Upper GI Pathology

Question 1

Barrett Esophagus

Answer 1

Premalignant condition resulting from chronic injury

Question 2

Metaplasia of lower esophageal mucosa from —– to ——

Answer 2

Stratified squamous epithelium to nonciliated columnar epithelium w/ GOBLET CELLS

Question 3

Non-goblet columnar epithelial

Answer 3

Similar to stomach surface

Question 4

Goblet cells

Answer 4

acid mucin vacuole distends cytoplasm & compress nucleus

Question 5

Absorptive cells

Answer 5

Paneth cells
Endocrine cells

Question 6

Classification

Answer 6

Barrett esophagus does not have metastatic potential by itself

Negative dysplasia vs Positive dysplasia (low-grade, high-grade)

Question 7

Positive dysplasia low grade

Answer 7

Barrett’s mucosa

Question 8

Positive dysplasia high grade

Answer 8

Higher chance of progressing to invasive esophageal adenocarcinoma

Question 9

Cause of barrett esophagus

Answer 9

GERD

Question 10

Risk factors for Barrett Esophagus

Answer 10

Male, 5th decade, whites
Obesity
Smoking
Alcohol
Hiatal hernia

Question 11

Micro of Barrett Esophagus

Answer 11

Columnar metaplasia w/ goblet cells involving esophagus

Question 12

Endoscopy

Answer 12

Biopsy required for diagnosis
Velvety mucosa
Salmon-colored tongue above esophageal junction (extend into distal esophagus GE junction)

Question 13

Biomakers that predict prognosis risk for Barrett Esophagus

Answer 13

Abnormalities of p16 (INK4/CDKNA)

Frequent TP53 mutations

Question 14

Esophageal adenocarcinoma

Answer 14

Malignant epithelial tumor of the esophagus w/ glandular differentiation

Question 15

Incidence of Esophageal adenocarcinoma

Answer 15

Increasing 2/2 increasing obesity, GERD, declining H. pylori infection

Question 16

Demographic of adenocarcinoma

Answer 16

67 yo male

Question 17

Etiology of adenocarcinoma

Answer 17

All develops in the setting of intestinal metaplasia (Barrett’s esophagus)

Question 18

Risk fx for adenocarcinoma

Answer 18

Obesity
Smoking (sq cell carcinoma of esophagus)
Alcohol
Genetic predisposition

Question 19

Location of adenocarcinoma

Answer 19

Distal 1/3 esophagus

Question 20

Early gross path of adenocarcinoma

Answer 20

Ulcer
Nodule
Polyp
Plaque

Question 21

Late gross path of adenocarcinoma

Answer 21

Fungating or annular
Ulcer

Question 22

Micro of adenocarcinoma

Answer 22

Gland crowding
Cribriform plates
Dirty necrosis

Question 23

Adenocarcinoma advanced tumors sx

Answer 23

Progressive dysphagia (solids –>liquids)
WT loss
Retrosternal/epigastric pain

Question 24

Squamous cell carcinoma of the esophagus

Answer 24

Malignant epithelial neoplasm w/ squamous cell differentiation

Question 25

Keratinocyte-like cells that may contain intercellular bridges and/or keratinization

Answer 25

Pathology of squamous cell carcinoma of the esophagus

Question 26

Risk fx of squamous cell carcinoma of the esophagus (1/2)

Answer 26

Tobacco: majority, potentiates risk assoc w/ alcohol Alcohol Japanese alcoholics -- ALDH2 gene

Question 27

ALDH2 gene (aldehyde dehydrogenase 2 gene)

Answer 27

Japanese alcoholics at risk for squamous cell carcinoma of the esophagus

Question 28

Risk fx of squamous cell carcinoma of the esophagus (2/2)

Answer 28

Nitrosamines in pickled/moldy foods; vitamin deficiencies Plummer-vinson syndrome Achalasia Tylosis (AD skin disorder) Celiac disease (risk d/t iron deficiency anemia) Prior corrosive ingestion

Question 29

Gastric adenocarcinoma

Answer 29

Malignant epithelial cell tumor of gastric origin

Question 30

Early Gastric Adenocarcinoma

Answer 30

Limited to mucosa & submucosa

Question 31

Advanced Gastric Adenocarcinoma

Answer 31

Invade muscularis propria or more deeply

Question 32

pathogenesis gastric Adenocarcinoma

Answer 32

Multifactorial disease w/ strong environmental influences Chronic mucosal injury

Question 33

Risk factors gastric adenocarcinoma

Answer 33

1. H. pylori infection (CagA) 2. GERD 3. Bile reflux gastropathy following gastric surgery 4. Autoimmune gastritis 5. Diet (dried salted/smoked meats) 6. Smoking

