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GI/GU Illness > Pathology of the Salivary Glands and Oesophagus > Flashcards

Pathology of the Salivary Glands and Oesophagus Flashcards

1
Q

How do mucoceles occur?

A

ductal blockage or rupture with saliva leakage into the surrounding stroma or trauma

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2
Q

Where do mucoceles occur?

A

they occur on the lower lip

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3
Q

What is the treatment for mucoceles?

A

excision

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4
Q

Why do mucoceles recur?

A

due to incomplete excision

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5
Q

What is acute bacterial sialadenitis caused by?

A

Secondary to ductal obstruction or retrograde entry of oral cavity bacteria

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6
Q

When does acute bacterial sialadenitis occur?

A

occurs in patients with abnormal dryness of the mouth

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7
Q

what are the viral causes of acute sialadenitis?

A

mumps

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8
Q

What causes chronic sialadenitis? (3)

A
  1. Sjogren syndrome
  2. Radiation
  3. Graft vs Host Disease
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9
Q

What are the benign tumours of the salivary glands?

A
  1. Pleomorphic adenomas

2. Warthin’s tumour

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10
Q

What is the cause of pleomorphic adenoma?

A

translocation with PLAG1 activation which promotes growth factors

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11
Q

What are the histological characteristics of pleomorphic adenoma?

A

mixture of stromal and epithelial elements

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12
Q

What is the treatment of pleomorphic adenomas?

A

surgical excision
risk of recurrence if not completely excised
risk of damage to superficial facial nerve

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13
Q

What is the risk of pleomorphic adenoma?

A

long standing potential for carcinoma-ex-adenoma

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14
Q

What are the risk factors for Warthin’s tumour?

A

Male sex

Smokers

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15
Q

What are the histological characteristics of warthin’s tumour

A
  1. well encapsulated

2. consisting of glandular spaces lined by a double layer of epithelial cells separated by a dense lymphoid stroma

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16
Q

What are the malignant tumours of the salivary glands? (3)

A
  1. mucoepidermoid carcinoma
  2. adenoid cystic carcinoma
  3. acinic cell carcinoma
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17
Q

What is the most common primary malignant salivary tumour?

A

mucoepidermoid carcinoma

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18
Q

What are the histological characteristics of mucoepidermoid carcinoma? (2)

A
  1. lacks well defined capsule

2. cords, sheets or cystic arrangements of squamous, mucous or intermediate cells

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19
Q

What influences the aggression of mucoepidermoid carcinoma?

A

more squamous and intermediate cells

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20
Q

What is the cause of mucoepidermoid carcinoma?

A

a recurrent chromosomal translocation t(11;19) resulting in a MECT1-MAML2 fusion gene which causes abnormal Notch signalling

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21
Q

What are the histological characteristics of adenoid cystic carcinoma? (4)

A
  1. small tumour cells
  2. scant cytoplasm
  3. arranged in tubular or cribiform patterns
  4. filled with basement membrane material
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22
Q

What are the clinical characteristics? (5)

A
  1. slow growing
  2. recurrent
  3. invasive
  4. relentless
  5. usually fatal
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23
Q

What are the histological characteristics of acinic cell carcinoma?

A

resembles normal salivary serous acinar cells

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24
Q

What are the structural congenital abnormalities of the oesophagus? (3)

