Rosai Chapter 14 - Stomach Flashcards by Jonathan Emmanuel Cancio

Superomedial margin of the stomach

Lesser curvature

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Inferolateral margin of the stomach

Greater curvature

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Mucin secreted by the gastric mucosa is almost entirely of:

Neutral type

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Neutral-type mucin secreted by the gastric mucosa is positive for:

Periodic-acid Schiff (PAS)

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Neutral-type mucin secreted by the gastric mucosa is negative for:

Alcian blue

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IHCs of foveolar epithelium (2):

MUC1

- MUC5AC

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IHC of foveolar glands:

-MUC6

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Endocrine cells of the Pyloric mucosa of the stomach (3)

G cells
Enterochromaffin cells
D cells

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Endocrine cell of the Fundic mucosa of the stomach

Enterochromaffin-like (ECL) cells

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Most common endocrine cell of the Pyloric mucosa of the stomach

-G cells (50%)

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Gastrin producing endocrine cell of the pyloric mucosa of the stomach

G cells

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Serotonin producing endocrine cell of the pyloric mucosa of the stomach

Enterochromaffin cells

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Somatostatin producing endocrine cell of the pyloric mucosa of the stomach

D cells

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Histamine storing endocrine cell of the fundic mucosa of the stomach

ECL cells

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Layers of Muscularis Mucosae

ICOL

Inner circular
Outer longitudinal

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Layers of Muscularis propria

IOMCOL

Inner oblique
Middle circular
Outer longitudinal

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The layer of muscularis propria that forms the pyloric sphincter at gastroduodenal junction

Middle circular

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In what layer of the muscularis propria can you find the Auerbach (myenteric) plexus and Interstitial cells of Cajal?

Between the Middle Circular and Outer Longitudinal

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Most common age of onset of Hypertrophic Pyloric Stenosis

-3 and 12 weeks

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Main differential diagnosis of congenital hypertrophic pyloric stenosis

Pyloric atresia

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This differential diagnosis of congenital hypertrophic pyloric stenosis is a genetically determined disease associated with Epidermolysis bullosa

Pyloric atresia

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Two main features of Chronic Gastritis:

infiltration of the lamina propria by inflammatory cells; and eventually
Atrophy of the glandular epithelium

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CHRONIC SUPERFICIAL GASTRITIS vs. CHRONIC ATROPHIC GASTRITIS:

-Inflammation is limited to foveolar region

Chronic superficial gastritis

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CHRONIC SUPERFICIAL GASTRITIS vs. CHRONIC ATROPHIC GASTRITIS

-Absence of glandular atrophy

Chronic superficial gastritis

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CHRONIC SUPERFICIAL GASTRITIS vs. CHRONIC ATROPHIC GASTRITIS -Inflammation is more extensive

Chronic atrophic gastritis

CHRONIC SUPERFICIAL GASTRITIS vs. CHRONIC ATROPHIC GASTRITIS -Presence of glandular atrophy

Chronic atrophic gastritis

Two types of metaplastic change in Chronic Gastritis:

- Pyloric metaplasia of the fundic mucosa | - Intestinal metaplasia

Type of Metaplastic change in Chronic Gastritis: -a replacement of the fundic-type glands by mucus-secreting glands

-Pyloric metaplasia of the fundic mucosa

Type of Metaplastic change in Chronic Gastritis: -gradual process that proceeds as an advancing front along the fundic-pyloric junction and moves proximally toward the cardia

-Pyloric metaplasia of the fundic mucosa

Type of Metaplastic change in Chronic Gastritis: -refers to the progressive replacement of the gastric mucosa by epithelium having the light and electron microscopic features of intestinal epithelium of either small or large bowel type, including goblet cells, absorptive (brush border) cells, Paneth cells, and a variety of endocrine cells

-Intestinal metaplasia

Two types of Intestinal Metaplasia

- Complete (Type I) | - Incomplete (Type II)

Type of Intestinal Metaplasia: -gastric mucosa changes to a pattern nearly identical to that of small bowel epithelium, with the development of villi and crypts in the most advanced cases

-Complete (Type I)

