Neoplasms Flashcards
What are complications that can arise from chronic GERD?
Barrett esophagus
Barrett esophagus is what type of metaplasia
Gastric or Intestinal type metaplasia that replaces squamous esophageal epithelium with goblet cells
Barrett esophagus metaplasia can progress to what malignancy
Esophageal adenocarcinoma
Besides Barretts esophagus what are other risk factors for esophageal adenocarcinoma
Tobacco use and radiation exposure
Esophageal adenocarcinoma Is more common in what patient population
white males
esophageal adenocarcinoma is located where in most cases
distal third of the esophagus and gastric cardia
What can be seen microscopically For esophageal adenocarcinoma
tumors produce mucin and formation of glands that are often of the intestinal type morphology
what are specific risk Factors for esophageal squamous cell carcinoma
Poverty; achalasia, plumber Vincent syndrome; Diet deficiency in fruits and vegetables; Frequent consumption of very hot beverages; Hpv infections
Esophageal squamous cell carcinoma is commonly found in what region of the esophagus
middle third
75% of gastric polyps are of what type
hyperplastic and inflammatory types
hyperplastic polyps are most commonly seen in which age groups
Patients 50 to 60 years of age
What are the histologic characteristics of gastric polyps
Elongated foveolar glands With edematous lamina propria and cystic dilation
Why has the prevalence of fundic gland polyps Increased And what is the underlying physiologic mechanism
increased usage of proton pump inhibitors
Proton pump inhibitors inhibit acid production which leads to increased gastrin secretion and gland hyperplasia
For cases of Germline fundic gland polyps, what are the genetic culprits
Apc gene and dna repair gene MUTYH
Gastric adenoma is a pre-malignant neoplastic lesion that is commonly found in what region of the stomach
antrum
gastric adenomas are common in what patient population
males 50 to 60 years of age
gastric polyps are commonly associated with what chronic disease
chronic gastritis
Helicobacter Is associated with decreased risk of esophageal adenocarcinoma. explain why
helicobacter causes gastric atrophy which leads to reduced acid secretion and reflux
What are the histologic characteristics of fundic gland polyps
No inflammation; cystically dilated irregular glands lined by a heterogeneous mixture of different gastric cells
Gastric adenomas commonly occur with what type of metaplasia
Chronic gastritis induced intestinal metaplasia
Microscopically what kind of epithelium Is seen with gastric adenoma
Pseudo stratification
90% of stomach malignancies are of what type
Gastric adenocarcinoma
Gastric adenoCarcinoma Is more commonly found in patients of what nationalities
Japan, Costa Rica, Chile, Eastern Europe
why have cases of gastric adenocarcinoma dropped in the US
Decreased prevalence of H pylori And reduced consumption of N-nitroso compounds
Familial gastric adenocarcinomas are associated with mutations in what genes
loss of function mutations in CDH 1 gene that encodes E-cadherin
What genetic mutations are commonly associated with Gastric tumors of the diffuse sporadic type
CDH1
what genetic mutations are commonly associated with the intestinal type gastric tumors
mutations in the Wnt pathway which includes APC and genes encoding B-catenin
Describe the gross categorizations of gastric adenocarcinoma
Exophytic
Superficial spreading- involves mucosa & submucosa
Excavated-ulcerated & penetrating
Linitis plastica-infiltration of gastric wall
The vast majority of gastric adenocarcinomas are located where
Along the lesser curvature of the stomach or the antrum
Describe the histological classifications of gastro adeno carcinomas
Intestinal type-microscopic ulcerating gland formation; cells contain apical mucin vacuoles
diffuse type: Clusters of premature gastric wall and individual discohesive cells due to the absence of E-cadherin; Glands are composed of Signet ring cells; Commonly associated with linitis plastica
What are signet ring cells
cells with large use and vacuoles, And cytoplasmic dilation that pushes nuclei to the periphery Of the cell
What are the epidemiological characteristics of intestinal gastric adenocarcinoma
Males with a mean age of 55 years; Association with H pylori
What are the epidemiological characteristics associated with diffuse gastric adenocarcinoma
Younger patients; Not associated with H pylori
Does linitis plastica consist of glands?
no; there is absence of glands
Where to do gastric carcinomas metastasized to
liver, Virchow’s node, ovaries, rectum, umbilicus
What are common laboratory findings of gastric carcinoma
Microcytic hemolytic anemia caused by iron deficiency and positive hemoccult
What are common systemic clinical manifestations of gastric carcinomas
Hepatomegaly, ascites, left supraclavicular Adenopathy, Krukenberg Tumor, Blumer’s Shelf, Acanthosis Nigricans
sister mary Joseph Nodule
Gastric lymphoma commonly presents in what decade of life
6th decade of life
What is the most common type of gastric lymphoma
B cell type: MALTomas, & DLBCL
Gastric lymphoma usually arises from what
Sites of chronic inflammation
What is the most common cause of gastric MALTomas?
