Robbins GI morphologies stomach

Question 1

lamina propria shows moderate edema, slight vascular congestion

surface epithelium intact

foveolar cell hyperplasia, sinuous profile

epithelial proliferation present.

minor # of neutrophils present and a few lymphocytes and plasma cells.

Answer 1

gastropathy and mild acute gastritis may be difficult to recognize, since the lamina propria shows only moderate edema and slight vascular congestion. The surface epithelium is intact, but foveolar cell hyperplasia, with characteristic corkscrew profiles and epithelial proliferation are typically present. Neutrophils are not abundant, but a few may be found among the epithelial cells or within mucosal glands in gastritis. There are few lymphocytes and plasma cells.

Question 2

1. presence of neutrophilic infiltrate above basement membrane and in direct contact with epithelial cells
2. mucosal damage/erosions
3. fibrin-containing purulent exudate in the lumen.
4. dark punctae in hyperemic mucosa

Answer 2

1. signifies active inflammation, or, in this case, gastritis (rather than gastropathy).
2. term active inflammation is preferred over acute inflammation, since active inflammation may be present in both acute and chronic disease states.
3. With more severe mucosal damage, erosions and hemorrhage develop. Erosion denotes loss of the epithelium, resulting in a superficial mucosal defect. It is accompanied by a pronounced mucosal neutrophilic infiltrate and a fibrin-containing purulent exudate in the lumen. Hemorrhage may occur and cause dark punctae in hyperemic mucosa. Concurrent erosion and hemorrhage is termed acute erosive hemorrhagic gastritis. Large areas of the gastric surface may be denuded, although the involvement is typically superficial. When erosions extend deeply, they may progress to ulcers, as described later.

Question 3

sharply demarcated, multiple rounded ulcers less than 1 cm in diameter.

ulcer base has brown to black appearance

indications of scarring and blood vessel thickening absent

after treatment, ulcers healed perfectly.

Answer 3

1. Stress-related gastric mucosal injury ranges from shallow erosions caused by superficial epithelial damage to deeper lesions that penetrate the depth of the mucosa.
2. Acute ulcers are rounded and less than 1 cm in diameter.
3. The ulcer base is frequently stained brown to black by acid digestion of extravasated blood and may be associated with transmural inflammation and local serositis.
4. Unlike peptic ulcers, which arise in the setting of chronic injury, acute stress ulcers are found anywhere in the stomach and are most often multiple.
5. Microscopically, acute stress ulcers are sharply demarcated, with essentially normal adjacent mucosa.
6. There may be a suffusion of blood into the mucosa and submucosa and an associated inflammatory reaction.
7. Conspicuously absent are the scarring and blood vessel thickenings that characterize chronic peptic ulcers. Healing with complete re-epithelialization occurs within days to several weeks after removal of the injurious factors.

Question 4

1. ________ and _______ are characteristic of H. pylorigastritis.
2. H. pylori in infected individuals: organism is concentrated within the ______ in the _________regions.
3. H. pylori display ____and are generally______ association with ______ or ________epithelium.
4. Within the stomach, H. pylori are most often found in the ______.
5. the ______ occurs at somewhat lower rates.
6. H. pylori are less common in ______ of the _________.
7. ______ biopsy is preferred for evaluation of H. pylori gastritis.
8. When viewed endoscopically, H. pylori-infected _______ is usually _____and has a coarse or even _____appearance.
9. _____ infiltrate generally includes variable numbers of ______within the________including some that cross the basement membrane to assume an _________ and accumulate in the ______ to create _________.
10. In addition, the _______ contains large numbers of _____ and increased numbers of _______.