A
  1. oesophageal atresia
  2. tracheo-oesophageal fistula
  3. cysts and ectopias
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25
What is oesophageal atresia? (2)
1. part of the oesophagus is replaced by a thin, noncanalized cord with pouches above and below the atretic segment 2. absence of a lumen
26
What are the clinical characteristics of oesophageal atresia? (2)
can't feed | regurge bubbly saliva
27
What is a tracheo-oesophageal fistula?
connection between the oesophagus and trachea or a mainstem bronchus
28
What are the clinical characteristics of a tracheo-oesophageal fistula? (4)
1. affected children develop symptoms within 24 hours 2. cannot swallow 3. coughs and distressed on feeding 4. develops aspiration bronchopneumonia
29
How are tracheo-oesophageal fistulas treated?
urgent surgical correction required
30
What are the types of oesophageal obstruction? (6)
1. stricture 2. web 3. ring 4. divertivulum 5. ulcerated tumour 6. exophytic tumour
31
How does structural/mechanical oesophageal obstruction manifest in terms of eating/swallowing?
unable to swallow solids at first but then progresses to solids and liquids
32
What is oesophageal stenosis?
stricture due to oesophageal wall fibrous thickening
33
What causes oseophageal stenosis?
acquired due to 1. gastro-oesophageal reflux 2. radiation 3. scleroderma 4. caustic injury
34
What are oesophageal diverticula?
outpouchings of alimentary tract containing one or more wall layers
35
Who are most affected by oesophageal diverticula?
middle aged or elderly patients
36
What is the pathogenesis of oesophageal diverticula? (3)
1. failure of relaxation 2. increased pressure above the cricopharyngeus 3. increased pressure above the lower oesophageal sphincter
37
What causes Zenker's diverticulum?
increased pressure above the cricopharyngeus
38
What causes epiphrenic diverticulum?
increased pressure above the lower oesophageal sphincter
39
What are the symptoms of oesophageal diverticula?
1. food regurgitation 2. halitosis 3. dysphagia 4. excessive salivation 5. heartburn 6. mass in the neck
40
What is the pathogenesis of oesophageal achalasia? (2)
1. failure to relax lower oesophageal sphincter (LES) with swallowing, increased LES tone, loss of peristalsis 2. loss of intrinsic inhibitory innervation of the LES
41
What is the presentation of oesophageal achalasia?
1. progressive dysphagia 2. regurgitation 3. aspiration of food (coughing)
42
In whom is oesophageal achalasia usually seen in?
younger people
43
What investigations should be done if someone presents with achalasia? (2)
1. manometry | 2. bird beak barium swallow
44
What are people with achalasia at increased risk for? (3)
1. oesophagitis 2. aspiration pneumonia 3. squamous cell carcinoma of oesophagus
45
What is Mallory-Weiss Syndrome?
a tear or laceration of the mucous membrane most common at the gastroesophageal junction
46
What is the pathogenesis of Mallory-Weiss Syndrome?
failure to relax lower oesophageal sphincter in time in advance of vomiting
47
Who is usually affected by Mallory-Weiss Syndrome?
middle aged and elderly men
48
What is the presentation of Mallory-Weiss Syndrome?
persistent chest pain post-vomiting
49
What are the precipitating factors of Mallory-Weiss syndrome? (3)
1. alcohol 2. retching/vomiting 3. straining at stool
50
What are the complications of Mallory-Weiss Syndrome? (4)
1. massive haematemesis 2. inflammation 3. residual ulcer 4. transmural tear
51
What are the causes of gastroesophageal reflux? (3)
1. increased intragastric pressure 2. decreased anti-reflux/valve tone 3. increased intra-abdominal pressure
52
What is a hiatal hernia?
Stomach protrusion above the diaphragm
53
What are the two types of hiatal hernia?
1. sliding (axial) (95%) | 2. paraoesophageal (<5%)
54
What is a sliding (axial) hiatal hernia? (2)
1. shortened oesophagus | 2. bell-like dilation of the stomach within the thoracic cavity
55
What is a paraoesophageal hiatal hernia? (2)
1. cardia of the stomach dissects into the thorac besides the oesophagus 2. vulnerable to strangulation and infection
56
