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PATHOLOGY > Rosai Chapter 15 - Small Bowel > Flashcards

Rosai Chapter 15 - Small Bowel Flashcards

1
Q

The anatomic landmark for the duodenojejunal junction, at which site the bowel becomes unfixed and wrapped in mesentery

A

Ligament of Treitz

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2
Q

other name of Transverse mucosal folds in the innerside of the small bowel

A

Valvulae conniventes or Kerckring folds

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3
Q

a two-lip structure in which lymphoid tissue and often adipose tissue tends to accumulate and where the small bowel ends

A

ileocecal valve

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4
Q

What small bowel segment?

Mucosa is Short and Stubby (sometimes leaf-like)

A

Duodenum

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5
Q

What small bowel segment?

Mucosa is Tall and Club-like

A

Jejunum

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6
Q

What small bowel segment?

Mucosa is of intermediate height

A

Ileum

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7
Q

IHC of Normal small bowel enterocytes

Pattern of CK7 and CK20

A
  • CK7 neg

- CK20 pos

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8
Q

Most common location of heterotopic pancreas

A

Duodenum (particularly in the region of the Ampulla of Vater)

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9
Q

The consequence of a persistent patency of the entire vitelline duct

A

Enteroumbilical fistula

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10
Q

Most common complication of total intestinal aganglionosis

A

Enterocolitis

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11
Q

Transverse mucosal folds in the proximal jejunum

A

Prominent

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12
Q

Transverse mucosal folds in the terminal ileum

A

Flat or Absent

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13
Q

Location of Peyer patches in the terminal ileum

A

Antimesenteric side

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14
Q

This comprise the lower 20% of the small bowel epithelium and represent its proliferative zone

A

Crypts of Lieberkuhn

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15
Q

A type of transmembrane glycoprotein involved in signaling and adhesion and has been found to stain the human lymph (lacteal) vessels of the bowel but not the lymph vessels of other organs

A

CD38

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16
Q

Characteristic feature of the ileum

A

Peyer patches

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17
Q

Lymph drainage of duodenum (2)

A
  • Portal nodes

- Pyloric nodes

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18
Q

Lymph drainage of jejunum and proximal ileum (2)

A
  • Nodes located in the mesentery

- Nodes located around the SMA

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19
Q

Lymph drainage of Terminal ileum

A

Ileocolic nodes

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20
Q

An abnormal thickening of the pylorus that causes small bowel obstruction in the neonatal population

A

Infantile hypertrophic pyloric stenosis

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21
Q

The result of persistence of the proximal portion of the vitelline duct

A

Meckel diverticulum

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22
Q

Usual location of Meckel diverticulum in adults

A

approximately 80 cm proximal to the ileocecal valve

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23
Q

Characteristic location of Jejunal diverticula

A

along the Mesenteric border

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24
Q

a congenital anomaly resulting from an error in intestinal development such that (most commonly):

  • Cecum is on the left
  • Duodenal-jejunal flexure is on the right
  • Mesentery is narrow and unstable in position
A

Malrotation

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25
Q

a congenital defect affecting collagen fibers throughout the body, may result in serious intestinal complication such as spontaneous perforation and massive bleeding

A

Ehlers-Danlos syndrome

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26
Q

Other name of Celiac disease (3):

A
  • Celiac sprue
  • Nontropical sprue
  • Gluten-sensitive enteropathy
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27
Q

Characteristics of Celiac disease in its fully developed state (3):

A
  • Totally flat mucosa
  • a dramatic clinical and morphologic response to the removal of gluten from the diet
  • Relapse when gluten is reintroduced
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28
Q

Macroscopic findings in Celiac disease (4):

A
  • Scalloping or denting of the duodenal folds
  • an absence or reduction in the number of folds
  • a submucosal vascular pattern
  • “Mosaicism”, in which the mucosa has a somewhat nodular appearance
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29
Q

Preferred serologic test for Celiac disease in patients above 2 years old

A

-anti-tissue transglutaminase (TTG) IgA antibody

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30
Q

More specific, but much more expensive and technically difficult to perform serologic test for Celiac disease

A

-anti-endomysial antibodies

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31
Q

May be useful in children who are less than 2 years of age or in adults who are IgA deficient serologic test for Celiac disease (2):

A
  • Deamidated gliadin peptide (DPG) IgA and IgG

- anti-TTG IgG assay

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32
Q

Two types of Refractory Celiac Disease (RCD)

A
  • Type I

- Type II

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33
Q

Type of RCD

-the lymphocytes maintain a normal immunophenotype

A

-Type I

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34
Q

Type of RCD

-there is clonal expansion of an aberrant population of T-cells that many believe represents an early form of enteropathy-associated lymphoma and have thus designated as “Cryptic intraepithelial lymphoma”