Answer 4

1. Intraepithelial neutrophils and subepithelial plasma cells are characteristic of H. pylorigastritis.
2. organism is concentrated within the superficial mucus overlying epithelial cells in the surface and neck regions. T
3. H. pylori display tropism for gastric epithelia and are generally not found in association with intestinal metaplasia or duodenal epithelium.
4. Within the stomach, H. pylori are most often found in the antrum
5. cardia occurs at somewhat lower rates.
6. H. pylori are less common in oxyntic (acid-producing) mucosa of the fundus and body.
7. Thus, an antral biopsy is preferred for evaluation of H. pylori gastritis.
8. When viewed endoscopically, H. pylori-infected antral mucosa is usually erythematous and has a coarse or even nodular appearance.
9. The inflammatory infiltrate generally includes variable numbers of neutrophils within the lamina propria, including some that cross the basement membrane to assume an intraepithelial location ( Fig. 17-12 B ) and accumulate in the lumen of gastric pits to create pit abscesses.
10. n addition, the superficial lamina propria contains large numbers of plasma cells and increased numbers of lymphocytes and macrophages.

Question 5

1. _____________ and ___________ cells are characteristic of H. pylorigastritis. When intense, inflammatory infiltrates may _____ mimicking _________
2. _________________________ frequently present and represent an induced form of ___________that has the potential to transform into ______________

Answer 5

Intraepithelial neutrophils and subepithelial plasma cells are characteristic of H. pylorigastritis. When intense, inflammatory infiltrates may create thickened rugal folds, mimicking the appearance of early cancers. Lymphoid aggregates, some with germinal centers, are frequently present and represent an induced form of mucosa-associated lymphoid tissue, or MALT, that has the potential to transform into lymphoma.

Question 6

AUTOIMMUNE GASTRITIS

Location

Inflammatory infiltrate

Acid production

Gastrin

Other lesions

Serology

Sequelae

Associations

Answer 6

Autoimmune GASTRITIS

Body

Lymphocytes, macrophages

Decreased

Increased

Neuroendocrine hyperplasia

Antibodies to parietal cells (H ⁺ ,K ⁺ -ATPase, intrinsic factor)

Atrophy, pernicious anemia, adenocarcinoma, carcinoid tumor

Autoimmune disease; thyroiditis, diabetes mellitus, Graves disease

Question 7

Autoimmune gastritis is characterized by ___________ within the_____________

Answer 7

Autoimmune gastritis is characterized by diffuse mucosal damage of the oxyntic (acid-producing) mucosa within the body and fundus.

Question 8

1. Autoimmune gastritis is characterized by……
2. Damage to the _______ is typically ___________
3. With diffuse atrophy, the ____________ appears ________, and ___________ are lost. If ____________severe, _______________within epithelial cells.
4. the inflammatory infiltrate is typically composed of ____________often in association with ________________
5. The superficial lamina propria plasma cells typical _________ are _______, and the inflammatory reaction is _____ and _______ on the gastric glands
6. When atrophy is incomplete, ______ of ______ may give the appearance of ___________.
7. In other areas, small surface elevations may represent sites of _________
   
   1. characterized by the presence of______________

Answer 8

1. Autoimmune gastritis is characterized by diffuse mucosal damage of the oxyntic (acid-producing) mucosa within the body and fundus.
2. damage to the antrum and cardia is typically absent or mild.
3. With diffuse atrophy, the oxyntic mucosa of the body and fundus appears markedly thinned, and rugal folds are lost.
4. If vitamin B 12 deficiency is severe, nuclear enlargement (megaloblastic change) occurs within epithelial cells.
5. the inflammatory infiltrate is typically composed of lymphocytes, macrophages, and plasma cells, often in association with lymphoid aggregates and follicles.
6. The superficial lamina propria plasma cells typical of H. pylori gastritis are absent, and the inflammatory reaction is deeper and centered on the gastric glands ( Fig. 17-13 A ).
7. When atrophy is incomplete, residual islands of oxyntic mucosa may give the appearance of multiple small polyps or nodules.
8. In other areas, small surface elevations may represent sites of intestinal metaplasia,
9. characterized by the presence of goblet cells and columnar absorptive cells

Question 9

1. Autoimmune Gastritis
2. Although present in most patients,_________can be difficult to appreciate on hematoxylin and eosin-stained sections. This______ which can be clearly demonstrated with immunostains for ___________, parallels the degree of mucosal atrophy and is a physiologic response to decreased acid production.
3. Over time, _____ can stimulate e______in the fundus and body.
4. Rarely, this may progress to form small, multicentric, low-grade neuroendocrine (carcinoid) tumors.