Type of Intestinal Metaplasia: Histochemistry: - Sialomucin - small amounts: Sulfomucins and/or Neutral mucins

-Complete (Type I)

Type of Intestinal Metaplasia: IHC: - Positive for MUC2 - Decrease or Negative for MUC1, MUC5AC, and MUC6

-Complete (Type I)

Type of Intestinal Metaplasia: H. pylori - absent in foci

-Complete (Type I)

Type of Intestinal Metaplasia: -absorptive cells are absent, whereas columnar cells with the appearance of gastric foveolar cells are retained

-Incomplete (Type II)

Type of Intestinal Metaplasia: Histochemistry: -Positive for either neutral mucins (Type IIA) or sulfomucins (Type IIB)

-Incomplete (Type II)

Type of Intestinal Metaplasia: IHC: -Positive for MUC2 and mucins normally expressed in the stomach

-Incomplete (Type II)

Type of Intestinal Metaplasia: H.pyori - may be present, foci

-Incomplete (Type II)

Two types of Chronic Gastritis

- Type A or Immune | - Type B or Nonimmune

Type of Chronic Gastritis -Less common

-Type A or Immune

Type of Chronic Gastritis -usually affects the Fundus in a diffuse manner but spares the antrum

-Type A or Immune

Type of Chronic Gastritis -Neuroendocrine hyperplasia

-Type A or Immune

Type A or Immune Chronic Gastritis is associated with (3):

- Antibodies to Parietal cells - Hypochlorhydria or Achlorhydria - Increased serum Gastrin

Type of Chronic Gastritis -More frequent

-Type B or Nonimmune

Type of Chronic Gastritis -begins in the antrum and progresses proximally

-Type B or Nonimmune

Two subdivisions of Type B or Nonimmune Chronic Gastritis

- Hypersecretory gastritis | - Environmental gastritis

This subdivision of Type B or Nonimmune chronic gastritis is restricted to the antrum and associated with hyperchlorhydria and often duodenal peptic ulceration

-Hypersecretory gastritis

This subdivision of Type B or Nonimmune chronic gastritis involves BOTH Antrum and Fundus in an initially patchy and eventually diffuse distribution

-Environmental gastritis

Ultimate cause for ulceration in peptic ulcers

-Acid peptic digestion

This form of acute gastric ulcer is seen following surgery or trauma

-Stress ulcer

This form of acute gastric ulcer is seen in patients with CNS injury or disease

Cushing ulcer

This form of acute gastric ulcer is seen as a complication of long-term steroid therapy

Steroid ulcer

This form of acute gastric ulcer is seen in patients with extensive burns

Curling ulcer

Ulcer that always occurs in an achlorhydric zone of mucosa (i.e. an area of stomach lined by pyloric-type mucosa)

Chronic peptic ulcer

Microscopically, chronic peptic ulcer will show four more or less distinct layers (4):

- a surface coat or purulent exudate, bacteria, and necrotic debris - Fibrinoid necrosis - Granulation tissue - Fibrosis which can replace the muscle wall and even extend into the subserosa

Morphologic changes when ulcers are infected by H. pylori (4):

- Loss of the apical portion and dropout of epithelial cells - Epithelial pits - Erosions - Cellular tufts

Most common cyst and are often associated with intestinal metaplasia

Intramucosal cysts

other name of Submucosal cysts

Gastritis cystica profunda

Bezoar composed of hair

Trichobezoar

Bezoar composed of vegetable matter

Phytobezoar

More than 85% of this bezoar is caused by ingestion of unrippened persimmons

Phytobezoar

Factors favoring the development of Bezoars (3):

- Lack of teeth - Vagotomy or Previous gastric surgery - Obstructing lesions of the gastric outlet

other name of Aneurysms of gastric vessel (2):

- Dieulafoy disease | - Caliber-persistent artery

other name of Gastric antral vascular ectasia (GAVE):

"Watermelon stomach"

Gastric hyperplastic polyps tend to arise in a background of (5):

- Hypochlorhydria - Low levels of Pepsinogen I - Hypergastrinemia - Chronic gastritis - Gastric atrophy

