Pathology 1-Salivary gland tumors Achalasia Esophageal pathologies Barrett esophagus Esophageal cancer Flashcards
A patient had removal of a salivary gland tumor. Which gland was likely involved?
Parotid gland
A patient has a painless, moveable salivary gland mass removed. The tumor is benign, but later recurs. Why did it recur?
Recurs with incomplete excision or intraoperative rupture (it is likely a pleomorphic adenoma, a benign mixed tumor)
Pleomorphic adenomas typically consist of what two types of connective tissue?
Chondromyxoid stroma and epithelium
A patient has a benign tumor made of heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue. Diagnosis?
Warthin tumor (papillary cystadenoma lymphomatosum), which is a benign cystic tumor with germinal centers
Warthin tumor is a ____ (malignant/benign) cystic tumor with ____ (germinal/follicular) centers.
Benign; germinal
A patient presents with a painless, slow-growing mass and is found to have the most common type of malignant salivary tumor. What is it?
Mucoepidermoid carcinoma
A patient has a painless mass in the parotid area. Histology of the lesion shows mucinous and squamous components. What do you suspect?
Mucoepidermoid carcinoma, which typically presents as a painless, slow-growing mass
A patient had a salivary gland tumor rupture intraoperatively, & the tumor recurs a few weeks later. Type of salivary gland tumor?
Pleomorphic adenoma
What is another name of the papillary cystadenoma lymphomatosum?
Warthin tumor
Achalasia results from the failure of what process to occur?
Relaxation of the lower esophageal sphincter
In a man with high lower esophageal sphincter resting pressure/uncoordinated peristalsis, you see innervation loss from which plexus?
The myenteric (Auerbach) plexus, which innervates the LES
What is the most common presenting symptom of achalasia?
Progressive dysphagia to both solids and liquids (vs. obstruction, which presents as dysphagia to solids only)
After you diagnose a man with achalasia, you should advise him that he has increased risk for what malignancy?
Esophageal squamous cell carcinoma
What is the etymology of the word achalasia?
A = absence of, and chalasia = relaxation
What is the underlying pathophysiology of dysphagia associated with CREST?
Esophageal dysmotility (poor peristalsis) and low esophageal pressure proximal to the lower esophageal sphincter
A man has dysphagia. Work-up shows esophageal smooth muscle atrophy, poor peristalsis, low LES pressure, reflux, and a stricture. Diagnosis?
Sclerodermal esophageal dysmotility (part of CREST syndrome)
A man complains of dry cough and chest pain not associated with activity and worse when supine. If not treated, he is at risk for what?
Barrett esophagus (a complication of GERD)
A man has increasing asthma frequency, as well as nocturnal cough and mild chest discomfort before falling asleep. What might you prescribe?
Proton pump inhibitor or H2 receptor blocker (GERD can cause adult-onset asthma, and nocturnal cough and dyspnea are common)
A 45-year-old woman comes to the ED with vomiting. Her vomitus becomes bloody and painful. What is the cause of her hematemesis?
Mallory-Weiss tears, which often result from vomiting associated with alcoholics and bulimics (cause painful bleeding)
Ingestion of what compound classically causes esophageal strictures?
Lye (strictures are also seen with gastroesophageal reflux disease)
Esophagitis is commonly caused along with what three etiologies?
Reflux, infection, and chemical ingestion
Which of these infectious agents is least likely to be associated with esophagitis: HSV-1, cytomegalovirus, Candida, Helicobacter pylori?
H. pylori (this bacterium is associated with peptic ulcer disease but rarely with esophagitis)
• Esophagitis associated with HSV-1 shows ____ ulcers on endoscopy, whereas esophagitis associated with cytomegalovirus shows ____ ulcers.
Punched-out; linear
Endoscopy performed on a patient with esophagitis shows white pseudomembranes. Is the patient immunocompromised?
Yes, as this is Candida esophagitis, which often occurs in immunocompromised patients
Plummer-Vinson syndrome has what symptom triad?
Dysphagia due to esophageal webs, Iron deficiency anemia, and Esophageal webs (plumbers DIE)
A patient has a food allergy that causes dysphagia, heartburn, and strictures. Does it respond to GERD therapy?
• No, as this is eosinophilic esophagitis, which does not respond to typical GERD therapies
patient with numerous allergies and GERD unresponsive to therapy has an esophageal biopsy. What is it likely to show?
A Eosinophilic infiltration (this is eosinophilic esophagitis, common in patients with atopy)
Is Barrett esophagus an example of dysplasia, hyperplasia, neoplasia, or metaplasia?
Metaplasia
In patients with Barrett esophagus, there is a replacement of ____ epithelium with ____ epithelium.
Nonkeratinized squamous; intestinal (columnar)
What causes Barrett esophagus?
Chronic acid reflux resulting in glandular metaplasia
What specific malignancy is associated with Barrett esophagus?
Adenocarcinoma (Barrett = Becomes adenocarcinoma, results from reflux)
Name at least six risk factors associated with esophageal cancer.
Achalasia, Alcohol, Barrett esophagus, Cigarette smoking, Diverticula, Esophageal web, Familial, Fat, GERD, Hot liquids (AABCDEFFGH)
A Mexican woman with dysphagia of solids now has difficulty with liquids as well. She also smokes. Which part of her esophagus is affected?
Likely affects the upper two-thirds of the esophagus (this is squamous cell carcinoma)
Worldwide, which type of esophageal cancer is most common?
Esophageal squamous cell carcinoma
A patient (native of the United States) presents with esophageal cancer. Which part of the esophagus is it most likely to affect?
The lower third (this is esophageal adenocarcinoma, which is more common than squamous cell esophageal cancers in the United States)
A patient with a history of Barrett esophagus has dysphagia for solids and liquids and weight loss. What is the likely diagnosis?
Esophageal adenocarcinoma
An alcoholic with a Zenker diverticulum has dysphagia with hot liquids. What type of esophageal cancer is he at high risk for?
Esophageal squamous cell cancer
An obese patient with a very long history of GERD has started to have dysphagia to liquids. What finding is likely on esophageal biopsy?
Esophageal adenocarcinoma (long history of GERD is a risk factor for Barrett esophagus, which is followed by esophageal cancer)
A smoker presents with progressive dysphagia and weight loss in the past few months. What is his likely diagnosis?
Esophageal squamous cell cancer or esophageal adenocarcinoma
A patient with Hirschsprung disease has progressive dysphagia and other symptoms of achalasia. What type of cancer is he at high risk for?
Esophageal cancer