Answer 9

1. Although present in most patients, endocrine cell hyperplasia can be difficult to appreciate on hematoxylin and eosin-stained sections.
2. This hyperplasia, which can be clearly demonstrated with immunostains for proteins such as chromogrannin A, parallels the degree of mucosal atrophy and is a physiologic response to decreased acid production.
3. Over time, hypergastrinemia can stimulate endocrine cell hyperplasia in the fundus and body.
4. Rarely, this may progress to form small, multicentric, low-grade neuroendocrine (carcinoid) tumors.

Question 10

1. Peptic ulcers occur in the context of ……..
2. most common in the….and involve the……..
3. Gastric peptic ulcers are predominantly located……..near the interface of……..
4. Peptic ulcers are…..in …..
5. The classic peptic ulcer is a….. and …..
6. The mucosal margin may….. slightly….but usually …..
7. In contrast, _____ margins are more characteristic of cancers .
8. ____ into the _____ is a surgical emergency
   
   1. may be identified by detection of _________ on _______

Answer 10

1. Peptic ulcers occur in the context of chronic gastritis
2. most common in the proximal duodenum, where they occur within a few centimeters of the involve the anterior duodenal wall.
3. Gastric peptic ulcers are predominantly located along the lesser curvature near the interface of the body and antrum.
4. Peptic ulcers are solitary in more than 80% of patients.
5. The classic peptic ulcer is a round to oval and sharply punched-out
6. The mucosal margin may overhang the base slightly, particularly on the upstream side, but is usually level with the surrounding mucosa.
7. In contrast, heaped-up margins are more characteristic of cancers .
8. Perforation nto the peritoneal cavity is a surgical emergency
9. In contrast, heaped up margins are more typical of cancers.
10. may be identified by detection of free air under the diaphragm on upright radiographs of the abdomen.

Question 11

1. The base of peptic ulcers is _________
2. Active ulcers may be lined by _____
3. Beneath this, ______infiltrated with _____ and a ____ or _____ forms the ulcer base

Answer 11

1. The base of peptic ulcers is smooth and clean as a result of peptic digestion of exudate.
2. Active ulcers may be lined by a thin layer of fibrinoid debris underlaid by a predominantly neutrophilic inflammatory infiltrate.
3. Beneath this, granulation tissue infiltrated with mononuclear leukocytes and a fibrous or collagenous scar forms the ulcer base

Question 12

1. a few areas appear polypoid, and enlarged rugae are present in the body and fundus
2. antrum is spared.
3. glands elongated with corkscrew-like appearance
4. cystic dilation
5. Inflammation is usually minimal
6. hypoplasia of parietal and chief cells
7. _________ is characterized by irregular enlargement of the gastric rugae.
8. ______ is the most histologically characteristic feature

Answer 12

1. Menetrier’s dx
2. irregular enlargement of the gastric rugae.
3. Histologically, the most histologically characteristic feature is the hyperplasia of the foveolar mucous cells

Question 13

1. multiple polyps smaller than 1 cm in diameter in patient with atrophic gastritis.
2. polyps are ovoid in shape and have a smooth surface
3. some erosions present
4. polyps are cystically dilate and elongated foveolar glands
5. The lamina propria dematous wiith varying degrees of acute and chronic inflammation
6. surface ulceration may be present

Answer 13

1. Inflammatory and Hyperplastic Polyps
   
   1. Up to 75% of all gastric polyps are inflammatory or hyperplastic polyps
   2. polyps are most common in individuals between 50 and 60 years of age
   3. usually develop in association with chronic gastritis
   4. Among individuals with H. pylori gastritis, polyps may regress after bacterial eradication

Question 14

1. polyps occur in the gastric body and fundus
2. well-circumscribed
3. smooth surface.
4. cystically dilated
5. lined by flattened parietal and chief cells. Inflammation is typically absent/minimal

Answer 14

1. Fundic Gland Polyps
   
   1. Dysplasia and even cancer may occur in FAP-associated fundic gland polyps, but sporadic fundic gland polyps carry no cancer risk.
   2. Fundic gland polyps occur sporadically and in individuals with familial adenomatous polyposis (FAP).
   3. prevalence of fundic gland polyps has increased markedly in recent years as a result of increasing use of proton pump inhibitor therapy

Question 15

1. biopsy of a solitary lesion less than 2 cm in diameter from the antrum.
   