Distinguishing microscopic feature of Fundic gland polyps

Microcysts lined by fundic epithelium

Key molecular alteration in Sporadic fundic gland polyp

activating mutation of the Beta-catenin gene

Key molecular alteration in Familial fundic gland polyp (associated with FAP)

somatic, 2nd hit alterations in the APC gene

This other type of gastric epithelial polypoid lesion arises against a background of atrophic gastritis and represents an early stage of hyperplastic polyp

Foveolar hyperplasia

This other type of gastric epithelial polypoid lesion is associated with Peutz-Jeghers syndrome and juvenile polyposis

Hamartomatous polyps

other names of Menetrier disease (3)

- Hypertophic or Hyperplastic gastropathy - Giant hypertrophic gastritis - Giant hypertophy of gastric rugae

Two forms of Menetrier disease

- Typical form | - Localized form

This form of Menetrier disease has diffuse involvement of the fundic portion, with sparing of the antrum

-Typical form

This form of Menetrier disease is well-circumscribed cerebroid mass, either in the fundus or the antrum

-Localized form

Two forms of Gastric dysplasia

- Intestinal type (Adenomatous, Type I) | - Gastric type (Foveolar, Type II)

Two categories of Gastric dysplasia

- Low grade | - High grade (aka CIS)

Most common subtype of gastric carcinoma

intestinal-type adenocarcinoma

Secretory product of most gastric adenocarcinoma, intestinal-type

Acid mucosubstance

Acid mucosubstance in intestinal-type gastric adenocarcinoma can be detected by what stains (3)?

- Mayer mucicarmine - Alcian blue - Colloidal iron stains

Secretory product of most gastric adenocarcinoma, diffuse-type (2)

- Acidic; or | - Neutral (predominating)

Main mucin types in gastric adenocarcinoma (IHC): -Intestinal-type

MUC1

Main mucin types in gastric adenocarcinoma (IHC): -Diffuse-type

MUC5AC

Main mucin types in gastric adenocarcinoma (IHC): -Mucinous-type

MUC2

Main mucin types in gastric adenocarcinoma (IHC): -Unclassified-type

MUC5B

Main mucin types in gastric adenocarcinoma based on location (IHC): -Antral tumors

MUC5AC

Main mucin types in gastric adenocarcinoma based on location (IHC): -Cardia tumors

MUC2

Hepatoid Adenocarcinoma of the Stomach vs. HCC of the liver -Positive for PLUNC protein

Hepatoid Adenocarcinoma of the Stomach

Hepatoid Adenocarcinoma of the Stomach vs. HCC of the liver -Positive for SALL4

Hepatoid Adenocarcinoma of the Stomach

Hepatoid Adenocarcinoma of the Stomach vs. HCC of the liver -Negative for PLUNC protein

HCC of the liver

Hepatoid Adenocarcinoma of the Stomach vs. HCC of the liver -Negative for SALL4

HCC of the liver

other name of Lymphoepithelioma-like carcinoma

Undifferentiated carcinoma with intense lymphoid infiltration

other name of Sarcomatoid carcinoma

Carcinosarcoma

Isolated nodal metastasis in the left supraclavicular region

-Trousseau sign or Virchow node

Three types of gross appearances of early carcinoma at endoscopy

- Protruding or Type I - Superficial or Type II - Excavated or Type III

Type of gross appearance of early carcinoma at endoscopy: - Polypoid - Nodular - Villous

-Protruding or Type I

Type of gross appearance of early carcinoma at endoscopy: - Elevated - Flat - Depressed

-Superficial or Type II

Most frequent sites of distant metastases of gastric carcinomas (5):

- Liver - Peritoneum - Lung - Adrenal gland - Ovary

Remains the strongest prognostic indicator of gastric carcinomas

Anatomic stage

Single best predictive indicator of prognosis

Lymph node status

Predominating cell in this Gastric WDNET -Solitary

-G-cells (Gastrinoma)

Predominating cell in this Gastric WDNET -Located in the Antrum

-G-cells (Gastrinoma)

