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GI > SM_162b: Pathology of Colonic Disorders > Flashcards

SM_162b: Pathology of Colonic Disorders Flashcards

1
Q

Colon is the part of the mucosa that extends from the ____ to ____

A

Colon is the part of the mucosa that extends from the cecum to rectum

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2
Q

Four layers of colon are ____, ____, ____, and ____

A

Four layers of colon are the mucosa, submucosa, muscularis propria, and adventitia / serosa

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3
Q

Describe staging carcinomas based on histology of colon

A

Staging carcinomas based on histology of colon

  • Mucosa: Tis (in situ)
  • Submucosa: T1
  • Muscularis propria: T2
  • Serosa: T3
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4
Q

Colonic mucosa consists of ____, ____, and ____ and functions to ____ and ____

A

Colonic mucosa consists of epithelium, lamina propria, and muscularis mucosae and functions to absorb water and allow passage of stool protection

  • Epithelium: absorptive cells, goblet cells, Paneth cells (only in right colon), endocrine cells
  • Lamina propria: plasma cells, eosinophils, lymphocytes
  • Muscularis mucosae: thin smooth layer created by gentle agitation
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5
Q

These are ____ and ____

A

These are endocrine cells and Paneth cells

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6
Q

Colonic submucosa consists of ____ and ____

A

Colonic submucosa consists of loose connective tissue and ganglion cells (Meissner’s plexus)

  • Loose connective tissue: fibroblasts, lymphatics, blood vessels
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7
Q

____ is the main layer of the GI tract and creates peristalsis

A

Muscularis propria is the main layer of the GI tract and creates peristalsis

  • Inner circular smooth muscle layer
  • Outer longitudinal smooth muscle layer
  • Ganglion cells (Auerbach’s plexus)
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8
Q

Colitis is inflammation of the colon and presents with ____, ____, ____, ____, and ____

A

Colitis is inflammation of the colon and presents with abdominal pain, diarrhea, urgency, hemorrhage, and incontinence

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9
Q

Infectious colitis is most commonly ____ and involves ____ and ____

A

Infectious colitis is most commonly active inflammation and most commonly involves cryptitis and crypt abscesses

  • Cryptitis: neutrophils in the epithelium
  • Crypt abscesses: neutrophils in the crypt lumina
  • Pattern of inflammation depends the causative agent
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10
Q

Cryptitis is ____

A

Cryptitis is neutrophils in the epithelium

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11
Q

Crypt abscesses are ____

A

Crypt abscesses are neutrophils in the crypt lumina

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12
Q

Pseudomembranous colitis involves a pseudomembrane composed of ____, ____, and ____

A

Pseudomembranous colitis involves a pseudomembrane composed of necrotic epithelial cells, acute inflammatory cells, and fibrinous material

  • Causes: Clostridioides difficile, ischemic colitis, IBD
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13
Q

Describe Clostridium difficile membranous colitis pathophysiology

A

Clostridium difficile membranous colitis pathophysiology

  1. Administration of antibiotic
  2. Overgrowth of C. difficile
  3. Production of toxins
  4. Epithelial / endothelial damage and inflammation

Presents with diarrhea, abdominal pain, nausea / vomiting, fever

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14
Q

Clostridium difficile pseudomembranous colitis is diagnosed via ____

A

Clostridium difficile pseudomembranous colitis is diagnosed via testing for C. difficile toxin in the stool

(endoscopy also used)

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15
Q

Discrete, raised creamy yellow plaques of 1-5 mm on the colon indicates ___

A

Discrete, raised creamy yellow plaques of 1-5 mm on the colon indicates pseudomembranous colitis

(C. difficile)

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16
Q

This is a ____ that occurs in ____

A

This is a pseudomembrane that occurs in pseudomembranous colitis

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17
Q

Microscopic colitis is ____ with two entities: ____ and ____

A

Microscopic colitis is chronic non-bloody diarrhea with two entities: lymphocytic colitis and collagenous colitis

  • Radiologic and endoscopic studies are normal
  • Pathology can identify the process
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18
Q

IBD is ____ that consists of ____ and ____ and presents as ____

A

IBD is chronic relapsing inflammation of all or portions of the GI tract that consists of Crohn’s Disease and Ulcerative Colitis and presents as subtle abdominal pain to bloody diarrhea

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19
Q

Ulcerative colitis is primarily an ____ and begins in the ____ and progresses ____

A

Ulcerative colitis is primarily an inflammatory condition of the mucosa and begins in the rectum and progresses proximally

(may involve the entire colon)

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20
Q

Ulcerative colitis involves clinical features of ____, ____, and ____

A

Ulcerative colitis involves clinical features of sudden bloody diarrhea, vague abdominal pain, and acute toxic megacolon

  • Acute toxic megacolon: pancolitis -> dilatation -> no peristalsis -> rapid deterioration
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21
Q

