stomach and small bowel pathology

Question 1

describe what an Inflammatory/Hyperplastic Polyp looks like on endoscopy

Answer 1

smooth, irregular, multi-lobated appearance

Question 2

describe what an Inflammatory/Hyperplastic Polyp looks like on histolgy

Answer 2

cystically dilated foveolae,

inflammation and edema

Question 3

describe a fundic gland polyp on endoscopy

Answer 3

dome like bumps in the stomach

Question 4

describe a fundic gland polyp on histology

Answer 4

Cystically dilated oxyntic gland

Question 5

descibe an adenoma on endoscopy and histologically

Answer 5

dome like bump with surface irregularities

Dark, atypical cells

Question 6

what is Hypertrophic Pyloric Stenosis

Answer 6

Hyperplasia of pyloric muscularis propria → obstructs gastric outflow

Question 7

what is the clinical presentation of Hypertrophic Pyloric Stenosis

Answer 7

Presents in 2-3rd week of life with regurgitation and persistent projectile non-bilious vomiting
Firm ovoid abdominal mass

Question 8

what is the treatment for hypertrophic pyloric stenosis

Answer 8

Surgical splitting of muscularis propria (“myotomy”)

Question 9

what is the pathophys of Autoimmune Gastritis

Answer 9

Anti-parietal cell and anti-intrinsic factor antibodies

Question 10

name the 3 benign neoplastic diseases.

Answer 10

Inflammatory / hyperplastic polyp
Fundic gland polyp
Adenomatous polyp (adenoma)

Question 11

name the 4 Malignant (potentially) of the stomach

Answer 11

Malignant:
     Adenocarcinoma
     Lymphoma
Potentially Malignant:
     Carcinoid tumor
     Gastrointestinal stromal tumor

Question 12

________, is the most prevalent type of gastric polyp

with rare progression to cancer; associated with Helicobacter and other chronic gastritides

Answer 12

Inflammatory/hyperplastic polyp

Question 13

_______ have very rare progression to cancer (in FAP patients); FAP associated and sporadic (usually PPI associated)

Answer 13

Fundic gland polyp

Question 14

__________ have Common progression to cancer; increased incidence in FAP, Helicobacter gastritis, and other chronic gastritides

Answer 14

adenomas

Question 15

________ accounts for 90% of all malignant gastric tumors

Answer 15

adenocarcinomas

Question 16

what are late Sx’s of gastric adenocarcinomas

Answer 16

weight loss, anorexia, early satiety, anemia

Question 17

what is the Overall 5-year survival for gastric adenocarcinoma, and if detected early

Answer 17

30% (90% for early gastric cancer)

Question 18

describe the 3 genetic aspects of Adenocarcinoma

Answer 18

1)Wnt signalling pathway activation
Common in intestinal type cancers
Can occur with loss of APC (as in FAP)
2)Loss of CDH1 (mutation or methylation)
Common in diffuse type cancers
Germline loss of CDH1 in familial gastric cancer
3)Amplification of Her2/neu
Occurs in a minority of tumors (intestinal > diffuse)
Susceptible to tyrosine kinase inhibitor trastuzumab

Question 19

Diffuse (signet ring cell) type on histology is seen in ____

Answer 19

Adenocarcinoma

Question 20

5% of gastric cancers are _______

with most of those being _______

Answer 20

lymphomas,

MALT lymphomas (low-grade B-cell)

Question 21

Carcinoid (Neuroendocrine) Tumoris associated with_____

Answer 21

gastric atrophy and MEN-I

Question 22

what is the appearance of carcinoid tumors on histology

Answer 22

Nests and trabeulae of monomorphic cells (rosettes)

Question 23

Mesenchymal neoplasm derived from interstitial cells of Cajal (pacemaker cells controlling peristalsis) are called _____

Answer 23

Gastrointestinal Stromal Tumor (GIST)

Question 24

The Most contain mutation in Gastrointestinal Stromal Tumor (GIST) is the ______

Answer 24

c-kit oncogene

Question 25

features of Gastrointestinal Stromal Tumor on histology:

Answer 25

Spindle cell proliferation,

c-kit immunohistochemical stain