Predominating cell in this Gastric WDNET -Non-argentaffin

Both G-cells and ECL cells

Predominating cell in this Gastric WDNET -Non-argyrophilic

-G-cells (Gastrinoma)

Predominating cell in this Gastric WDNET -immunoreactive for Gastrin

-G-cells (Gastrinoma)

Predominating cell in this Gastric WDNET -sometimes associated with peptic ulcer

-G-cells (Gastrinoma)

Predominating cell in this Gastric WDNET -Multiple, often polypoid

-ECL cells

Predominating cell in this Gastric WDNET -distributed throughout FUNDUS

-ECL cells

Predominating cell in this Gastric WDNET -Strongly argyrophilic

-ECL cells

Predominating cell in this Gastric WDNET -Nonreactive for gastroduodenopancreatic hormones

-ECL cells

Predominating cell in this Gastric WDNET -accompanied by diffuse hyperplasia of similar cells in the surrounding mucosa

-ECL cells

This type of ECL cell tumor of the stomach is associated with chronic atrophic gastritis

-Type I

This type of ECL cell tumor of the stomach is associated with MEN I

-Type II

This type of ECL cell tumor of the stomach is sporadic

-Type III

Main features that relate to prognosis of ECL cell tumors of the stomach (5)

"DM TAM" - Direct invasion - Metastases - Tumor size - Angioinvasion - Mitotic activity and/or Ki-67 index

staining pattern of CD117 (c-Kit) in GISTs

-Membranous and Cytoplasmic

staining pattern of CD117 (c-Kit) in Mesenchymal tumors other than GIST

-Cytoplasmic with a coarse granular pattern

Characteristics of Kit-negative GISTs (5):

"My POEM" - Myxoid stroma - harbor PDGFRA mutations - arise in the Omentum - Epithelioid morphology - numerous Mast cells

Most common symptoms of abdominal GISTs (2):

- Abdominal pain | - Melena

Carney triad

- GIST - Pulmonary chondroma - Extra-adrenal paraganglioma

Carney-Stratakis syndrome

-GIST with associated familial paraganglioma

Fibromatosis (Desmoid tumor) vs. GIST - Extensively involve the GI wall - Positive cytoplasmic staining of CD117

-Fibromatosis (Desmoid tumor)

SFT vs GIST - Positive: CD34 & STAT6 - Negative: CD117 & DOG1

SFT

SFT vs. GIST - Positive: CD34, CD117, & DOG1 - Negative: STAT6

GIST

True smooth muscle tumors vs GIST - more densely eosinophilic cytoplasm - stain strongly for smooth muscle markers (SMA, Desmin, h-Caldesmon)

-True smooth muscle tumors

Gastric Schwannomas vs GIST - Peripheral lymphoid infiltrate - Strong S100 positivity

-Gastric Schwannomas

Most common sites of metastases of malignant GISTs (3)

- Liver - Peritoneum - Lungs

Prognostic parameters in GISTs (3):

- Tumor site - Tumor size - Mitotic index (mitoses/5 sq. mm)

Compositions of MALT (3):

- Lymphoid nodules (which in the ileum form the Peyer patches) - Lymphocytes and Plasma cells in the Lamina propria - Intraepithelial lymphocytes

True intranuclear eosinophilic inclusions made up of immunoglobulins

Dutcher bodies

Most helpful diagnostic clues favoring a marginal zone lymphoma from chronic gastritis and other low-grade lymphomas (3):

- Cytologic atypia - Dutcher bodies - Lymphoepithelial lesions

IHC useful for highlighting lymphoepithelial lesions in MALT-type Lymphoma

-Cytokeratins

Characteristics of MALT lymphomas harboring API2-MALT1 fusion or t(11;18) translocation (3):

- predicts a lack of response to anti-Helicobacter therapy - can protect against transformation to a large B-cell lymphoma - associated with higher-stage disease

Mantle cell lymphoma vs. Follicular Lymphoma Positive for: - CD5 - Cyclin D1

Mantle cell lymphoma

Mantle cell lymphoma vs. Follicular Lymphoma Positive for: - CD10 - BCL6

Follicular Lymphoma

IHC which highlights the areas of large cell transformations, which portends a worse prognosis

