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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
Q

What is oesophageal atresia? (2)

A
  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
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26
Q

What are the clinical characteristics of oesophageal atresia? (2)

A

can’t feed

regurge bubbly saliva

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27
Q

What is a tracheo-oesophageal fistula?

A

connection between the oesophagus and trachea or a mainstem bronchus

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28
Q

What are the clinical characteristics of a tracheo-oesophageal fistula? (4)

A
  1. affected children develop symptoms within 24 hours
  2. cannot swallow
  3. coughs and distressed on feeding
  4. develops aspiration bronchopneumonia
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29
Q

How are tracheo-oesophageal fistulas treated?

A

urgent surgical correction required

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30
Q

What are the types of oesophageal obstruction? (6)

A
  1. stricture
  2. web
  3. ring
  4. divertivulum
  5. ulcerated tumour
  6. exophytic tumour
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31
Q

How does structural/mechanical oesophageal obstruction manifest in terms of eating/swallowing?

A

unable to swallow solids at first but then progresses to solids and liquids

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32
Q

What is oesophageal stenosis?

A

stricture due to oesophageal wall fibrous thickening

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33
Q

What causes oseophageal stenosis?

A

acquired due to

  1. gastro-oesophageal reflux
  2. radiation
  3. scleroderma
  4. caustic injury
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34
Q

What are oesophageal diverticula?

A

outpouchings of alimentary tract containing one or more wall layers

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35
Q

Who are most affected by oesophageal diverticula?

A

middle aged or elderly patients

36
Q

What is the pathogenesis of oesophageal diverticula? (3)

A
  1. failure of relaxation
  2. increased pressure above the cricopharyngeus
  3. increased pressure above the lower oesophageal sphincter
37
Q

What causes Zenker’s diverticulum?

A

increased pressure above the cricopharyngeus

38
Q

What causes epiphrenic diverticulum?

A

increased pressure above the lower oesophageal sphincter

39
Q

What are the symptoms of oesophageal diverticula?

A
  1. food regurgitation
  2. halitosis
  3. dysphagia
  4. excessive salivation
  5. heartburn
  6. mass in the neck
40
Q

What is the pathogenesis of oesophageal achalasia? (2)

A
  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
Q

What is the presentation of oesophageal achalasia?

A
  1. progressive dysphagia
  2. regurgitation
  3. aspiration of food (coughing)
42
Q

In whom is oesophageal achalasia usually seen in?

A

younger people

43
Q

What investigations should be done if someone presents with achalasia? (2)

A
  1. manometry

2. bird beak barium swallow

44
Q

What are people with achalasia at increased risk for? (3)

A
  1. oesophagitis
  2. aspiration pneumonia
  3. squamous cell carcinoma of oesophagus
45
Q

What is Mallory-Weiss Syndrome?

A

a tear or laceration of the mucous membrane most common at the gastroesophageal junction

46
Q

What is the pathogenesis of Mallory-Weiss Syndrome?

A

failure to relax lower oesophageal sphincter in time in advance of vomiting

47
Q

Who is usually affected by Mallory-Weiss Syndrome?

A

middle aged and elderly men

48
Q

What is the presentation of Mallory-Weiss Syndrome?

A

persistent chest pain post-vomiting

49
Q

What are the precipitating factors of Mallory-Weiss syndrome? (3)

A
  1. alcohol
  2. retching/vomiting
  3. straining at stool
50
Q

What are the complications of Mallory-Weiss Syndrome? (4)

A
  1. massive haematemesis
  2. inflammation
  3. residual ulcer
  4. transmural tear
51
Q

What are the causes of gastroesophageal reflux? (3)

A
  1. increased intragastric pressure
  2. decreased anti-reflux/valve tone
  3. increased intra-abdominal pressure
52
Q

What is a hiatal hernia?

A

Stomach protrusion above the diaphragm

53
Q

What are the two types of hiatal hernia?