A

-Type II

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35
Q

Two types Enteropathy-associated T-cell Lymphoma (EATL):

A
  • Type I or Classical

- Type II or Monomorphic Epitheliotropic

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36
Q

Type of EATL

-associated with Celiac disease

A

-Type I or Classical

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37
Q

Type of EATL

-Majority of cases

A

-Type I or Classical

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38
Q

Type of EATL

-NOT typically associated with CD or the CD-associated HLA haplotypes

A

-Type II or Monomorphic Epitheliotropic

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39
Q

Features in favor of Tropical Sprue (3):

A
  • isolation of enterotoxigenic coliform bacilli
  • the endemic nature of the disease
  • well-known response to antibiotics
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40
Q

other name of Whipple disease

A

-intestinal lipodystrophy

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41
Q

Characteristic microscopic finding in Whipple disease

A

-infiltrate of histiocytes that fills the lamina propria and distorts the villi

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42
Q

An immune-mediated disease due to an abnormal response to gluten and related proteins in genetically susceptible people

A

Celiac disease (CD)

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43
Q

CD vs Tropical sprue

-Most prominent in the proximal small bowel with decreasing involvement distally

A

-Celiac disease (CD)

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44
Q

CD vs Tropical sprue

-BOTH the distal and proximal small bowel are involved

A

-Tropical sprue

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45
Q

Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies

Grade 0

A

Normal

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46
Q

Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies

Grade 1

A

Intraepithelial lymphocytes (IELs) only

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47
Q

Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies

Grade 2

A

IELs PLUS crypt proliferation

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48
Q

Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies

Grade 3a

A

Mild shortening of villi

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49
Q

Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies

Grade 3b

A

Moderate shortening of villi

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50
Q

Modified Marsh (Marsh-Oberhuber) criteria grading system for CD in small bowel biopsies

Grade 3c

A

Severe shortening of villi

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51
Q

This disease of malabsorption is characterized by increased deposition of eosinophilic hyaline material within the lamina propria, in addition to villous blunting and inflammatory changes

A

Collagenous sprue

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52
Q

This disease of malabsorption is clinically defined as persistent or recurrent symptoms and an abnormal biopsy, despite adherence to a gluten-free diet and the exclusion of other entities that could cause malabsorption

A

Refractory celiac disease (RCD)

53
Q

Type of EATL

-Microscopically very variable, consisting of a mixture of pleomorphic variably sized cells with conspicuous nucleoli and variably present necrosis

A

-Type I or Classical

54
Q

Type of EATL

  • Positive: CD3, CD7, TIA-1 and the ab T-cell receptor
  • Negative: CD4, CD5, and CD56
  • Variably expressed: CD8 and CD30
A

-Type I or Classical

55
Q

Type of EATL

-composed of monotonous small to intermediate sized cells with inconspicuous nucleoli

A

-Type II or Monomorphic Epitheliotropic

56
Q

Type of EATL

  • Positive: CD3, CD7, CD8, and CD56
  • Negative: CD5
A

-Type II or Monomorphic Epitheliotropic

57
Q

A complication of CD which is characterized by abdominal pain, fever, and intestinal perforation or obstruction superimposed on a background of a malabsorption syndrome

A

Ulcerative duodenojejunoileitis

58
Q

CD vs Tropical sprue

-PARTIAL villous atrophy with increased lamina propria inflammation and increased IELs

A

-Tropical sprue

59
Q

This malabsorption disease is associated with both folate and vitamin B12 deficiencies and responds to vitamin supplementation and tetracycline

A

Tropical sprue

60
Q

A systemic disorder with protean manifestations including arthritis, diarrhea, weight loss, malabsorption, and neurologic symptoms

A

Whipple disease

61
Q

a malabsorption disease with increased IELs and the apical villous cytoplasm shows striking vacuolation

A

Abetalipoproteinemia

62
Q

a malabsorption disease in which a protein-losing enteropathy develops probably as a result of the entrance of protein-rich fluid into the extracellular space of the lamina propria from the dilated lymphatic channels, and subsequent drainage into the gut lumen

A

intestinal lymphangiectasia

63
Q

a prerequisite for the formation of duodenal peptic ulcer

A

-a preserved fundic mucosa in the stomach

64
Q

usual site of Crohn disease

65
Q

Most typical ulcers in Crohn disease

66
Q

Features of transmural involvement in Crohn disease (7):