-BCL6

Main microscopic differential diagnosis of Large B-cell lymphoma

Undifferentiated carcinoma

Features favoring a diagnosis of Lymphoma over carcinoma (3):

- lack of continuity between epithelium and tumor cells - lack of suggestion of an acinar pattern - preservation of muscularis mucosae fibers

Most common form of treatment failure in Large B-cell Lymphoma

Distant disease

Favorable prognostic features of Large B-cell Lymphoma (4):

- Small tumor size - Superficial mural invasion - Presence of low-grade MALT-type areas - Absence of regional lymph node involvement

other name of Plexiform fibromyxoma

Plexiform angiomyxoid myofibroblastic tumor

Two most common forms of gastric Germ cell tumors (2):

- Choriocarcinoma | - Yolk sac tumor

Metastatic Lobular carcinoma of the Breast vs. Diffuse-type Adenocarcinoma of the Stomach -Presence of tumor cells with a bull's eye appearance (indicative of intracellular lumina)

Metastatic Lobular carcinoma of the Breast

Metastatic Lobular carcinoma of the Breast vs. Diffuse-type Adenocarcinoma of the Stomach Positive: - Hormone receptors - GCDFP-15 - GATA3

Metastatic Lobular carcinoma of the Breast

Metastatic Lobular carcinoma of the Breast vs. Diffuse-type Adenocarcinoma of the Stomach -Loss of E-cadherin

Metastatic Lobular carcinoma of the Breast

Metastatic Lobular carcinoma of the Breast vs. Diffuse-type Adenocarcinoma of the Stomach Positive: - CK20, DAS-1 - MUC2, MUC5AC, MUC6 - CDX2

Diffuse-type Adenocarcinoma of the Stomach

The junction between the corpus and the antrum is marked on the serosal side by a notch in the lesser curvature known as the

Incisura

Internally, the mucosa is thrown into coarse folds called

Rugae

Two major compartments of the mucosa

- Foveolar | - Glandular

Origin of the blood supply of the stomach (3):

- Celiac axis - Hepatic artery - Splenic artery

Lymphatic drainage of Cardia and most of lesser curvature

-Left gastric nodes

Lymphatic drainage of Pylorus and distal lesser curvature (2)

- Right gastric nodes | - Hepatic nodes

Lymphatic drainage of Proximal portion of the greater curvature

Pancreaticosplenic nodes in the splenic hilum

Lymphatic drainage of Distal portion of greater curvature (2)

- right gastroepiploic nodes in greater omentum | - pyloric nodes at the head of the pancreas

may result from the ingestion of alcohol, salicylates, and other anti-inflammatory drugs, or by the reflux of bile salts

Acute gastritis

It is more often referred to as reactive or chemical gastropathy, as there is typically little inflammation, and as such, there is little gastritis

Acute gastritis

an acute life-threatening condition usually engrafted on a background of chronic gastritis

Hemorrhagic gastritis

an exceptionally rare condition which is characterized by a thick subepithelial collagen band associated with a mucosal inflammatory infiltrate often rich in eosinophils

Collagenous gastritis

presents in a gastric biopsy as infiltration of the lamina propria by eosinophils, which in severe cases is diffuse and accompanied by degenerative and regenerative changes of the surface and foveolar epithelium.

Allergic/Eosinophilic Gastroenteritis

DUODENAL vs GASTRIC ulcer -More common

Duodenal ulcer

DUODENAL vs GASTRIC ulcer -classically associated with acid hypersecretion

Duodenal ulcer

DUODENAL vs GASTRIC ulcer -secrete either low normal or below normal amounts of acid

Gastric ulcer

Characteristics of Aneurysms of gastric vessels (4):

- usually Single - located in the Submucosa - usually high on the Lesser curvature - characterized by a Large tortuous vessel surmounted by a small defect in the overlying mucosa

an acquired vascular disease of the stomach that may result in blood loss and iron deficiency anemia

