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PATHOLOGY > Rosai Chapter 17 - Large Bowel > Flashcards

Rosai Chapter 17 - Large Bowel Flashcards

1
Q

The large bowel comprises the

A

terminal 1 to 1.5 m of the GIT

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2
Q

Flexure

-junction of Ascending and Transverse colon

A

Hepatic

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3
Q

Flexure

-junction of Transverse and Descending colon

A

Splenic

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4
Q

Rectum forms

A

distal 8 to 15 cm of extraperitoneal large bowel

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5
Q

Paneth cells are normally present only in the (2):

A
  • Cecum

- Proximal right colon

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6
Q

POSITIVE or NEGATIVE

IHC of epithelial cells of the normal colonic mucosa:

CK8

A

POSITIVE

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7
Q

POSITIVE or NEGATIVE

IHC of epithelial cells of the normal colonic mucosa:

CK18

A

POSITIVE

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8
Q

POSITIVE or NEGATIVE

IHC of epithelial cells of the normal colonic mucosa:

CK19

A

POSITIVE

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9
Q

POSITIVE or NEGATIVE

IHC of epithelial cells of the normal colonic mucosa:

CK20

A

POSITIVE

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10
Q

POSITIVE or NEGATIVE

IHC of epithelial cells of the normal colonic mucosa:

CK7

A

NEGATIVE

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11
Q

Most important complications of Hirschsprung disease (2)

A
  • Acute intestinal obstruction

- Enterocolitis

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12
Q

Microscopic hallmark of Hirschsprung disease

A

-absence of ganglion cells (aganglionosis) in BOTH plexuses of a segment of bowel

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13
Q

Standard guideline in which biopsy should be taken for Hirschsprung disease in INFANTS

A

2cm above the anal valve

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14
Q

Standard guideline in which biopsy should be taken for Hirschsprung disease in OLDER CHILDREN

A

3cm above the anal valve

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15
Q

IHC characteristic of Hirschsprung disease

A

Loss of Calretinin-immunoreactive nerves

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16
Q

For frozen section evaluation of Hirschsprung disease to be reliable, the tissue should be:

A

at least 4 mm long

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17
Q

other name of intestinal neuronal dysplasia (2):

A
  • Neuronal colonic dysplasia

- Hyperganglionosis

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18
Q

Main complications of Diverticulosis (3):

A
  • Hemorrhage
  • Perforation
  • Diverticulitis
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19
Q

Risk factors in the development of carcinoma in patients with ulcerative colitis (4):

A
  • Patients with extensive colitis
  • those with disease for greater than 7-10 years
  • young age of colitis onset
  • Primary sclerosing cholangitis
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20
Q

Earliest gross change in patients with ulcerative colitis who develop carcinoma

A

-thick mucosa with a finely nodular or velvety surface configuration

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21
Q

Two important diagnostic feature of Crohn disease in the colon

A
  • Grossly, segmental distribution (with “skip” areas that can be demonstrated radiographically)
  • Preference for the right side of the colon
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22
Q

Typical triad of colonic Crohn disease

A
  • Fissures
  • Noncaseating sarcoid-like granulomas
  • Transmural involvement
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23
Q

The main features of large bowel Crohn disease to look for in an endoscopic biopsy (5):

A
  • Patchy mucosal inflammation
  • Granulomas
  • Preservation of the Goblet cell population
  • Pyloric gland metaplasia
  • Maintenance of the architecture of the glands
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24
Q

Classic site of involvement of Arteriosclerosis which could lead to ischemic colitis

A

Splenic flexure

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25
Q

other name of Acute infectious-type colitis

A

Acute self-limited colitis

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26
Q

Ulcerative colitis vs. Infectious-etiology

-Crypt distortion and plasma cell infiltration in the basal portion of the mucosa

A

-Ulcerative colitis

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27
Q

Ulcerative colitis vs. Infectious-etiology

-Acute inflammation out of proportion to chronic features

A

-Infectious-etiology

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28
Q

Main microscopic abnormalities of Allergic colitis and proctitis on rectal biopsy (2):

A
  • Mucosal edema

- Marked eosinophilic infiltration

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29
Q

Lymphocytic colitis vs. Collagenous colitis

Main microscopic differences:

-absence of a thickened collagenous layer

A

Lymphocytic colitis

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30
Q

Lymphocytic colitis vs. Collagenous colitis

Main microscopic differences:

-greater prominence of intraepithelial lymphocytes

A

Lymphocytic colitis

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31
Q

Most common changes of Diversion colitis microscopically (3):

A
  • Mild to moderate lamina propria expansion, predominantly by plasma cells
  • Crypt abscesses
  • Follicular lymphoid hyperplasia (most common and prominent)
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32
Q

Feature favoring TUBERCULOSIS vs. CROHN DISEASE

-Caseation and coalescence of the granuloma

A

-Tuberculosis

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33
Q

Feature favoring TUBERCULOSIS vs. CROHN DISEASE

-Longitudinal ulcers

A

-Crohn disease

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34
Q

Feature favoring MYCOPHENOLATE-INDUCED INJURY vs. GVHD

-lack of endocrine aggregates in the lamina propria

A

Mycophenolate-induced injury

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35
Q

Feature favoring MYCOPHENOLATE-INDUCED INJURY vs. GVHD

-lack of apoptotic microabscesses

A

Mycophenolate-induced injury

36
Q

Feature favoring MYCOPHENOLATE-INDUCED INJURY vs. GVHD

-Eosinophils greater than 15 per 10 HPF

A

Mycophenolate-induced injury

37
Q

Key diagnostic feature of Pneumatosis cystoides intestinalis

A

-the arrangement of the giant cells around intact, partial, or collapsed cyst

38
Q

Two forms of Colitis Cystica Profunda

A
  • Localized

- Diffuse

39
Q

Form of Colitis Cystica Profunda:

-located in the rectum, 5-12cm from the anal margin

40
Q

Form of Colitis Cystica Profunda:

-presents as plaque, nodule, or polyp

41
Q

Form of Colitis Cystica Profunda:

-associated with chronic proctitis

42
Q

Form of Colitis Cystica Profunda:

-often associated with mucosal prolapse

43
Q

Form of Colitis Cystica Profunda:

-result of inflammation and ulceration of the bowel

44
Q

Form of Colitis Cystica Profunda:

-ulceration provides the means by which mucosa can extend along granulation tracts and thus form lakes of mucus in the submucosa

45
Q

Form of Colitis Cystica Profunda:

-easily mistaken for a Mucinous carcinoma

46
Q

other name of Mucosal prolapse

A

Solitary rectal ulcer syndrome

47
Q

other name of Adenomatous polyps

A

Tubular adenomas

48
Q

Villous component in Tubulovillous Adenomas

A

25% or more

49
Q

Villous component in Villous Adenomas

A

75% or more

50
Q

Features of “Pseudoinvasion” in an adenomatous polyp (3):

A
  • the cytologic features of the misplaced glands are similar to those on the surface
  • the glands are surrounded by inflamed loose stroma (lamina propria) and scattered bundles of muscularis mucosae, rather that the desmoplastic reaction associated with invasive carcinoma
  • there are abundant hemosiderin deposits around the dysplastic glands
51
Q

Most common polyp with a serrated (sawtoothed) architecture

A

Hyperplastic polyps

52
Q

Characteristic features of sessile serrated polyps

A

basal crypt distortion or lateral spread of crypts at the base or BOTH

53
Q

WHO criteria for serrated polyposis syndrome (SPS) (3):

A
  • at least 5 serrated polyps proximal to the sigmoid colon, with 2 or more greater than 10 mm in greatest dimension
  • any number of serrated polyps proximal to the sigmoid colon in an individual with a 1st-degree relative with SPS
  • more than 20 serrated polyps of any size throughout the colon
54
Q

Characteristic features of Traditional Serrated Adenoma (TSA)

A
  • often distinctly eosinophilic cytoplasm with centrally or basally located uniform slightly hyperchromatic pencillate nuclei, with frequent mitoses
  • “ectopic crypt foci”
55
Q

This feature of TSA are abortive attempts at new crypt base formation high in the polyp

A

Ectopic crypt foci

56
Q

Most frequent colonic polyp seen in children

A

-Juvenile (retention) polyp

57
Q

Most important features of Peutz-Jeghers Polyps (4):

A
  • Lack of cellular atypia
  • Disorganization of glands
  • Occurrence of several cell types (including Paneth cells)
  • the presence of smooth muscle fibers from the muscularis mucosae (which give the lesion a hamartomatous appearance)
58
Q

Familial Adenomatous Polyposis (FAP) is also known as:

A

Polyposis coli

59
Q

How many polyps should be present in FAP?