   1. columnar epithelial with mucous cells intestinal-type columnar epithelium that exhibits varying degrees of dysplasia
   2. pseudostratification
   3. hyper­chromasia of epithelial cell nuclei
   4. epithelial crowding.
2. biopsy of a solitary lesion less than 2 cm in diameter from the antrum.
   
   1. “gland-within-gland” appearance
   2. cribriform like structures.

Answer 15

1. Gastric adenomas are usually solitary lesions less than 2 cm in diameter
2. most commonly located in the antrum.
3. The majority of adenomas are composed of intestinal-type columnar epithelium that exhibits varying degrees of dysplasia
4. Dysplasia can be classified as low or high grade, and both grades may include enlargement, elongation, pseudostratification, and hyper­chromasia of epithelial cell nuclei, and epithelial crowding.
5. High-grade dysplasia is characterized by more severe cytologic atypia and irregular architecture, including glandular budding and gland-within-gland, or cribriform, structures.
6. Gastric adenomas are pre-malignant neoplastic lesions. However, the risk of transformation to invasive cancer is much higher in gastric adenomas.

Question 16

1. Gastric antrum > lesser curvature > greater curvature
2. Those with the an ______ which tend to form bulky tumors and are composed of ___________
3. This with the ______ pattern are more often composed of signet-ring cells

Answer 16

1. Most gastric adenocarcinomas involve the gastric antrum; the lesser curvature is involved more often than the greater curvature.
2. Gastric tumors with an intestinal morphology, which tend to form bulky tumors are composed of glandular structures
3. Diffuse infiltrative growth pattern are more often composed of signet-ring cells

Question 17

1. Histologically, gastric MALToma takes the form of _______ in the ______
2. Characteristically, the neoplastic lymphocytes infiltrate the gastric glands focally to create diagnostic_______ ( Fig. 17-19 A , inset).
3. Reactive-appearing ______ may be present, and, in about _____of tumors, plasmacytic differentiation is observed.
4. Like other tumors of mature B cells, MALTomas express the B-cell markers_____&______
5. They do not express____ or _____
6. they are also positive for _____ in about 25% of cases

Answer 17

1. Histologically, gastric MALToma takes the form of a dense lymphocytic infiltrate in the lamina propria
2. Characteristically, the neoplastic lymphocytes infiltrate the gastric glands focally to create diagnostic lymphoepithelial lesions
3. Reactive-appearing B-cell follicles may be present, and, in about 40% of tumors, plasmacytic differentiation is observed.
4. Like other tumors of mature B cells, MALTomas express the B-cell markers CD19 and CD20.
5. They do not express CD5 or CD10,
6. they are positive for CD43 in about 25% of cases

Question 18

1. Grossly, carcinoids are ____ or _______ masses that create ___________ _________ ______.
2. In the stomach they typically arise_______
3. Microscopically the nodule is composed of __________
4. The chromatin texture is frequently described as a ________pattern.
5. Carcinoids tend to be _______ in color and are very______ as a consequence of an intense desmoplastic reaction, which may cause ____ of the bowel.
6. Histologically, carcinoids are composed of ____, _____, _____, or _____ of cells with _____, ________ cytoplasm and a __________ nucleus (a lot of stuff in this blank)
7. In most tumors there is minimal_________ but _____, ______, and ______ may be present in rare cases.
8. Immunohistochemical stains are typically positive for endocrine granule markers, such as ______and _________