A
  • Transmural inflammation
  • often with prominent Lymphoid follicles in a linear or “string of beads” array
  • Edema
  • Lymph vessel dilation
  • Thickening of the muscularis mucosae
  • Neural hyperplasia
  • Fibrosis
67
Q

Microscopic features of Crohn disease that have greater diagnostic significance (3):

A
  • Transmural involvement
  • Fissures
  • Granulomas
68
Q

Two microscopic features of Crohn disease that have greater diagnostic significance which may not be appreciable on mucosal biopsy

A
  • Transmural involvement

- Fissures

69
Q

ileitis typically associated with ulcerative colitis

A

-“Backwash” ileitis

70
Q

Main changes in Backwash ileitis (5):

A

“SNAPP”

  • Superficial erosions
  • Neutrophilic and mononuclear inflammation in the lamina propria
  • villous Atrophy with crypt regeneration
  • Patchy cryptitis and crypt abscesses
  • with or without Pyloric metaplasia
71
Q

Most common mycobacterium isolated from the GIT and it is frequently found in the small bowel

72
Q

Most common side effect of Mycophenolate mofetil (MMF)

A

GI toxicity, specifically diarrhea

73
Q

Main change morphologically of Idiopathic eosinophilic enteritis and gastroenteritis

A

-Patchy or diffuse eosinophilic infiltration of any layer of the intestinal wall

74
Q

Second most common symptomatic primary immunodeficiency after IgA deficiency

75
Q

Most consistent microscopic change in GVHD

A

single epithelial cell necrosis

76
Q

in Intussusception, what do you call the part which swallows the part of the bowel just proximal to it?

A

intussuscipiens

77
Q

in Intussusception, what do you call the swallowed portion

A

intussusceptum

78
Q

Most frequently involved site in GI amyloidosis

A

Small bowel

79
Q

other name of Microvillous inclusion disease

A

Familial microvillous atrophy

80
Q

IHC staining pattern of CD10 in Microvillous inclusion disease

A

Cytoplasmic

81
Q

other name of Brunner gland nodules (4):

A
  • Brunner gland hamartoma
  • Brunner gland adenoma
  • Nodular hyperplasia of Brunner glands
  • Brunneroma
82
Q

Most common location of Brunner gland nodules

A

-Posterior wall of the duodenum at the junction between the 1st and 2nd portions

83
Q

Neoplasms associated with Peutz-Jeghers syndrome (4)

A
  • a distinctive ovarian neoplasm knowns as sex-cord tumor with annular tubules
  • Adenoma malignum of uterine cervix
  • ovarian Mucinous tumors
  • Breast carcinoma (often bilateral)
84
Q

Microscopically, the most common pattern of WNET

A

Solid nests of monotonous-appearing cells with:

  • Small, round nuclei
  • a moderate amount of finely granular cytoplasm
  • indistinct nucleoli
85
Q

Basis of grading of WNET (2)

A
  • Mitotic rate and/or

- Proliferation (Ki-67) index

86
Q

Small bowel WNET vs. Gastric carcinoid

TTF-1 - negative

A

Small bowel WNET

87
Q

Small bowel WNET vs. Gastric carcinoid

TTF-1 - weakly positive

A

Gastric carcinoid

88
Q

Small bowel WNET vs. WNET of Appendix

S100 - negative

A

Small bowel WNET

89
Q

Small bowel WNET vs. WNET of Appendix

Origin - Endocrine cells from Lieberkuhn crypts

A

Small bowel WNET

90
Q

Small bowel WNET vs. WNET of Appendix

Origin - Subepithelial endocrine cells related to nerves

A

WNET of Appendix

91
Q

Small bowel WNET vs. WNET of Appendix

S100 - positive

A

WNET of Appendix

92
Q

Most common genetic alteration in small bowel WNET

A

loss of all or most of chromosome 18

93
Q

DUODENAL vs. ILEAL endocrine tumors

PDX-1 - positive

A

Duodenal endocrine tumors

94
Q

DUODENAL vs. ILEAL endocrine tumors

CDX-2 - negative

A

Duodenal endocrine tumors

95
Q

DUODENAL vs. ILEAL endocrine tumors

PDX-1 - negative

A

Ileal endocrine tumors

96
Q

DUODENAL vs. ILEAL endocrine tumors

CDX-2 - positive

A

Ileal endocrine tumors

97
Q

Mixed adenoneuroendocrine carcinomas (MANECs) should contain what percentage of neuroendocrine component?