A

minimum of 100

60
Q

Distinct microscopic appearance characteristic of thyroid carcinoma in patients with FAP

A

-cribriform and morular formations

61
Q

Hereditary Flat Adenoma Syndrome (5)

A
  • variant of FAP
  • polyps are Flat rather than elevated
  • Polyps less than 100
  • Right-sided predominance
  • same gene as FAP (APC)
62
Q

Gardner syndrome (5):

A
  • variant of FAP
  • numerous large bowel adenomas
  • multiple osteomas of the skull and mandible
  • multiple keratinous cysts of the skin
  • soft tissue neoplasms, especially fibromatosis
63
Q

other name of Hereditary Nonpolyposis Colorectal Cancer (HNPCC)

A

Lynch syndrome

64
Q

Turcot syndrome (3)

A
  • variant of HNPCC
  • colorectal adenomatous polyps
  • brain tumors, usually glioblastomas
65
Q

Variant of HNPCC associated with tumors of sebaceous glands

A

-Muir-Torre syndrome

66
Q

other name of Cowden syndrome

A

Multiple hamartoma syndrome

67
Q

Malignant colorectal polyps should be assessed for the following features (2)

A
  • Tumor differentiation
  • Angiolymphatic invasion (LVI)
  • Adequacy of excision
68
Q

Best indicator of submucosal invasion

A

Stromal desmoplasia

69
Q

Features of colorectal carcinomas that arise in HNPCC (7)

A
  • young patient age
  • right-sided location
  • mucinous features
  • poor differentiation (solid or medullary appearance)
  • tumor-infiltrating lymphocytes
  • lack of “dirty” necrosis
  • presence of a Crohn-like inflammatory reaction
70
Q

Staining profile in HNPCC

-Normal staining profile

A

-Low likelihood of HNPCC

71
Q

Abnormal result of test for BRAF V600E and/or MLH1 methylation

A

-Low likelihood of HNPCC

72
Q

Characteristics of carcinoma of the large bowel with higher CEA values (3)

A
  • tumors that have spread beyond the bowel wall
  • in poorly-differentiated neoplasms
  • in tumors associated with Angiolymphatic and Perineural invasion
73
Q

Immunohistochemically, the main mucin protein cores expressed by conventional colorectal adenocarcinoma (2)

A
  • MUC 1

- MUC 3

74
Q

Tumors associated with MSI (4):

A
  • Mucinous or Poorly-differentiated
  • with a prominent host response
  • a circumscribed growth pattern
  • Right-sided location
75
Q

Two distinct subtypes of Serrated carcinomas:

A
  • MSI High

- MSI low or stable

76
Q

Subtype of Serrated Carcinoma:

-More common

77
Q

Subtype of Serrated Carcinoma:

-arise in proximal colon from SSPs

78
Q

Subtype of Serrated Carcinoma:

-Less common

A

-MSI low or stable

79
Q

Subtype of Serrated Carcinoma:

-arise in the distal colon from TSAs

A

-MSI low or stable

80
Q

Single most important predictor of clinical behavior for colorectal carcinoma

A

Anatomic extent of tumor (Pathologic stage)

81
Q

Lymph nodes that should be examined in specimens which have not been subjected to neoadjuvant therapy for colorectal adenocarcinoma

A

-at least 10 (and ideally 12)

82
Q

Most common sites of metastatic involvement of colorectal carcinoma

A
  • regional lymph nodes

- Liver

83
Q

WDNET Grading

  • Ki-67 proliferation index - <3%
  • Mitotic index - < 2 per 10 hpf
84
Q

WDNET Grading

  • Ki-67 proliferation index - 3-20%
  • Mitotic index - 2-20 per 10 hpf
85
Q

Most common type of true smooth muscle tumors of the colon

A

-Leiomyoma

86
Q

Three pseudomalignant benign vascular conditions which can be mistaken for an Angiosarcoma

A
  • Florid vascular proliferation
  • Pyogenic granuloma (Lobular capillary hemangioma)
  • Reactive angioendotheliomatosis

PATHOLOGY (26 decks)

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