Gastric antral vascular ectasia (GAVE or "watermelon stomach")

appears as a small yellow intramucosal lesion characterized by the accumulation of neutral fat in foamy histiocytes in the lamina propria

Xanthoma (xanthelasma)

Secondary to the administration of aluminum-containing antacids or sucralfate therapy in organ transplant patients

Mucosal calcinosis

Polyps which are randomly distributed in the stomach and are generally small, sessile, and multiple, with a smooth or slightly lobulated contour

Hyperplastic polyps

Type of Polyp Micro: they show elongation, tortuosity, and dilation (often cystic) of the gastric foveolae, with a component of pyloric or—less commonly—fundic type of glands in the deeper portion. The stroma, usually prominent, is characterized by edema, patchy fibrosis, inflammatory cells, and scattered smooth muscle bundles from the muscularis mucosae.

Hyperplastic polyps

Characteristics of Adenomas (3)

- usually Antral in location - generally Single and Large - either Sessile or Pedunculated

Characteristics of Pyloric gland adenoma (5)

- frequently develop in the setting of Chronic gastritis with intestinal metaplasia and/or atrophy - most common in Elderly patients - slight Female predilection - most often arise in the Fundus/Body - usually less than 2 cm

Type of Polyp Micro: composed of tightly packed tubules comprised of cuboidal or columnar cells with pale to eosinophilic cytoplasm. They lack an apical cap of mucin.

Pyloric gland adenoma

may arise in the setting of chronic gastritis or familial adenomatous polyposis (FAP) and is composed of oxyntic glands with parietal and chief cells.

Oxyntic gland adenoma

incredibly common and present as multiple small (average size 2.3 mm) polypoid projections in the gastric fundus or body

Fundic gland polyp

Fundic gland polyps can occur in (3)

- sporadic form or present in patients with the Zollinger–Ellison syndrome - those on long-term treatment with proton pump inhibitors - those affected by FAP

Type of Polyp Micro: this lesion is centered in the submucosa and is characterized by a vascular and fibroblastic proliferation (often in a whorl-like arrangement around blood vessels) and a polymorphic inflammatory response, usually dominated by eosinophils

Inflammatory fibroid polyp

Disease characterized by Hypochlorhydria or Achlorhydria and often impressive hypoproteinemia

Menetrier disease

occur most often in areas of mucosal injury, resulting in epithelial cells which are immature, with basophilic cytoplasm, slightly hyperchromatic nuclei, and reduced or absent mucus secretion

Regenerative changes

Carcinoma characterized by prominent glandular formations and abundant mucin deposition, nearly all of which is extracellular

Mucinous adenocarcinoma

a type of gastric carcinoma having both glandular and hepatocellular differentiation, with frequent admixtures between the two components

Hepatoid adenocarcinoma

a tumor of dualcomposition, with epithelial elements (usually glandular) intermingling with a sarcoma-like spindle cell component

Sarcomatoid carcinoma

carcinoma confined to the mucosa or to the mucosa and submucosa (not extending into the muscularis externa), regardless of the status of the regional lymph nodes

"Early" gastric carcinoma

Bilateral ovarian metastases from the diffuse type of gastric carcinoma

Krukenberg tumor

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: Tumor cannot be assessed ```

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: No evidence of primary tumor ```

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: High-grade dysplasia, defined as malignant cells confined to the epithelium by the basement membrane ```

Tis

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: Tumor invades the lamina propria or muscularis mucosae ```

T1a

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: Tumor invades the submucosa ```

T1b

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: Tumor invades the muscularis propria ```

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: Tumor penetrates the subserosal connective tissue without invasion of the visceral peritoneum or adjacent structures ```

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: Tumor invades the serosa (visceral peritoneum) ```

T4a

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: Tumor invades adjacent structures/organs ```

T4b

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma Regional Lymph Nodes (N) category: Regional lymph nodes cannot be assessed

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma Regional Lymph Nodes (N) category: No regional lymph node metastasis

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma Regional Lymph Nodes (N) category: Metastasis in one or two regional lymph nodes

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma Regional Lymph Nodes (N) category: Metastasis in three to six regional lymph nodes