Question 34

Gross/Micro pathology of gastric adenocarcinoma

Answer 34

1. Gland-forming tumors -- intestinal-type carcinoma form bulky tumors 2. Diffuse-type carcinoma -- diffuse infiltrative growth pattern (signet ring cell carcinoma)

Question 35

Infiltrating glands w/ fused, papillary, or cribriform architecture Cells contain LARGE, hyperchromatic nuclei

Answer 35

Gland-forming tumors --> intestinal-type carcinoma

Question 36

Signet ring cell carcinoma Large mucin vacuole compresses the nucleus Cells grow in nests, cords, singly Round, irregular nuclei & variable amounts of eosinophilic cytoplasm

Answer 36

Diffuse-type gastric adenoma carcinoma --> diffuse infiltrative growth pattern

Question 37

Plastica

Answer 37

not pliable w/ an appearance similar to "leather bottle" stomach CDH1 mutation gastric adenocarcinomas (E-cadherin)

Question 38

Early Gastric Adenocarcinoma clinical features

Answer 38

Asymptomatic Ab pain Mimics peptic ulcer disease: epigastric pain, dyspepsia (sister mary joseph nodule)

Question 39

Advanced Gastric Adenocarcinoma clinical features

Answer 39

Ab pain (epigastrium) Anemia Vomiting WT Loss

Question 40

Met/paraneoplastic signs: Gastric Adenocarcinoma clinical features

Answer 40

Intra Abdominal dissemination & ascites Ovaries (Krukenberg tumor) Aconthosis nigricans/Leser-Trelat sign Lymphatic spread --> L supraclavicular node (Virchow node) Hematogenous spread --> liver & lung St. Mary J Nodule

Question 41

Gastric marginal zone (MALT) lymphoma

Answer 41

Low-grade lymphoma composed of heterogenous B-cell population

Question 42

Gastric marginal zone (MALT) lymphoma

Answer 42

Stomach is common site of extranodal lymphomas

Question 43

Cause of Gastric marginal zone (MALT) lymphoma

Answer 43

Most assoc w/ chronic H. pylori infection CagA+ most immunogenic

Question 44

Trisomies 3, 12, 18

Answer 44

Common in Cause of Gastric marginal zone (MALT) lymphoma

Question 45

Translocation associated with Gastric MALT lymphoma

Answer 45

t(11;18)(q21;q21)

Question 46

Diffuse proliferation of small-medium sized lymphocytes → monocytoid appearance w/ abundant pale cytoplasm

Answer 46

Microscopic signs of Gastric MALT

Question 47

Gastric glands infiltrated by lymphocytes (lymphoepithelial lesions) & uniform monocytoid morphology of the cells infiltrating the lamina propria

Answer 47

Microscopic signs of Gastric MALT

Question 48

GI stromal tumor

Answer 48

Mesenchymal tumor of the GI tract w/ characteristic histologic, immunohistochemical, molecular features

Question 49

GI stromal tumor molecular sign

Answer 49

CD117, KIT Neurofibromatosis type I

Question 50

Amenable to tyrosine kinase inhibitor therapy (imatinib)

Answer 50

GI Stromal Tumor -- KIT mutations = 85% of cases

Question 51

GI Stromal Tumor -- AD familial syndrome

Answer 51

Mutations in exons 11 & 13 of KIT

Question 52

Carney triad

Answer 52

GI Stromal Tumor Pulm chondroma Catecholamine-secreting paraganglioma

Question 53

GI Stromal Tumor: Older Adults

Answer 53

KIT & PDGFRA-mutated GISTs (60-65yo)

Question 54

GI Stromal Tumor: <21 yo

Answer 54

GISTs are SDH deficiency

Question 55

Well-defined round-oval tumor w/ epicenter in muscularis propria

Answer 55

Gross features of GI Stromal Tumor

Question 56

Firm to fleshy or gelatinous cut surface

Answer 56

Gross features of GI Stromal Tumor

Question 57

Hemorrhage & cystic degeneration in large tumors

Answer 57

Gross features of GI Stromal Tumor

Question 58

Site of GI Stromal Tumor

Answer 58

Stomach>> Jejunum/ileum>> duodenum>rectum

Question 59

Micro of GI Stromal Tumor

Answer 59

neoplastic cells → spindled/epithelioid mesenchymal neoplasm thought to arise/differentiate toward interstitial cells of Caja (ICC) or pacemaker cells

Question 60

GI bleeding d/t mucosal ulceration (MOST COMMON) GI obstruction, abdominal pain Incidental findings during surgery

Answer 60

Clinical features of GI Stromal Tumor