H. pylori infections trigger activation NF-kappaB transcription factor
Gastric lymphoma is associated with translocations of what gene and its function
NF-kappaB: transcription factor that promotes B cell growth & survival
Which gastric layer are maltomas found
Lamina propria
Microscopically what happens in gastric MALTomas
Lymphocytes infiltrate nearby glands Creating lymphoepithelial lesions
What clusters of differentiation besides 19 and 20 can also be positive for a gastric MALTomas
CD43 In 25% of cases
Gastric carcinoid is of what type of malignancy
Neuroendocrine malignancy
Gastrocarcinoids are commonly associated with what conditions
Endocrine cell hyperplasia; autoimmune induced chronic atrophic gastritis, MEN 1, and Zollinger-Ellison syndrome
Gastric carcinoids are derived from which type of stomach cells
enterochromaffin cells
Gastric carcinoids Are derived in which layer of the stomach
Intramural and some mucosal layers; overlying mucosal layer may be intact or ulcerated
what are the distinct histological characteristics of gastric carcinoids
Salt and pepper nucleus
What type of hormones do gastric carcinoid cells secrete
Mostly histamine and some somatostatin and serotonin
Gastric carcinoids are commonly associated with what type of gastritis
Atrophic Gastritis
describe the clinical manifestations of carcinoid syndrome
Skin flushing, Sweating, bronchospasm, abdominal pain, diarrhea
what cardiopathy is commonly seen in cases of carcinoid syndrome
right sided cardiac valvular fibrosis
Carcinoid syndrome is most commonly associated with what stage of gastric carcinoid
Metastasis to the liver
Gastrointestinal stromal tumors Are commonly occurring in which decades of life
5th or 6th decade
Gastrointestinal stromal tumors are commonly associated with this triad
Carney Triad
Gastrointestinal stromal tumors are of what type of neoplasm
Mesenchymal neoplasm
Gastrointestinal stromal tumors are derived from what kind of cells
Cajal: nnervated network of intestinal pacemaker cells for gut peristalsis
Which layer of the GI canal is gastrointestinal stromal tumors derived from
Muscularis propria
GIST stains positive for what cluster of Differentiation
c-KIT or CD117
Seventy five to 80% of all GIST cases have gain of function mutations in genes encoding what Protein
receptor tyrosine kinase KIT
What is the second most common gene mutation associated with GIST
PDGFRA
KIT & PPDGFRA GIST subtypes respond to this tyrosine kinase inhibitor.
imatinib
describe the gross characteristics of GIST
submucosal mass w/ central umblication & ulceration
What kind of cells would you expect to see under the microscope for GI stromal tumors
Spindle cells with epithelial features
What is the pathogenesis of Menetrier disease?
excessive secretion of TGF alpha and hyperactivation of EGF receptors on gastric epithelial cells
What are gross characteristics of Menetrier Disease
Hypertrophy of gastric rugae
What can be seen microscopically in menetrier disease?
diffuse hyperplasia of foveolar epithelium in body and fundus; foveolar epitheliall cells have a corkscrew-like appearance w/ cystic dilation
What is a common lab finding in hypertrophic gastropathies like menetrier disease?
hypoproteinemia due to loss of albumin
Hypertrophic gastropathies increase risk of what malignancy
gastric adenocarcinoma
Most pediatric cases of menetrier disease are assoc. w/ what?
CMV & respiratory infections
What is Zollinger-Ellison syndrome?
a hypertrophic gastropathy caused by gastrinoma; gastrinomas secrete large amounts of gastrin and are usually located in the pancreas & small intestine
ZE syndrome Is associated with what secondary complications
duodenal ulcers and chronic diarrhea
Hyperplasia of what type of cells would you expect to see in ZE syndrome
Parietal cells; This results in mucosal thickening; also, Mucous neck cells (causes hyperproduction of mucin); proliferation of endocrine cells as well
Gastronomas of what mutation are associated with more aggressive tumor behavior
MEN1 gene
What are the clinical manifestations of Carney Triad
presents in young females with gastric GIST, paraganglioma & pulmonary chondroma
what is a krukenberg tumor?
rare ovarian tumor from a cancer that has metastases to the ovaries; usually BL
what is blumer’s shelf?
palpable mass in Rectum
whare are sister mary Joseph nodules found?
subcutaneous periumbilical area
List the Triad of symptoms for plumber Vincent syndrome
Dysphagia, Iron deficiency anemia, Esophageal webs
what are the Characteristics of Barrett esophagus
Patches of red velvety mucosa extending up from the GE junction