What are the symptoms of hiatal hernia? (4)
1. asymptomatic in most 2. in some retrosternal chest pain 3. in some gastric reflux 4. in some acid brash
57
What are the consequences of gastroesophageal reflux? (6)
1. heartburn and acid brash 2. oesophagitis 3. stricture 4. adenocarcinoma 5. dysplasia 6. metaplasia
58
What are the infectious causes of oesophagitis? (4)
1. bacterial - rare 2. viral - immunocompromised 3. fungal - immunocompromised 4. fungal candidiasis
59
What are the irritation causes of oesophagitis? (4)
1. reflux 2. ingestion of corrosive substances, hot fluids, drugs 3. radiotherapy 4. eosinophilic oesophagitis
60
What are the systemic toxicity causes of oesophagitis? (2)
1. uraemia | 2. chemotherapy
61
What are the systemic disorders that cause oesophagitis? (2)
1. GVHD | 2. skin diseases
62
What are the contributing factors of GORD? (2)
1. overwhelmed/impaired anti-reflux mechanism at throaco-abdominal junction 2. reduced reparative capability of the oesophageal mucosa
63
What are the risk factors for GORD? (3)
1. middle aged men 2. increased intraabdominal pressure - overweight, pregnant 3. poor LES function and delayed gastric emptying
64
What are the symptom of GORD? (7)
1. dysphagia 2. odynophagia 3. heartburn 4. regurgitation 5. water brash 6. haematemesis 7. melena
65
How is GORD diagnosed?
1. endoscopy +/- biopsy | 2. pH monitoring
66
What is the gross/endoscopic morphology of GORD?
hyperemia and oedema
67
What are the histological characteristics of GORD? (4)
1. thickened basal zone and thinning of superficial epithelial layers 2. papillae extend into upper 1/3 of surface epithelium 3. inflammatory cell infiltrate 4. superficial necrosis and ulceration
68
What are the complications of GORD? (4)
1. barretts's oesophagus 2. ulcer 3. bleeding 4. stricture
69
What is Barrett's oesophagus?
metaplasia of the lower oesophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells
70
What is the risk of Barrett's oesophagus?
increased risk of dysplasia and adenocarcinoma
71
What is the gross morphology of Barrett's oesophagus?
irregular circumferential band of red, velvety mucosa above the gastro-oesophageal junction
72
What is the microscopic morphology of Barrett's oesophagus?
epithelium with columnar cells interspersed inflammatory cells
73
What is the most common benign oesophageal tumour?
leiomyoma
74
What is the most common malignant oesophageal tumour?
squamous cell carcinoma
75
Where does squamous cell carcinoma usually occur in the oesophagus?
the middle third
76
What are the clinical features of oesophageal squamous cell carcinoma? (6)
1. progressive dysphagia solids than liquids 2. chest pain and odynophagia 3. weight loss 4. metastasis 5. haemorrhage - haematemesis, melena 6. sepsis secondary to ulceration
77
What is the gross appearance of oesophageal squamous cell carcinoma? (3)
1. polypoid 2. ulcerating 3. infiltrating
78
What is the microscopic features of oesophageal squamous cell carcinoma?
moderately to well differentiated squamous cell carcinoma with or without keratinisation
79
How does oesophageal squamous cell carcinoma spread?
via rich submucosal lymphatic networks to the nearby lymph nodes and extend deeply into adjacent mediastinal structures
80
What are the high risk areas for oesophageal squamous cell carcinoma? (3)
1. Iran 2. China 3. Southern Brazil
81
What are the causes of squamous cell carcinoma in high risk areas? (4)
1. food preservation - Mursik 2. nutritional deficiency 3. hot beverages - mate 4. HPV
82
What is the main cause of oesophageal squamous cell carcinoma?
alcohol and tobacco
83
What is the gene mutation associated with oesophageal squamous cell carcinoma?
1. TP53 gene mutation 2. Cyclin D1 3. Rb
84
Where does oesophageal adenocarcinoma occur?
in the distal 1/3 of the oesophagus
85
What is the most common gene mutation in oesophageal adenocarcinoma?
TP53 gene mutation 60%
86
What is the microscopic morphology of oesophageal adenocarcinoma?
malignant cells with glandular differentiation

GI/GU Illness (15 decks)

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