A

at least 30%

98
Q

other name of Gangliocytic paraganglioma (2):

A
  • Nonchromaffin paraganglioma

- Paraganglioneuroma

99
Q

Three cell components present in Gangliocytic Paraganglioma

A
  • Endocrine cells with a carcinoid-like appearance arranged in compact nests and trabeculae containing dense-core granules ultrastructurally
  • isolated Ganglion cells
  • spindle-shaped Schwann cells and/or Sustentacular cells
100
Q

Gangliocytic Paraganglioma cell component immunoreactive for a variety of markers, particularly PP

A

-Endocrine cells with a carcinoid-like appearance arranged in compact nests and trabeculae containing dense-core granules ultrastructurally

101
Q

Gangliocytic Paraganglioma cell component immunoreactive for NSE and other neural markers

A

-isolated Ganglion cells

102
Q

Gangliocytic Paraganglioma cell component immunoreactive for S100 protein

A

-spindle-shaped Schwann cells and/or Sustentacular cells

103
Q

the presence of this characteristic structure in small bowel GIST is a sign of good prognosis

A

Skeinoid fibers

104
Q

Leiomyomas & Leiomyosarcomas vs. IFP

Smooth muscle markers - positive

A

Leiomyomas & Leiomyosarcomas

105
Q

Leiomyomas & Leiomyosarcomas vs. IFP

CD117 & DOG1 - negative

A

BOTH Leiomyomas & Leiomyosarcomas and IFP

106
Q

Leiomyomas & Leiomyosarcomas vs. IFP

KIT mutation - negative

A

Leiomyomas & Leiomyosarcomas

107
Q

Leiomyomas & Leiomyosarcomas vs. IFP

PDGFR mutation - negative

A

Leiomyomas & Leiomyosarcomas

108
Q

Leiomyomas & Leiomyosarcomas vs. IFP

SMA - variable
Desmin - negative

109
Q

Leiomyomas & Leiomyosarcomas vs. IFP

Gain-of-function mutation in PDGFRA

110
Q

Leiomyomas & Leiomyosarcomas vs. IFP

CD34 - positive
S100 - negative

111
Q

Most common location of small bowel Hemangiomas

A

mid-jejunum

112
Q

Most common variety of small bowel Hemangioma

A

Cavernous hemangioma

113
Q

GI involvement in von Recklinghausen disease may manifest in a variety of ways (6):

A
  • Hyperplasia of the submucosal and myenteric nerve plexuses
  • Mucosal ganglioneuromatosis
  • GISTs showing varying degrees of neural or smooth muscle differentiation
  • Somatostatin-rich endocrine tumor of the duodenum
  • Adenocarcinoma with (and perhaps without) neuroendocrine features
  • Gangliocytic paraganglioma
114
Q

other name of small bowel IMFTs (2):

A
  • inflammatory pseudotumors of the GIT

- Plasma cell granulomas

115
Q

Important concepts to consider when evaluating malignant lymphomas involving the small bowel include (3):

A
  • whether or not they are truly primary versus part of a systemic disease
  • their cell lineage (B, T, or NK cell)
  • the presence and type of an associated or predisposing condition
116
Q

Most common site of primary extranodal lymphoma

117
Q

Most frequent extranasal site of involvement of Extranodal NK/T cell lymphoma (ENKTL), nasal type

118
Q

Positive or Negative IHCs of ENKTL, nasal type:

CD56

119
Q

Positive or Negative IHCs of ENKTL, nasal type:

TIA-1

120
Q

Positive or Negative IHCs of ENKTL, nasal type:

Granzyme B

121
Q

Positive or Negative IHCs of ENKTL, nasal type:

CD4

122
Q

Positive or Negative IHCs of ENKTL, nasal type:

CD8

123
Q

Positive or Negative IHCs of ENKTL, nasal type:

surface CD3

124
Q

Most common type of lymphoma found in the small bowel

A

B-cell lymphomas

125
Q

Key features of low-grade extranodal marginal zone B-cell lymphoma of “MALT type” (3):

A
  • Predominance of small lymphoid cells (centrocyte-like or monocytoid B cells)
  • Formation of lymphoepithelial lesions
  • presence of Reactive follicles
126
Q

other name of Immunoproliferative Small Intestinal Disease (IPSID) (2):

A
  • Mediterranean Lymphoma

- Middle Eastern Lymphoma

127
Q

Most common location of lymphoid hyperplasia

A

-ileocecal region

128
Q

Most important features of lymphoid hyperplasia when the differential diagnosis is malignant lymphoma (4):

A
  • presence of highly reactive germinal centers
  • numerous cell types
  • prominent Vascularity
  • Polyclonality (as determined immunohistochemically)
129
Q

Most common types of tumor metastasizing to the small bowel

A

Malignant melanoma

PATHOLOGY (26 decks)

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