Answer 18

1. Grossly, carcinoids are intramural or submucosal masses that create small polypoid lesions
2. In the stomach they typically arise within oxyntic mucosa.
3. Microscopically the nodule is composed of tumor cells embedded in dense fibrous tissue.
4. The chromatin texture is frequently described as a “salt and pepper” pattern
5. Carcinoids tend to be yellow or tan in color
6. they are very firm as a consequence of an intense desmoplastic reaction, which may cause kinking and obstruction of the bowel.
7. Histologically, carcinoids are composed of islands, trabeculae, strands, glands, or sheets of uniform cells with scant, pink granular cytoplasm and a round to oval stippled nucleus
8. In most tumors there is minimal pleomorphism, but anaplasia, mitotic activity, and necrosis may be present in rare cases.
9. Immunohistochemical stains are typically positive for endocrine granule markers, such as synaptophysin and chromogranin A.
10. Microscopically the nodule is composed of tumor cells embedded in dense fibrous tissue.
11. The chromatin texture is frequently described as a “salt and pepper” pattern

Question 19

1. Primary gastric GISTs can be up to diameter.
2. They usually form a _____ and ______ fleshy mass, covered by ulcerated or intact mucosa but can also _____ toward the serosa.
3. The cut surface shows a ____appearance.
4. Metastases may take the form of_________ throughout the _______or as one or more nodules in the _______
5. GISTs composed of ____ _____ ____ are classified as ______
6. whereas tumors dominated by ______ cells are termed epithelioid type
7. The most useful diagnostic marker is ____ which is detectable in_____ and 95% of gastric GISTs
8. On cross-section a ______ within the white, fleshy tumor.
9. Histologically the tumor is primarily composed of_____ or _____ of _____ tumor cells.

Answer 19

1. 30 cm
2. solitary, well circumscribed, project outward
3. whorled
4. multiple serosal nodules, peritoneal cavity, liver
5. thin elongated cells, spindle cells
6. epithelioid appearing cells
7. KIT, Cajal cells
8. whorled-pattern
9. bundles or fascicles of spindle tumor cells

Question 20

_________ are pre-malignant neoplastic lesions.

Answer 20

Gastric adenomas

Question 21

1. _______may penetrate the gastric wall, but more frequently grow __________ to form either an ____ or an ___________
2. In contrast, _______ is generally composed of __________, likely as a result of E-cadherin loss.
3. These cells do not form glands but instead have ________ creating _______ cell morphology.

Answer 21

1. Although intestinal-type adenocarcinomas may penetrate the gastric wall, they more frequently grow along broad cohesive fronts to form either an exophytic mass or an ulcerated tumor.
2. In contrast, diffuse gastric cancer is generally composed of discohesive cells, likely as a result of E-cadherin loss.
3. These cells do not form glands but instead have large mucin vacuoles that expand the cytoplasm and push the nucleus to the periphery, creating a signet-ring cell morphology.

Question 22

Although intestinal-type adenocarcinomas may penetrate the gastric wall, they more frequently grow along broad cohesive fronts to form either an exophytic mass or an ulcerated tumor. The neoplastic cells often contain apical mucin vacuoles, and abundant mucin may be present in gland lumina. In contrast, diffuse gastric cancer is generally composed of discohesive cells, likely as a result of E-cadherin loss. These cells do not form glands but instead have large mucin vacuoles that expand the cytoplasm and push the nucleus to the periphery, creating a signet-ring cell morphology. They permeate the mucosa and stomach wall individually or in small clusters, and may be mistaken for inflammatory cells, such as macrophages, at low magnification. Release of extracellular mucin in either type of gastric cancer can result in formation of large mucin lakes that dissect tissue planes.

Question 23

1. A mass may be difficult to appreciate in diffuse gastric cancer, but these infiltrative tumors often evoke a desmoplastic reaction that ______ the gastric wall
2. When there are large areas of infiltration, ________ wall may impart a leather bottle appearance termed _______

Answer 23

1. A mass may be difficult to appreciate in diffuse gastric cancer, but these infiltrative tumors often evoke adesmoplastic reaction that stiffens the gastric wall and may provide a valuable diagnostic clue.
2. When there are large areas of infiltration, diffuse rugal flattening and a rigid, thickened wall may impart aleather bottle appearance termed linitis plastica