Rosai Chapter 17 - Large Bowel Flashcards
1
Q
The large bowel comprises the
A
terminal 1 to 1.5 m of the GIT
2
Q
Flexure
-junction of Ascending and Transverse colon
A
Hepatic
3
Q
Flexure
-junction of Transverse and Descending colon
A
Splenic
4
Q
Rectum forms
A
distal 8 to 15 cm of extraperitoneal large bowel
5
Q
Paneth cells are normally present only in the (2):
A
- Cecum
- Proximal right colon
6
Q
POSITIVE or NEGATIVE
IHC of epithelial cells of the normal colonic mucosa:
CK8
A
POSITIVE
7
Q
POSITIVE or NEGATIVE
IHC of epithelial cells of the normal colonic mucosa:
CK18
A
POSITIVE
8
Q
POSITIVE or NEGATIVE
IHC of epithelial cells of the normal colonic mucosa:
CK19
A
POSITIVE
9
Q
POSITIVE or NEGATIVE
IHC of epithelial cells of the normal colonic mucosa:
CK20
A
POSITIVE
10
Q
POSITIVE or NEGATIVE
IHC of epithelial cells of the normal colonic mucosa:
CK7
A
NEGATIVE
11
Q
Most important complications of Hirschsprung disease (2)
A
- Acute intestinal obstruction
- Enterocolitis
12
Q
Microscopic hallmark of Hirschsprung disease
A
-absence of ganglion cells (aganglionosis) in BOTH plexuses of a segment of bowel
13
Q
Standard guideline in which biopsy should be taken for Hirschsprung disease in INFANTS
A
2cm above the anal valve
14
Q
Standard guideline in which biopsy should be taken for Hirschsprung disease in OLDER CHILDREN
A
3cm above the anal valve
15
Q
IHC characteristic of Hirschsprung disease
A
Loss of Calretinin-immunoreactive nerves
16
Q
For frozen section evaluation of Hirschsprung disease to be reliable, the tissue should be:
A
at least 4 mm long
17
Q
other name of intestinal neuronal dysplasia (2):
A
- Neuronal colonic dysplasia
- Hyperganglionosis
18
Q
Main complications of Diverticulosis (3):
A
- Hemorrhage
- Perforation
- Diverticulitis
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
20
Q
Earliest gross change in patients with ulcerative colitis who develop carcinoma
A
-thick mucosa with a finely nodular or velvety surface configuration
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
22
Q
Typical triad of colonic Crohn disease
A
- Fissures
- Noncaseating sarcoid-like granulomas
- Transmural involvement
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
24
Q
Classic site of involvement of Arteriosclerosis which could lead to ischemic colitis
A
Splenic flexure
25
other name of Acute infectious-type colitis
Acute self-limited colitis
26
Ulcerative colitis vs. Infectious-etiology
-Crypt distortion and plasma cell infiltration in the basal portion of the mucosa
-Ulcerative colitis
27
Ulcerative colitis vs. Infectious-etiology
-Acute inflammation out of proportion to chronic features
-Infectious-etiology
28
Main microscopic abnormalities of Allergic colitis and proctitis on rectal biopsy (2):
- Mucosal edema
| - Marked eosinophilic infiltration
29
Lymphocytic colitis vs. Collagenous colitis
Main microscopic differences:
-absence of a thickened collagenous layer
Lymphocytic colitis
30
Lymphocytic colitis vs. Collagenous colitis
Main microscopic differences:
-greater prominence of intraepithelial lymphocytes
Lymphocytic colitis
31
Most common changes of Diversion colitis microscopically (3):
- Mild to moderate lamina propria expansion, predominantly by plasma cells
- Crypt abscesses
- Follicular lymphoid hyperplasia (most common and prominent)
32
Feature favoring TUBERCULOSIS vs. CROHN DISEASE
-Caseation and coalescence of the granuloma
-Tuberculosis
33
Feature favoring TUBERCULOSIS vs. CROHN DISEASE
-Longitudinal ulcers
-Crohn disease
34
Feature favoring MYCOPHENOLATE-INDUCED INJURY vs. GVHD
-lack of endocrine aggregates in the lamina propria
Mycophenolate-induced injury
35
Feature favoring MYCOPHENOLATE-INDUCED INJURY vs. GVHD
-lack of apoptotic microabscesses
Mycophenolate-induced injury
36
Feature favoring MYCOPHENOLATE-INDUCED INJURY vs. GVHD
-Eosinophils greater than 15 per 10 HPF
Mycophenolate-induced injury
37
Key diagnostic feature of Pneumatosis cystoides intestinalis
-the arrangement of the giant cells around intact, partial, or collapsed cyst
38
Two forms of Colitis Cystica Profunda
- Localized
| - Diffuse
39
Form of Colitis Cystica Profunda:
-located in the rectum, 5-12cm from the anal margin
Localized
40
Form of Colitis Cystica Profunda:
-presents as plaque, nodule, or polyp
Localized
41
Form of Colitis Cystica Profunda:
-associated with chronic proctitis
Localized
42
Form of Colitis Cystica Profunda:
-often associated with mucosal prolapse
Localized
43
Form of Colitis Cystica Profunda:
