by?
Treatment?

A

Colonizaiton of small intesting by E. Coli, Klebsiella, Enterobacter

See changes similar to celiac but in Jejunum and TI

Antibiotics, folate and B12

28
Q

What is Waldenstrom Macroglobulinemia?

Associated with?

H and E?

A

Lyphoproliferative dx with monoclonal IgM production/deposition

Men>65 yrs, lymphplasmacytic lymphoma (B-Cell)

Dilated lymphatic with acelluarl eosinophlic material: IgM+, PASD+, Congo Red-

29
Q

Abetalioprotenimia gene expression (AD, AR, etc)?

H and E?

A

Caused b autosomal co-dominant pattern of Apopliprotein B mutation

See vacuoles/foamy of clear material on mucosal surface of enterocyte

30
Q

Appendiceal Adenoma H and E?

Low grade appendicieal mucinous neoplasm?

Adeno of appendix?

A

Flat undulating dysplastic epithelium with preserved muscularis mucosae; luminal mucin present

Like above but with Loss of muscularis mucoase and fibrosis of submucosa; mucin/dysplastic cells in wall and outside appendix; can be high grade

Needs in vasion including budding and irregular glands; dysplastic stroma

31
Q

What is Goblet cell carcinoid of appendix?

Can a mass be seen grossly?

A

Older patients; mucin producing cells with NE and glandular differentiation (goblet like Paneth; pink granular); connentric pattern infiltation into appendix wall; NO GROSS MASS

32
Q

What is ameobic colitis?

What is in the trophocyte?

A

E. HIstolitics; Trophozoities 10-60 microns; Nucleus 3-5 microns with karyosome and peripheral rim of chromosome

Numberus fine vacuoles in cytoplasm resembling histeocytes

Ingrested RBCs and histeocytes in background

33
Q

Most common appendix polyp?

A

Serrated; serrated lumen with distal crypt dilation touching muscularis mucosa

34
Q

Lymphocytic colitis?

Associations?

A

NO LP inflammation; T lymphocytes CD8+) in LP; more common in females

A/W: Autoimmune disease, E. coli, C. jejuni, drugs: NSAID, flutamide, cimetidine, carbamaepine, sertaline

35
Q

Collagenous colitis?
Associations?

A

Females; watery diarrhea

Thick superficial collagenous band >10 micros (dripping candle)

A/W: Autoimmune, Drugus: NSAIDS, lanosprazole, ticlopidien, simvastatin

36
Q

Pseudomembranous colitis associated with?

Endo result?

H and E?

Lab test to order?

A

Drugs: Clindamycin, linomycin, apicillin, cephalosporins. Patient with watery/bloody diarrhea

2-5mm yellow plauques

Mushroom lesion of superfical inflammation and necrosis

C. Diff toxin

37
Q

Who gets solitary rectual ulcer syndrome (mucosal prolapse)?

Endoscopy results?

H and E?

A

20-50 year olds; due to abnormal sphincter contraction during pooping

Anterior wall ulcer (40%), multiple ulcers (20%), polypoid lesion (25%)

Histology: ulceration, crypt hyperplasia, luminal serration, mild distorion of arch, fibromuscular replacement of LP, scant inflammation

38
Q

Ischemic colitis?

H and E?

A

Old patients with cardio issues

Mimics IBD: Withering of epithelium, hylanizatno of LP, mild inflammation, crypt loss/whitering

39
Q

How many years after to start IBD dysplasia screening?

Risk of invasive cancer at 30 years?

What to do if patient has normal endoscopy but has dysplasia on H and E?

What about polypoid dysplasia?

A

8 years

20-30% after 30 years (similar to familial syndromes; APC, TP53, KRAS common)

Colectomy; high risk!!

Can monitor; low risk of invasion

40
Q
A
41
Q

Sessile serrated polyp criteria?

Dysplastic ones lose what?

Most common rectum polyp?

A

One gland dilated at muscularis mucosae; presence of microvesicular mucin (distal portion); absense of neuroendocrine cells

MLH1

Rectum: Traditional serrated adenoma, eosinophilic cytoplasms, tufting, papillary infolding, atopic crypts in surface epithelium, pencilate nuclei

42
Q

What gene can be used as surrogate marker for Lynch syndrome?

Most colorectal cancers that are MSI stable have what mutation?

A

BRAF negative but microsatellite high!

KRAS

GI (4 decks)

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