Pathology of gastric diseases

Question 1

Which portion of the gastric mucosa varies? Which part remains the same?

Answer 1

Foveolar compartment=same

Glandular compartment=varies

Question 2

What does the oxyntic mucosa produce?

Answer 2

acid and pepin

Question 3

What are three congential lesions of the stomach?

Answer 3

1. pancreatic heterotopia (pancreas doesn’t separate from teh stomach)
2. hernias (increased risk of GERD)
3. congenital hypertrophic pyloric stenosis (early projectile vomiting)

Question 4

What are risk factors for acute gastritis?

Answer 4

NSAIDs, alcohol
bile reflux
smoking
severe hypotension or stress

Question 5

What would you see in intestinal metaplasia?

Answer 5

Lots of mucin, producing cells

Question 6

Which layer of the stomach contains major vessels?

Answer 6

The submucosa. If ulcer erode to this depth, can have hemorrhage

Question 7

What is autoimmune gastritis?

Answer 7

Antibodies against parietal cells. Will see gastric atrophy and intestinal metaplasia. Also, endocrine cell hyperplasia

Question 8

What are you at risk of developing if you have autoimmune gastritis?

Answer 8

Neuroendocrine tumors (i.e. carcinoids)
Adenocarcinoma

Question 9

How do you stain for gastric carcinoids?

Answer 9

chromogranin immunostaining

Question 10

Menetrier disease

Answer 10

Hypertrophic Gastropathy=foveolar hyperplasia

Question 11

What are four types of gastric polyps?

Answer 11

1. hyperplastic
2. Gastric fundic
3. Peutz-Jeghers
4. Adenomatous

Question 12

Which type of polyp is malignant?

Answer 12

adenomatous polyp

Question 13

What is gastric fundic polyp assoc’d with?

Answer 13

Familial adenomatous polyposis and PPIs

Question 14

What does Peutz-Jeghers polyp look like?

Answer 14

Arborizing smooth muscle layer

Question 15

What are four types of gastric malignancies?

Answer 15

Adenocarcinoma (90%)
Lymphoma
Neuroendocrine (carcinoid)
GI stromal tumor

Question 16

What are the two types of gastric adenocarcinoma?

Answer 16

Intestinal:

• Dysplasia before
• arises in glands
• more common in men

Diffuse:

• Linitis plastica
• No dysplasia before
• Arises in individual cells, no discrete mass

Question 17

What is the most important prognostic variable in gastric adenocarcinoma?

Answer 17

depth of invasion

Question 18

How do you stage adenocarcinomas?

Answer 18

TNM

Question 19

What is a common metastasis site for adenocarinoma of the stomach/

Answer 19

Virchow’s node

Question 20

Krukenberg tumor:

Answer 20

Bilateral ovarian metastases

Question 21

How does H pylori cause MALT lymphoma?

Answer 21

H pylori stimulates T cells

T cells activate B cells–>malignancy

Question 22

How do you treat MALT lymphoma?

Answer 22

Antibiotics alone. But if cells have acquired t(11,18) then need to treat like a lymphoma

Question 23

Where do gastric carcinoids arise from?

Answer 23

ECL cells

Question 24

What kinds of cells are GI stromal tumors linked to?

Answer 24

Interstitial cells of cajal?

Question 25

What mutations would you see in GI stromal tumors?

Answer 25

C-kit or PDGFR-alpha tyrosine kinases have activating mutations

Question 26

How do you treat GI stromal tumors?

Answer 26

imatinib