The Gastrointestinal Tract

Question 1

Complication of long-standing GERD; characterized by intestinal metaplasia within the esophageal squamous mucosa; increased risk of esophageal adenocarcinoma.

Answer 1

Barrett esophagus

Question 2

Esophageal carcinoma associated with chronic GERD; usually occurs in the distal third of the esophagus; histologically characterized by gland formation and mucin production; premalignant lesion is Barrett esophagus.

Answer 2

Adenocarcinoma

Question 3

More common of the histologicpatterns of esophageal cancer; associated with smoking, alcohol, caustic injury, and frequent consumption of very hot beverages; usually occurs in the middle third of the esophagus; premalignant lesion is squamous dysplasia.

Answer 3

Squamous cell carcinoma

Question 4

Most common form of chronic gastritis; most common cause of multifocal atrophic gastritis; characterized by the following: predominantly antral, neutrophilic infiltrate with subepithelial plasma cells, serum gastrin normal to decreased; associated with hyperplastic/inflammatory polyps; (+) for H. pylori antibodies; sequelae includes gastric lymphoma.

Answer 4

H. pylori gastritis

Question 5

Most common form of gastritis in patients without H. pylori infection; most common cause of diffuse atrophic gastritis; characterized by the following: predominantly at the body, lymphocytic infiltrate with macrophages, serum gastrin increased; associated with neuroendocrine hyperplasia; (+) for antibodies against parietal cells (proton pump and intrinsic factor); clinically, patients present with achlorhydia (due to destruction of parietal cells), and megaloblastic anemia (due to Vitamin B12 deficiency).

Answer 5

Autoimmune gastritis

Question 6

Most common form of PUD.

Answer 6

Antral or duodenal (H. pylori)

Question 7

Histologic findings in PUD.

Answer 7

NIGS: N: necrosis, I: acute inflammation, G: granulation tissue, S: fibrous scar (from superficial to deep)

Question 8

Most common gastric polyp.

Answer 8

Inflammatory/ Hyperplastic (75%)

Question 9

The most common malignancy of the stomach (90%); has two types: intestinal (bulky tumors with gland-like structures histologically); and diffuse (intense desmoplasia leading to leather bottle stomach (linitis plastic) with signet ring cells containing mucin histologically. (Lauren classification of intestinal and diffuse is used); most common site: Antrum, on the lesser curvature.

Answer 9

Gastric adenocarcinoma

Question 10

Malignancy associated with H. pylori infection; most common site of occurrence is the stomach; eradication of H. pylori leads to tumor regression, except when it transforms to DLBCL.

Answer 10

Lymphoma/MALToma

Question 11

Tumors of neuroendocrine origin; common site is small intestine; may elaborate hormones that can lead to ZES (gastrin) or carcinoid syndrome (serotonin); most important prognostic factor is location i.e. midgut tumors are often multiple and aggressive; immunostains: Synaptophysin and Chromogranin A.

Answer 11

Carcinoid

Question 12

Most common mesenchymal tumor of the abdomen; more than half of cases occur in the stomach; cytogenetic origin is interstitial cells of Cajal (ICC); histologically composed of elongated spindle cells or plump epithelioid cells; Immunostains: KIT.

Answer 12

Gastrointestinal stromal tumor (GIST)

Question 13

Most common cause of intestinal obstruction.

Answer 13

Hernias

Question 14

Most common cause of intestinal obstruction in children <2 years old.

Answer 14

Intussusception

Question 15

Inflammatory bowel disease characterized by the following: continuous lesions usually limited up to submucosa, with rectal involvement but disease is limited to the colon only; associated with toxic megacolon and development of colonic adenocarcinoma.

Answer 15

Ulcerative colitis

Question 16

Most common site of diverticular disease.

Answer 16

Sigmoid (in areas penetrated by blood vessels)

Question 17

Type of diverticulum in sigmoid .diverticulosis.

Answer 17

False diverticulum

Question 18

Polyps common in the left colon; characterized by serrated architecture limited to the upper third of the crypt; no cytologic atypia and lateral growth; do not have malignant potential.

Answer 18

Hyperplastic polyp

Question 19

Polyps common in the right colon; characterized by serrated architecture throughout the whole length of the gland; no cytologic atypia but exhibits lateral growth (elephant-feet glands); has malignant potential like conventional adenomas.

Answer 19

Sessile serrated adenoma

Question 20

Autosomal dominant syndrome of hamartomatous polyps and mucocutaneous hyperpigmentation, associated with increased risk of visceral malignancies; histologically characterized by arborizing networks composed of smooth muscle intermixed with lamina propria.

Answer 20

Peutz-Jeghers syndrome

Question 21

Morphologic variants of colonic adenomas.

Answer 21

Tubular, Tubulovillous, Villous

Question 22

The single most important characteristic of adenomas that correlates with malignancy.

Answer 22

Size (>4cm) (others: architecture (villous), and severity of dysplasia

Question 23

Familial syndrome characterized by early onset development of numerous colonic polyps; main pathology is mutations on the APC gene (Ch5); criterion is the presence of at least 100 polyps.

Answer 23

Familial adenomatous polyposis (FAP)

Question 24

Familial syndrome characterized by early development of colon cancer and other visceral malignancies; main pathology is mutations in genes of DNA repair (MSH2 or MLH1) that leads to microsatellite instability and subsequent development of colonic adenocarcinoma.

Answer 24

Hereditary nonpolyposis colon cancer (HNPCC)/Lynch syndrome

Question 25

Most common malignancy of the gastrointestinal tract; two pathways are recognized; the adenoma carcinoma sequence involving APC among others; and the microsatellite instability pathway (sessile serrated adenoma-carcinoma sequence) involving MSH2 or MLH1; clinically characterized by different symptomatologies depending on location: (Right colon: usually anemia from bleeding from the bulky nonobstructive masses; Left colon: usually presents with change in bowel habits due to napkin-ring configuration of the lesion).

Answer 25

Colonic adenocarcinoma

Question 26

Two important prognostic factors in colonic adenocarcinoma.

Answer 26

Invasion and lymph node status

Question 27

Most common site of metastases of colonic adenocarcinoma.

Answer 27

Liver

Question 28

The most common cause of acute appendicitis in children and adults, respectively.

Answer 28

Lymphoid hyperplasia and Fecalith, respectively

Question 29

The most common tumor of the appendix.

Answer 29

Carcinoid