Pathology 1-Salivary gland tumors Achalasia Esophageal pathologies Barrett esophagus Esophageal cancer Flashcards

1
Q

A patient had removal of a salivary gland tumor. Which gland was likely involved?

A

Parotid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A patient has a painless, moveable salivary gland mass removed. The tumor is benign, but later recurs. Why did it recur?

A

Recurs with incomplete excision or intraoperative rupture (it is likely a pleomorphic adenoma, a benign mixed tumor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pleomorphic adenomas typically consist of what two types of connective tissue?

A

Chondromyxoid stroma and epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A patient has a benign tumor made of heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue. Diagnosis?

A

Warthin tumor (papillary cystadenoma lymphomatosum), which is a benign cystic tumor with germinal centers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Warthin tumor is a ____ (malignant/benign) cystic tumor with ____ (germinal/follicular) centers.

A

Benign; germinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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?

A

Mucoepidermoid carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A patient has a painless mass in the parotid area. Histology of the lesion shows mucinous and squamous components. What do you suspect?

A

Mucoepidermoid carcinoma, which typically presents as a painless, slow-growing mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A patient had a salivary gland tumor rupture intraoperatively, & the tumor recurs a few weeks later. Type of salivary gland tumor?

A

Pleomorphic adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is another name of the papillary cystadenoma lymphomatosum?

A

Warthin tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Achalasia results from the failure of what process to occur?

A

Relaxation of the lower esophageal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In a man with high lower esophageal sphincter resting pressure/uncoordinated peristalsis, you see innervation loss from which plexus?

A

The myenteric (Auerbach) plexus, which innervates the LES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common presenting symptom of achalasia?

A

Progressive dysphagia to both solids and liquids (vs. obstruction, which presents as dysphagia to solids only)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

After you diagnose a man with achalasia, you should advise him that he has increased risk for what malignancy?

A

Esophageal squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the etymology of the word achalasia?

A

A = absence of, and chalasia = relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the underlying pathophysiology of dysphagia associated with CREST?

A

Esophageal dysmotility (poor peristalsis) and low esophageal pressure proximal to the lower esophageal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A man has dysphagia. Work-up shows esophageal smooth muscle atrophy, poor peristalsis, low LES pressure, reflux, and a stricture. Diagnosis?

A

Sclerodermal esophageal dysmotility (part of CREST syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

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?

A

Barrett esophagus (a complication of GERD)

18
Q

A man has increasing asthma frequency, as well as nocturnal cough and mild chest discomfort before falling asleep. What might you prescribe?

A

Proton pump inhibitor or H2 receptor blocker (GERD can cause adult-onset asthma, and nocturnal cough and dyspnea are common)

19
Q

A 45-year-old woman comes to the ED with vomiting. Her vomitus becomes bloody and painful. What is the cause of her hematemesis?

A

Mallory-Weiss tears, which often result from vomiting associated with alcoholics and bulimics (cause painful bleeding)

20
Q

Ingestion of what compound classically causes esophageal strictures?

A

Lye (strictures are also seen with gastroesophageal reflux disease)

21
Q

Esophagitis is commonly caused along with what three etiologies?

A

Reflux, infection, and chemical ingestion

22
Q

Which of these infectious agents is least likely to be associated with esophagitis: HSV-1, cytomegalovirus, Candida, Helicobacter pylori?

A

H. pylori (this bacterium is associated with peptic ulcer disease but rarely with esophagitis)

23
Q

• Esophagitis associated with HSV-1 shows ____ ulcers on endoscopy, whereas esophagitis associated with cytomegalovirus shows ____ ulcers.

A

Punched-out; linear

24
Q

Endoscopy performed on a patient with esophagitis shows white pseudomembranes. Is the patient immunocompromised?

A

Yes, as this is Candida esophagitis, which often occurs in immunocompromised patients

25
Q

Plummer-Vinson syndrome has what symptom triad?

A

Dysphagia due to esophageal webs, Iron deficiency anemia, and Esophageal webs (plumbers DIE)

26
Q

A patient has a food allergy that causes dysphagia, heartburn, and strictures. Does it respond to GERD therapy?

A

• No, as this is eosinophilic esophagitis, which does not respond to typical GERD therapies

27
Q

patient with numerous allergies and GERD unresponsive to therapy has an esophageal biopsy. What is it likely to show?

A

A Eosinophilic infiltration (this is eosinophilic esophagitis, common in patients with atopy)

28
Q

Is Barrett esophagus an example of dysplasia, hyperplasia, neoplasia, or metaplasia?

A

Metaplasia

29
Q

In patients with Barrett esophagus, there is a replacement of ____ epithelium with ____ epithelium.

A

Nonkeratinized squamous; intestinal (columnar)

30
Q

What causes Barrett esophagus?

A

Chronic acid reflux resulting in glandular metaplasia

31
Q

What specific malignancy is associated with Barrett esophagus?

A

Adenocarcinoma (Barrett = Becomes adenocarcinoma, results from reflux)

32
Q

Name at least six risk factors associated with esophageal cancer.

A

Achalasia, Alcohol, Barrett esophagus, Cigarette smoking, Diverticula, Esophageal web, Familial, Fat, GERD, Hot liquids (AABCDEFFGH)

33
Q

A Mexican woman with dysphagia of solids now has difficulty with liquids as well. She also smokes. Which part of her esophagus is affected?

A

Likely affects the upper two-thirds of the esophagus (this is squamous cell carcinoma)

34
Q

Worldwide, which type of esophageal cancer is most common?

A

Esophageal squamous cell carcinoma

35
Q

A patient (native of the United States) presents with esophageal cancer. Which part of the esophagus is it most likely to affect?

A

The lower third (this is esophageal adenocarcinoma, which is more common than squamous cell esophageal cancers in the United States)

36
Q

A patient with a history of Barrett esophagus has dysphagia for solids and liquids and weight loss. What is the likely diagnosis?

A

Esophageal adenocarcinoma

37
Q

An alcoholic with a Zenker diverticulum has dysphagia with hot liquids. What type of esophageal cancer is he at high risk for?

A

Esophageal squamous cell cancer

38
Q

An obese patient with a very long history of GERD has started to have dysphagia to liquids. What finding is likely on esophageal biopsy?

A

Esophageal adenocarcinoma (long history of GERD is a risk factor for Barrett esophagus, which is followed by esophageal cancer)

39
Q

A smoker presents with progressive dysphagia and weight loss in the past few months. What is his likely diagnosis?

A

Esophageal squamous cell cancer or esophageal adenocarcinoma

40
Q

A patient with Hirschsprung disease has progressive dysphagia and other symptoms of achalasia. What type of cancer is he at high risk for?

A

Esophageal cancer