Crohn’s disease is ____, that occurs most commonly in the ____, and involves ____

A

Crohn’s disease is chronic discontinuous inflammation, that occurs most commonly in the terminal ileum and / or colon, and involves all layers of the GI tract (transmural inflammation)

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22
Q

Crohn’s disease clinical features are ____, ____, ____, and ____

A

Crohn’s disease clinical features are diarrhea (chronic, nocturnal, occassionally bloody), crampy abdominal pain, fever / malnutrition / fatigue / anemia, weight loss

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23
Q

Ulcerative colitis involves inflammation of ____, while Crohn’s Disease involves ____ inflammation

A

Ulcerative colitis involves inflammation of mucosa, while Crohn’s Disease involves transmural inflammation

24
Q

Ulcerative colitis histologic findings include ____, ____, and ____

A

Ulcerative colitis histologic findings include chronic inflammation, active inflammation, and limited to mucosa

  • Chronic inflammation: too many lymphocytes and plasma cells in lamina propria, distorted crypt architecture
  • Active inflammation: cryptitis (neutrophils in epithelium) and crypt abscess (neutrophils in the lumen of the crypt)
25
Q

Crohn’s disease histologic findings include ____, ____, ____, and ____

A

Crohn’s disease histologic findings include chronic inflammation, active inflammation, transmural inflammation, and noncaseating granulomas

  • Chronic inflammation: too many lymphocytes and plasma cells in lamina propria, distorted crypt architecture
  • Active inflammation (acute): cryptitis (neutrophils in epithelium)
26
Q

____ has gross pathology of heal stricture, serpiginous ulcers, and cobble stone due to patchy involvement

A

Crohn’s Disease has gross pathology of heal stricture, serpiginous ulcers, and cobble stone due to patchy involvement

27
Q

Describe macroscopic differences between ulcerative colitis and Crohn’s Disease

A

Macroscopic differences between ulcerative colitis and Crohn’s Disease

  • Crohn’s Disease: discontinuous, terminal ileum involved
  • Ulcerative colitis: continuous, rectum always involved
28
Q

Describe microscopic differences between ulcerative colitis and Crohn’s Disease

A

Microscopic differences between ulcerative colitis and Crohn’s Disease

  • Ulcerative colitis: mucosal inflammation, crypt abscess common
  • Crohn’s disease: transmural inflammation, granulomas
29
Q

___ is a common systemic complication of ulcerative colitis

A

Primary sclerosing colangitis is a common systemic complication of ulcerative colitis

  • Increased risk of biliary cancer
  • Also toxic megacolon, hemorrhage, inflammatory polyposis, and cancer
30
Q

Ulcerative colitis increases risk of ____ particularly with onset in childhood, pancolitis, and duration of disease > 10 years

A

Ulcerative colitis increases risk of colon cancer particularly with onset in childhood, pancolitis, and duration of disease > 10 years

  • Invasive cancer preceded by the development of dysplasia: low grade dysplasia, high grade dysplasia, indefinite for dysplasia
31
Q

____ are abnormal growths of tissue projecting from a mucous membrane and can be ____ or ____

A

Polyps are abnormal growths of tissue projecting from a mucous membrane and can be sessile or pedunculated (with stalk)

  • Non-neoplastic: hyperplastic, inflammatory, hamartomatous
  • Neoplastic: tubular adenoma, villous adenoma, tubulovillous adenoma, sessile serated adenoma
32
Q

Hyperplastic polyps ____, ____, ____, and ____

A

Hyperplastic polyps occur often in the left colon, are small (< 5 mm), include mature goblet cells and absorptive cells, and include a serration

  • Serration (star shaped): typically restricted to approximately the upper third of crypts
33
Q

Inflammatory polyp is composed of ____

A

Inflammatory polyp is composed of a non-neoplastic mixture of epithelial, stromal, and inflammatory cells

  • Related to IBD, prolapse type inflammatory polyps, and solitary rectal ulcer syndrome
34
Q

Describe pathophysiology of solitary rectal ulcer syndrome

A

Solitary rectal ulcer syndrome pathophysiology

  1. Impaired relaxation of anorectal sphincter
  2. Recurrent abrasion and ulceration of the mucosa
  3. Inflammatory polyp
  4. Entrapment of polyp in fecal stream
  5. Mucosal prolapse
35
Q

Solitary rectal ulcer syndrome presents with the triad of ____, ____, and ____

A

Solitary rectal ulcer syndrome presents with the triad of rectal bleeding, mucus discharge, and an inflammatory lesion / polyp

36
Q

Hamartamous polyps are ____ composed of ____ often with ____

A

Hamartamous polyps are benign tumor-like nodules composed of an overgrowth of tissue present in the area often with one element predominating

  • Sporadic: juvenile polyp, Peutz-Jeghers polyp
  • Components of various genetic / acquired syndromes
37
Q

