Small bowel and pancreas pathology

Question 1

In celiac disease, there is an exaggerated ______ response to gliadin resulting in cell injury

Answer 1

CD8+ T cell

Question 2

What haplotypes are associated with celiac disease

Answer 2

HLA-DQ2 or DQ8

Question 3

Describe the gross appearance of celiac disease

Answer 3

mostly in 2nd portion of duodenum through proximal jejunum

scalloping or flattening of mucosa on endoscopy

Question 4

Diagnosis?
atrophy or blunting of villi
increased intraepithelial lymphocytes in villous tips
increased plasma cells within lamina propria

Answer 4

celiac disease

Question 5

List complications of celiac disease

Answer 5

chronic malabsorption–> osteoporosis, short stature, chronic anemia, pancreatic insufficiency
lymphoma or adenocarcinoma in small intestine

Question 6

Infection with Tropheryma whippelii typically affects:

Answer 6

white males 30-49

proximal small intestine

Question 7

Diagnosis?
grossly shaggy mucosa, edematous bowel wall with white mucosal plaques
microscopy- distended macrophages in lamina propria with PAS+ granules, rod shaped bacili, dilated lymphatics or fat vacuoles

Answer 7

Whipple’s disease

Question 8

Carcinoid tumors arise from ______ cells in the GI tract

Answer 8

Kultschitzky

Question 9

All carcinoid tumors can secrete functional hormone. Tumors in the _____ have their hormones carried to the liver for first pass metabolism (inactivation)

Answer 9

intestine

Question 10

Diagnosis?
grossly small polypoid lesions beneath mucosa with surface ulceration, bright yellow cut surface
microscopy- cells growing in ribbons or sheets, uniform cells with granular cytoplasm

Answer 10

carcinoid/ neuroendocrine tumor

Question 11

GISTs arise from _______ cells

Answer 11

interstitial cells of cajal

Question 12

Most GISTs have a gain of function mutation in _____

Answer 12

c-kit, a tyrosine kinase receptor

Question 13

GISTs with c-kit mutations can be treated with _____

Answer 13

imatinib, a tyrosine kinase inhibitor

Question 14

Diagnosis?
Grossly solitary well-circumscribed lesion
microscopy- spindle cell proliferation

Answer 14

GIST

Question 15

Acute pancreatitis is ______ pancreatic injury, chronic pancreatitis is _____ injury

Answer 15

reversible, irreversible

Question 16

_______ are present in a majority of cases of acute pancreatitis

Answer 16

gallstones

Question 17

Diagnosis?
grossly swollen and edematous pancreas with fat necrosis, possible brown hemorrhage
microscopy: edema, hemorrhage, neutrophilic infiltrate

Answer 17

acute pancreatitis

Question 18

Diagnosis?
grossly atrophic and firm pancreas with calcifications
micrsocopy- increased interlobular connective tissue, inflammatory infiltrate, islet cell architecture preserved

Answer 18

chronic pancreatitis

Question 19

The precursor lesions to pancreatic adenocarcinoma are ______

Answer 19

PanINs

Question 20

Diagnosis?
Gross- hard stellate poorly defined mass in pancreas
microscopic- desmoplastic response, perineural and lymphatic invasion, loss of acinar architecture

Answer 20

pancreatic adenocarcinoma