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

Question 1

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

Answer 1

Parotid gland

Question 2

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

Answer 2

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

Question 3

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

Answer 3

Chondromyxoid stroma and epithelium

Question 4

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

Answer 4

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

Question 5

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

Answer 5

Benign; germinal

Question 6

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?

Answer 6

Mucoepidermoid carcinoma

Question 7

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

Answer 7

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

Question 8

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

Answer 8

Pleomorphic adenoma

Question 9

What is another name of the papillary cystadenoma lymphomatosum?

Answer 9

Warthin tumor

Question 10

Achalasia results from the failure of what process to occur?

Answer 10

Relaxation of the lower esophageal sphincter

Question 11

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

Answer 11

The myenteric (Auerbach) plexus, which innervates the LES

Question 12

What is the most common presenting symptom of achalasia?

Answer 12

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

Question 13

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

Answer 13

Esophageal squamous cell carcinoma

Question 14

What is the etymology of the word achalasia?

Answer 14

A = absence of, and chalasia = relaxation

Question 15

What is the underlying pathophysiology of dysphagia associated with CREST?

Answer 15

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

Question 16

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

Answer 16

Sclerodermal esophageal dysmotility (part of CREST syndrome)

Question 17

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?

Answer 17

Barrett esophagus (a complication of GERD)

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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

Question 20

Ingestion of what compound classically causes esophageal strictures?

Answer 20

Lye (strictures are also seen with gastroesophageal reflux disease)

Question 21

Esophagitis is commonly caused along with what three etiologies?

Answer 21

Reflux, infection, and chemical ingestion

Question 22

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

Answer 22

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

Question 23

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

Answer 23

Punched-out; linear

Question 24

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

Answer 24

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

Question 25

Plummer-Vinson syndrome has what symptom triad?

Answer 25

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

Question 26

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

Answer 26

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

Question 27

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

Answer 27

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

Question 28

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

Answer 28

Metaplasia

Question 29

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

Answer 29

Nonkeratinized squamous; intestinal (columnar)

Question 30

What causes Barrett esophagus?

Answer 30

Chronic acid reflux resulting in glandular metaplasia

Question 31

What specific malignancy is associated with Barrett esophagus?

Answer 31

Adenocarcinoma (Barrett = Becomes adenocarcinoma, results from reflux)

Question 32

Name at least six risk factors associated with esophageal cancer.

Answer 32

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

Question 33

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

Answer 33

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

Question 34

Worldwide, which type of esophageal cancer is most common?

Answer 34

Esophageal squamous cell carcinoma

Question 35

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

Answer 35

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

Question 36

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

Answer 36

Esophageal adenocarcinoma

Question 37

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

Answer 37

Esophageal squamous cell cancer

Question 38

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

Answer 38

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

Question 39

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

Answer 39

Esophageal squamous cell cancer or esophageal adenocarcinoma

Question 40

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

Answer 40

Esophageal cancer