-result of inflammation and ulceration of the bowel
Diffuse
44
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
Diffuse
45
Form of Colitis Cystica Profunda:
-easily mistaken for a Mucinous carcinoma
Diffuse
46
other name of Mucosal prolapse
Solitary rectal ulcer syndrome
47
other name of Adenomatous polyps
Tubular adenomas
48
Villous component in Tubulovillous Adenomas
25% or more
49
Villous component in Villous Adenomas
75% or more
50
Features of "Pseudoinvasion" in an adenomatous polyp (3):
- 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
Most common polyp with a serrated (sawtoothed) architecture
Hyperplastic polyps
52
Characteristic features of sessile serrated polyps
basal crypt distortion or lateral spread of crypts at the base or BOTH
53
WHO criteria for serrated polyposis syndrome (SPS) (3):
- 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
Characteristic features of Traditional Serrated Adenoma (TSA)
- often distinctly eosinophilic cytoplasm with centrally or basally located uniform slightly hyperchromatic pencillate nuclei, with frequent mitoses
- "ectopic crypt foci"
55
This feature of TSA are abortive attempts at new crypt base formation high in the polyp
Ectopic crypt foci
56
Most frequent colonic polyp seen in children
-Juvenile (retention) polyp
57
Most important features of Peutz-Jeghers Polyps (4):
- 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
Familial Adenomatous Polyposis (FAP) is also known as:
Polyposis coli
59
How many polyps should be present in FAP?
minimum of 100
60
Distinct microscopic appearance characteristic of thyroid carcinoma in patients with FAP
-cribriform and morular formations
61
Hereditary Flat Adenoma Syndrome (5)
- variant of FAP
- polyps are Flat rather than elevated
- Polyps less than 100
- Right-sided predominance
- same gene as FAP (APC)
62
Gardner syndrome (5):
- 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
other name of Hereditary Nonpolyposis Colorectal Cancer (HNPCC)
Lynch syndrome
64
Turcot syndrome (3)
- variant of HNPCC
- colorectal adenomatous polyps
- brain tumors, usually glioblastomas
65
Variant of HNPCC associated with tumors of sebaceous glands
-Muir-Torre syndrome
66
other name of Cowden syndrome
Multiple hamartoma syndrome
67
Malignant colorectal polyps should be assessed for the following features (2)
- Tumor differentiation
- Angiolymphatic invasion (LVI)
- Adequacy of excision
68
Best indicator of submucosal invasion
Stromal desmoplasia
69
Features of colorectal carcinomas that arise in HNPCC (7)
- 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
Staining profile in HNPCC
-Normal staining profile
-Low likelihood of HNPCC
71
Abnormal result of test for BRAF V600E and/or MLH1 methylation
-Low likelihood of HNPCC
72
Characteristics of carcinoma of the large bowel with higher CEA values (3)
- tumors that have spread beyond the bowel wall
- in poorly-differentiated neoplasms
- in tumors associated with Angiolymphatic and Perineural invasion
73
Immunohistochemically, the main mucin protein cores expressed by conventional colorectal adenocarcinoma (2)
- MUC 1
| - MUC 3
74
Tumors associated with MSI (4):
- Mucinous or Poorly-differentiated
- with a prominent host response
- a circumscribed growth pattern
- Right-sided location
75
Two distinct subtypes of Serrated carcinomas:
- MSI High
| - MSI low or stable
76
Subtype of Serrated Carcinoma:
-More common
-MSI High
77
Subtype of Serrated Carcinoma:
-arise in proximal colon from SSPs
-MSI High
78
Subtype of Serrated Carcinoma:
-Less common
-MSI low or stable
79
Subtype of Serrated Carcinoma:
-arise in the distal colon from TSAs
-MSI low or stable
80
Single most important predictor of clinical behavior for colorectal carcinoma
Anatomic extent of tumor (Pathologic stage)
81
Lymph nodes that should be examined in specimens which have not been subjected to neoadjuvant therapy for colorectal adenocarcinoma
-at least 10 (and ideally 12)
82
Most common sites of metastatic involvement of colorectal carcinoma
- regional lymph nodes
| - Liver
83
WDNET Grading
- Ki-67 proliferation index - <3%
- Mitotic index - < 2 per 10 hpf
Grade 1
84
WDNET Grading
- Ki-67 proliferation index - 3-20%
- Mitotic index - 2-20 per 10 hpf
Grade 2
85
Most common type of true smooth muscle tumors of the colon
-Leiomyoma
86
Three pseudomalignant benign vascular conditions which can be mistaken for an Angiosarcoma
- Florid vascular proliferation
- Pyogenic granuloma (Lobular capillary hemangioma)
- Reactive angioendotheliomatosis