Juvenile polyps occur often ____, are most often located in ____ and present with ____, and can be ____ or ____

A

Juvenile polyps occur often in children < 5 years, are most often located in rectum and present with bleeding, and can be sporadic or syndromic juvenile polyposis

  • Syndromic juvenile polyposis can undergo malignant transformation -> increased risk of colonic adenocarcinoma
38
Q

Syndromic juvenile polyposis can undergo ____ transformation leading to an increased risk of ____

A

Syndromic juvenile polyposis can undergo malignant transformation leading to an increased risk of colonic adenocarcinoma

39
Q

Peutz-Jeghers syndrome is caused by ____, results in ____, and increases risk of ____

A

Peutz-Jeghers syndrome is caused by STK11 gene mutation, results in GI hamartomatous polyps and mucocutaneous hyperpigmentation, and increases risk of malignancies

  • Malignancies: breast and GI (pancreas)
  • Complex architecture w/ smooth muscle bundles cutting through lamina propria
40
Q

Juvenile polyposis involves mutation in ____, while Peutz-Jeghers syndrome involves mutations in ____

A

Juvenile polyposis involves mutation in SMAD4, while Peutz-Jeghers syndrome involves mutations in STK11

41
Q

Neoplastic polyps of the colon are precursors for ____

A

Neoplastic polyps of the colon are precursors for colorectal carcinoma

  • Classification: tubular adenoma, villous adenoma, tubulovillous adenoma, sessile serrated adenoma
42
Q

Tubular adenomas have ____, are mostly ____ but may ____ if large, and have increased incidence with ____

A

Tubular adenomas have low grade dysplasia, are mostly silent but may bleed if large, and have increased incidence with age

43
Q

Villous adenoma is characterized by ____, most often located in the ____, and are ____ and ____

A

Villous adenoma is characterized by epithelial proliferation arranged as slender villi, most often located in the rectum, and are often larger and sessile

44
Q

Sessile serrated adenomas often occur in the ____, have ____ potential, and ____ typical cytologic features of dysplasia

A

Sessile serrated adenomas often occur in the right colon, have malignant potential, and lack typical cytologic features of dysplasia

  • Overlap histologically with hyperplastic polyps
45
Q
A
46
Q

Neoplastic polyps may undergo malignant transformation (adenoma-carcinoma sequence), particularly if ____

A

Neoplastic polyps may undergo malignant transformation (adenoma-carcinoma sequence), particularly if large

Size matters!

47
Q

Risk factors for colon cancer include ____, ____, and ____

A

Risk factors for colon cancer include smoking, dietary factors (high fat diet, low fiber diet), and obesity

48
Q

Describe carcinoma of the colon and rectum

A

Carcinoma of the colon and rectum

  • Distribution: rectosigmoid > ascending > descending
  • Ascending colon -> iron deficiency anemia, weight loss
  • Descending colon -> colicky pain, partial obstruction, hematochezia
  • Pathology: gross (ulcerating, annular, polypoid), microscopic (adenocarcinomas_
49
Q

Familial adenomatous polyposis results from ____ and causes ____

A

Familial adenomatous polyposis results from germline mutation of APC gene and causes colorectal adenocarcinoma often by age 30

  • APC: tumor suppressor gene, on chromosome 5
  • Autosomal dominant
  • Multiple tubular adenomas (> 100)
    Extra-intestinal manifestations: congenital hypertrophy of retinal pigmented epithelium at birth -> early screening
  • Treatment: colectomy
    *
50
Q

Hereditary nonpolyposis colorectal cancer (Lynch syndrome) has ____ inheritence, results from ____, and involves ____

A

Hereditary nonpolyposis colorectal cancer (Lynch syndrome) has autosomal dominant inheritence, results from mutations in genes encoding proteins responsible for detection / repair of errors during DNA replication, and involves familial clustering of cancers

  • DNA instability (microsatellite instability)
51
Q
A
52
Q

Hereditary nonpolyposis colorectal cancer (Lynch syndrome) is often ____

A

Hereditary nonpolyposis colorectal cancer (Lynch syndrome) is often right colon cancer

  • Younger age than sporadic
53
Q

MLH1, MSH2, MSH6, and PMS2 mutations can result in ____

A

MLH1, MSH2, MSH6, and PMS2 mutations can result in hereditary nonpolyposis colorectal cancer (Lynch syndrome)

  • DNA instability (microsatellite instability)
54
Q

Colonic adenocarcinoma may involve ____

A

Colonic adenocarcinoma may involve infiltrative carcinoma invading the submucosa

55
Q

Prognostic factors in colorectal carcinoma are ____, ____, and ____

A

Prognostic factors in colorectal carcinoma are depth of pentration (stage), metastasis to lymph nodes or other organs (liver), and type of differentiation

  • Poorly differentiated and mucinous -> poor prognosis
  • Prevention / screening via colonoscopy and removal of precursor

GI (40 decks)

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