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MD2 Medicine > Pathology of the Oesophagus and Stomach > Flashcards

Pathology of the Oesophagus and Stomach Flashcards

1
Q

What are oesophageal webs?

A

Mucosal and sub-mucosal webs protruding into lumen

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2
Q

What is achalasia?

A

Oesophageal sphincter doesn’t open > oesophagus dilates

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3
Q

What is a hiatus hernia?

A

Part of stomach enters thoracic cavity via oesophageal hiatus in diaphragm

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4
Q

What can cause infective oesophagitis?

A

Candida
Viral
- CMV
- HSV

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5
Q

In what general types of conditions are numerous eosinophils seen?

A

Allergic conditions
Parasitic conditions
GORD
Eosinophilic oesophagitis

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6
Q

What is the microscopic appearance of eosinophilic oesophagitis?

A 
Squamous mucosa without any glandular mucosa
Acanthotic
Moderate basal cell hyperplasia
Many areas of oedema
Eosinophils
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7
Q

What conditions would be considered if granulomas were present in the oesophagus?

A

TB
Sarcoidosis
Crohn’s disease

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8
Q

What is the typical age of patients with eosinophilic oesophagitis?

A

Young - 20s

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9
Q

What is the likely underlying cause of eosinophilic oesophagitis?

A

Food allergy

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10
Q

How may the patient present clinically with eosinophilic oesophagitis?

A

Dysphagia

Some may have burning in chest

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11
Q

What is the treatment for eosinophilic oesophagitis?

A

Avoid triggering food allergens

Immunosuppression with oral steroids if not settling

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12
Q

What part of the oesophagus is best to biopsy in the setting of GORD?

A

Distal

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13
Q

Compare the severity of GORD and eosinophilic oesophagitis if the middle and upper oesophagus are abnormal, too

A

GORD ascending disease - if middle and upper oesophagus affected > very severe disease
Eosinophilic oesophagitis affects whole oesophagus

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14
Q

What is the microscopic appearance of GORD?

A

Elongated stromal papillae
Mild basal cell hyperplasia
Scattered mixed inflammatory infiltrate

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15
Q

What condition can it be difficult to distinguish GORD from on pathology alone?

A

Eosinophilic oesophagitis, especially if many eosinophils present

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16
Q

What is the pathogenesis of GORD?

A

Gastric contents get into oesophagus due to relaxed sphincter

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17
Q

What are the risk factors for GORD?

A 
Smoking
Alcohol
Increased abdominal pressure
- Pregnancy
- Obesity
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18
Q

How can patients present clinically with GORD?

A

Central chest pain

Sore throat, sometimes

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19
Q

What is the treatment for GORD?

A

Antacids

PPIs

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20
Q

What are the potential complications of GORD?

A

Glandular metaplasia - adaptive response to resist acidic contents of stomach

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21
Q

What does indefinite for dysplasia mean?

A

In some conditions, especially if inflammation present, unsure if dysplasia/reactive change to inflammation

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22
Q

In which epithelium of the gastrointestinal tract are goblet cells usually present?

A

Intestinal

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23
Q

What features need to be present for the diagnosis of Barretts’ oesophagus?

A

Intestinal mucosa - has goblet cells

24
Q

What is the microscopic appearance of adenocarcinoma in the oesophagus?

A

Glands with columnar epithelium

Irregular invasive glands lined by cells with large, hyperchromatic nuclei with some loss of polarity and mitoses

25
Q

What features present in an oesophageal biopsy indicate intestinal metaplasia?

A

Goblet cells

26
Q

What features distinguish severe dysplasia from invasive adenocarcinoma?

A

If limited to crypts = dysplasia

If outside crypts = invasive carcinoma

27
Q

What is the management of metaplasia, with no dysplasia in an oesophageal biopsy?

A

Endoscopic surveillance

28
Q

What is the management of low grade dysplasia in an oesophageal biopsy?

A

Intensified surveillance

?Mucosal ablation

29
Q

What is the management of high grade dysplasia in an oesophageal biopsy?

A

Endoscopic mucosal resection

Prophylactic mucosal ablation

30
Q

What is the management of intramucosal carcinoma?

A

Curative treatment

?Endoscopic mucosal resection

31
Q

What is the management of carcinoma in the submucosa and beyond?

A

Curative treatment

32
Q

What are the main types of carcinoma of the oesophagus?

A

Adenocarcinoma

Squamous cell carcinoma

33
Q

What are the risk factors for developing adenocarcinoma of the oesophagus?

A

Barretts’ oesophagus

34
Q

What are the risk factors for developing squamous cell carcinoma of the oesophagus?

A

Alcohol
Smoking
Achalasia

35
Q

What is the macroscopic appearance of candidiasis of the oesophagus?

A

Whitish plaques

36
Q

How can the different regions of the stomach be distinguished histologically?

A

Fundus and body have parietal and chief cells

Antrum has mucus secreting cells

37
Q

Does the lamina propria of the stomach normally contain many mononuclear inflammatory cells?

A

No, only a few

38
Q

What features indicate that the gastric mucosa is specialised?

A

Presence of parietal and chief cells

39
Q

Intestinal metaplasia is indicated by the presence of what main feature in the stomach?

A

Goblet cells

40
Q

What does active chronic H pylori gastritis look like microscopically?

A

Inflammatory infiltrate
Occasional lymphoid aggregates in lamina propria
Numerous neutrophils
Occasional H pylori

41
Q

What if a biopsy report is out of keeping with the clinical impression?

A

Where is the mistake?

42
Q

What are the potential complications of H pylori?

A

Chronic gastritis
Dysphagia
Gastric carcinoma
Gastric lymphoma

43
Q

Where in the intestine is iron absorbed?

A

Duodenum

44
Q

What is melanosis coli?

A

Discolouration of mucosa
Common in people who take a lot of laxatives
Due to macrophages in lamina propria containing lipofuscin

45
Q

What are the two main histopathological types of gastric adenocarcinoma?

A

Intestinal - papillar/tubular architecture
Diffuse - scattered cells
- Signet cells
- Mucinous type

46
Q

What are the risk factors of gastric adenocarcinoma of the intestinal type?

A

H pylori gastritis
Consumption of smoked foods
Smoking
Alcohol

47
Q

What is the first step in management of gastric adenocarcinoma?

A

Partial/total gastrectomy

48
Q

What is the significance of perineural invasion of gastric adenocarcinoma?

A

Malignant cells can hide along nerves > can spread elsewhere in stomach

49
Q

What is the significance of lymphovascular invasion of gastric adenocarcinoma?

A

Cancer can spread elsewhere

50
Q

What are centrocyte and centroblast-like cells?

A

Major malignant cells in follicular lymphoma

51
Q

What technique is used to determine if the cells are CD20, CD3, CD5, etc positive?

A

Immunohistochemistry

Flow cytometry

52
Q

What types of lymphoma can occur in the gastrointestinal tract?

A

MALT - most common
Follicular
DBCL

53
Q

What are two major contributors of prognosis in gastrointestinal stromal tumours (GIST)?

A

Mitotic rate

Size of tumour

54
Q

What is CD117?

A

Growth factor receptor

55
Q

What is the relevance to the management of GIST if it is CD117 positive?

A

Can be blocked by tyrosine kinase inhibitors; eg: Glivec

56
Q

What is the proposed cell of origin of GIST, and what is its function?

A

Intestinal cells of Cajal
Intermediate between neural and muscle cells
Responsible for peristalsis

MD2 Medicine (18 decks)

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