A
  1. sliding (axial) (95%)

2. paraoesophageal (<5%)

54
Q

What is a sliding (axial) hiatal hernia? (2)

A
  1. shortened oesophagus

2. bell-like dilation of the stomach within the thoracic cavity

55
Q

What is a paraoesophageal hiatal hernia? (2)

A
  1. cardia of the stomach dissects into the thorac besides the oesophagus
  2. vulnerable to strangulation and infection
56
Q

What are the symptoms of hiatal hernia? (4)

A
  1. asymptomatic in most
  2. in some retrosternal chest pain
  3. in some gastric reflux
  4. in some acid brash
57
Q

What are the consequences of gastroesophageal reflux? (6)

A
  1. heartburn and acid brash
  2. oesophagitis
  3. stricture
  4. adenocarcinoma
  5. dysplasia
  6. metaplasia
58
Q

What are the infectious causes of oesophagitis? (4)

A
  1. bacterial - rare
  2. viral - immunocompromised
  3. fungal - immunocompromised
  4. fungal candidiasis
59
Q

What are the irritation causes of oesophagitis? (4)

A
  1. reflux
  2. ingestion of corrosive substances, hot fluids, drugs
  3. radiotherapy
  4. eosinophilic oesophagitis
60
Q

What are the systemic toxicity causes of oesophagitis? (2)

A
  1. uraemia

2. chemotherapy

61
Q

What are the systemic disorders that cause oesophagitis? (2)

A
  1. GVHD

2. skin diseases

62
Q

What are the contributing factors of GORD? (2)

A
  1. overwhelmed/impaired anti-reflux mechanism at throaco-abdominal junction
  2. reduced reparative capability of the oesophageal mucosa
63
Q

What are the risk factors for GORD? (3)

A
  1. middle aged men
  2. increased intraabdominal pressure - overweight, pregnant
  3. poor LES function and delayed gastric emptying
64
Q

What are the symptom of GORD? (7)

A
  1. dysphagia
  2. odynophagia
  3. heartburn
  4. regurgitation
  5. water brash
  6. haematemesis
  7. melena
65
Q

How is GORD diagnosed?

A
  1. endoscopy +/- biopsy

2. pH monitoring

66
Q

What is the gross/endoscopic morphology of GORD?

A

hyperemia and oedema

67
Q

What are the histological characteristics of GORD? (4)

A
  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
Q

What are the complications of GORD? (4)

A
  1. barretts’s oesophagus
  2. ulcer
  3. bleeding
  4. stricture
69
Q

What is Barrett’s oesophagus?

A

metaplasia of the lower oesophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells

70
Q

What is the risk of Barrett’s oesophagus?

A

increased risk of dysplasia and adenocarcinoma

71
Q

What is the gross morphology of Barrett’s oesophagus?

A

irregular circumferential band of red, velvety mucosa above the gastro-oesophageal junction

72
Q

What is the microscopic morphology of Barrett’s oesophagus?

A

epithelium with columnar cells interspersed inflammatory cells

73
Q

What is the most common benign oesophageal tumour?

A

leiomyoma

74
Q

What is the most common malignant oesophageal tumour?

A

squamous cell carcinoma

75
Q

Where does squamous cell carcinoma usually occur in the oesophagus?

A

the middle third

76
Q

What are the clinical features of oesophageal squamous cell carcinoma? (6)

A
  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
Q

What is the gross appearance of oesophageal squamous cell carcinoma? (3)

A
  1. polypoid
  2. ulcerating
  3. infiltrating
78
Q

What is the microscopic features of oesophageal squamous cell carcinoma?

A

moderately to well differentiated squamous cell carcinoma with or without keratinisation

79
Q

How does oesophageal squamous cell carcinoma spread?

A

via rich submucosal lymphatic networks to the nearby lymph nodes and extend deeply into adjacent mediastinal structures

80
Q

What are the high risk areas for oesophageal squamous cell carcinoma? (3)

A
  1. Iran
  2. China
  3. Southern Brazil
81
Q

What are the causes of squamous cell carcinoma in high risk areas? (4)

A
  1. food preservation - Mursik
  2. nutritional deficiency
  3. hot beverages - mate
  4. HPV
82
Q

What is the main cause of oesophageal squamous cell carcinoma?

A

alcohol and tobacco

83
Q

What is the gene mutation associated with oesophageal squamous cell carcinoma?

A
  1. TP53 gene mutation
  2. Cyclin D1
  3. Rb
84
Q

Where does oesophageal adenocarcinoma occur?

A

in the distal 1/3 of the oesophagus

85
Q

What is the most common gene mutation in oesophageal adenocarcinoma?

A

TP53 gene mutation 60%

86
Q

What is the microscopic morphology of oesophageal adenocarcinoma?

A

malignant cells with glandular differentiation

GI/GU Illness (15 decks)

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