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma Regional Lymph Nodes (N) category: Metastasis in 7-15 regional lymph nodes

N3a

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma Regional Lymph Nodes (N) category: Metastasis in 16 or more regional lymph nodes

N3b

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Distant Metastais (M) category: Distant metastasis ```

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Distant Metastais (M) category: No distant metastasis ```

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: there is perforation of the visceral peritoneum covering the gastric ligaments or the omentum ```

Definitions of AJCC TNM for squamous cell carcinoma and adenocarcinoma ``` Primary Tumor (T) category: A tumor may penetrate the muscularis propria with extension into the gastrocolic or gastrohepatic ligaments, or into the greater or lesser omentum, without perforation of the visceral peritoneum covering these structures ```

The adjacent structures of the Stomach (10)

- spleen, - transverse colon, - liver, - diaphragm, - pancreas, - abdominal wall, - adrenal gland, - kidney, - small intestine, and - retroperitoneum

made up of WDNETs admixed with a glandular (exocrine) component

Composite tumors

Characteristics of GISTs from Carney triad or Carney-Stratakis syndrome (8)

- Young patients - Female - Multinodular growth pattern - Epithelioid morphology - often LN mets - indolent clinical behavior - mutation in succinate-dehydrogenase complex of genes (SDH deficient) - loss of staining of SDHB

Characteristics of Gastric GIST with Spindle cells, low risk (5)

-bland spindle cells arranged in packets or whorls with normochromatic nuclei, -perinuclear vacuoles, -little mitotic activity (fewer than 5 mitotic figures/5 sq. mm ), -sometimes nuclear palisading resembling that seen in schwannoma and collagenous stroma, -occasionally with dystrophic calcification

Characteristics of Gastric GIST with Spindle cells, high risk (3)

- atypical spindle cells arranged into fascicles with easily identifiable mitotic figures, - necrosis, and - mucosal invasion

Characteristics of Gastric GIST with Epithelioid cells, low risk (5)

- abundant eosinophilic or clear cytoplasm, - multinucleation, - rare mitotic figures, - abundant stroma, and - no necrosis or mucosal invasion

Characteristics of Gastric GIST with Epithelioid cells, high risk (4)

- highly cellular tumors with high-grade nuclei, - less cytoplasm, - numerous mitotic figures and - show evidence of necrosis and/or mucosal invasion

the term that has been suggested for a peculiar biphasic epitheliomesenchymal gastric tumor which resembles synovial sarcoma but lacks the classic chromosomal translocation of the latter

Gastroblastoma

This tumor is usually located in the antrum and characterized microscopically by a plexiform intramural growth with multiple micronodules containing paucicellular to moderately cellular myxoid, collagenous, and fibromyxoid areas

Plexiform fibromyxoma

FAVORABLE or UNFAVORABLE prognostic indicator of gastric carcinoma: -Japanese ethnicity

Favorable

FAVORABLE or UNFAVORABLE prognostic indicator of gastric carcinoma: -Female gender

Favorable

FAVORABLE or UNFAVORABLE prognostic indicator of gastric carcinoma: -Younger patient age at diagnosis

Unfavorable

FAVORABLE or UNFAVORABLE prognostic indicatorof gastric carcinoma: -Small tumor size

Favorable -may be linked to depth of invasion

FAVORABLE or UNFAVORABLE prognostic indicatorof gastric carcinoma: -presence of Pushing margin

Favorable

FAVORABLE or UNFAVORABLE prognostic indicatorof gastric carcinoma: -presence of Infiltrating margins

Unfavorable

Most common type of gastric WDNET

ECL cell tumor

a tyrosine kinase receptor normally expressed by the interstitial cells of Cajal, mast cells, and germ cells

KIT

The presence and type of this KIT mutation has the highest response to the tyrosine kinase inhibitor imatinib mesylate (Gleevac; Glivec)

-Exon 11 mutations

The presence and type of this KIT mutation has the lowest response to the tyrosine kinase inhibitor imatinib mesylate (Gleevac; Glivec)

-wild-type phenotype

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Rosai Chapter 14 - Stomach Flashcards

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