Upper GI Pathology Flashcards
1
Q
- Autoimmune destruction (lymphocyte-mediated damage type IV hypersensitivity) of lacrimal and salivary glands, with fibrosis
- classically presents with dry eyes (keratoconjuctivitis), dry mouth (xerostomia) and reccurent dental carries in an older woman (50-60 yo)
- characterized by ANA and anti-SSA/Ro and anti-SS-B/La
- often associated with other autoimmune diseases (esp Rheumatoid arthritis)
- increased risk for B-cell lymphoma (unilateral enlargement of parotid gland)
A
Sjorgen’s Syndrome
2
Q
- most common benign neoplasm of salivary glands
- composed of stromal (e.g., cartilage) and epithelial tissue
- usually arises in parotid
- presents as a mobil, painless, circumscribed mass at the angle of the jaw
Path:
- epithelial cells forming ducts
- myxoid/mucoid stroma
A
Pleomorphic adenoma
3
Q
- most common malignant tumor of salivary glands
- composed of mucinous and squamous cells
- usually arises in the parotid
- commonly involves the facial nerve
Path:
- duct-like/cyst-like spaces lined by squamous cell carcinoma
- mucus-secreting cells intermixed
A
Mucoepidermoid carcinoma
4
Q
Triad:
- Incomplete LES relaxation
- Increased LES tone
- Esophageal aperistalsis
- due to primary (diopathic) or secondary loss of ganglia in the myenteric/Auerbach’s plexus
A
Achalasia
5
Q
- Fibrous circumferential bands or muscular hypertrophy above the GE junction
- asymptomatic, but may cause dysphagia
- almost always associated with a hiatal hernia
- core consists of muscularis mucosae, but not muscular is propria
A
Schatzky’s Ring
6
Q
- corrosive or inflammatory esphagitis
- fibrous thickening of the submucosa
- associated with atrophy of the muscularis propia
- due to inflammation and scarring of the reflux, radiation
- progressive dysphagia from solids to liquids
A
Strictures
7
Q
- semicircumferential, ledge-like protrusions of mucosa
- involves the upper esophagus
- increased risk for esophageal squamous cell carcinoma
A
Esophageal Web
8
Q
Characterized by:
- Iron deficiency
- Esophageal web
- beefy-red tongue due to atrophy glossitis
A
Plummer-Vinson Syndrome
9
Q
- acquired defect, due to gradual weakening of the wall of the swallowing channel
- arises above the upper esophageal sphincter (junction of esophagus and pharynx)
- located on posterior wall of esophagus
- presents as dysphagia, obstruction, and halitosis
- typically requires surgical intervention
A
Zenker’s Diverticula/Pulsion Diverticulum
10
Q
- Occurs near midpoint of the esophagus
- as a result of adhesions due to inflammatory process in the mediastinum
A
Traction Diverticulum
11
Q
- occurs immediately above the GE junction
A
Epiphrenic Diverticulum
12
Q
- cardia of the stomach protrudes into the thorax via a tear/weakness of the diaphragm
- Present with GERD/heartburn
A
Hiatal Hernias
13
Q
- Distension of submucosal veins in the lower esophagus
- arises secondary to portal hypertension
- presents with PAINLESS hematemesis
A
Varices
14
Q
- longitudinal laceration of mucosa at the GE junction
- caused by severe vomiting, usually due to alcoholism or bulimia
- presents with PAINFUL hematemesis
A
Mallory-Weiss Syndrome
15
Q
- complication of MW syndrome
- Rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema (air bubbles beneath the skin)
A
Boerhaave Syndrome
16
Q
- reflux of acid from th estomach due to reduced LES tone
- presents as heartburn
- ulceration with structure and Barrett esophagus are late complications
Risk factors:
- hiatal hernia
- smoking
- alcohol
Path:
- elongation of lamina propria papillae
- Basal cell hyperplasia
- Intercellular edema
- Scattered osinophils
A
Gastroesophageal Reflux Disease
17
Q
- Candida (white coating/thrush)
- Presence of pseudohyphae indicate infection
- Herpes simplex (ulcer)
- CMV (ulcer)
A
Infectious Esophagitis
18
Q
- Metaplasia of lower esophageal from stratified squamous epithelium to nonciliaated columnar epithelium with goblet cells (required)
- complication of GERD
- PRENEOPLASTIC: may progress to epithelial dysplasia or adenocarcinoma
A
Barrett Esophagus
19
Q
- neoplastic epithelial changes that are confined to the glandular basement membrane
A
Epithelial Dysplasia
20
Q
- malignant proliferation of glands
- arises from preexisting Barrett esophagus; metaplasia must occur prior, b/c esophagus does not normally have glands
- usually involves the lower 1/3 of the esophagus
A
Esophageal Adenocarcinoma
21
Q
- most common esophageal cancer worldwide
- Usually arises in upper or middle 1/3 of the esophagus
- alcohol, tobacco, very hot tea
- swirling pattern of with keratin pearls
A
Squamous Cell Carcinoma
22
Q
- narrowing of the pylorus at the gastroduodenal border due to hypertrophy of the muscularis propria
Congenital: Newborn with projectile non-bilious vomiting
- Associated with Turner Syndrome (monosomy 45 XO) and Edwards Syndrome (trisomy 18)
Acquired: complication of PUD or infiltrating cancer
A
Pyloric Stenosis
23
Q
Mucous Cells
A
Normal Gastric Mucosa in Cardia
24
Q
Parietal cells: Acid
Chief cells: pepsin
A
Normal Gastric Mucosa in Fundus and Body
25
Mucous cells
| G cells: Gastrin
Normal Gastric Mucosa in Fundus and Body
26
- Idiopathic increase in TGF-alpha
- results in diffuse hyperplasia of foveolar epithelium of the fundus and body
- atrophy of parietal cells
- cause of protein loss (hypoalbuminemia)
Hypertrophic Gastropathy
| Menetrier's Disease
27
- Necrosis involving the mucosa only
Erosions
28
- Necorsis penetrating into the submucosa and muscularis propria
Ulcers
29
- Ulcers due to shock, sepsis
Stress ulcers
30
- ulcers due to severe burns, most commonly the proximal duodenum
Curling ulcers
31
- ulcers in patients with intracranial disease
Cushing ulcers
32
- Chronic mucosal inflammation, with lymphoplasmacytic infiltration exanding to lamina propria
- Active: has neutrophils in the glands
- results in mucosal atrophy, intestinal metaplasia, and fibrosis
Chronic Gastritis
33
- autoimmune destruction of gastric parietal cells (acid) in the body and fundus
- decreased acid production
- hypergastrinemia
Autoimmune metaplastic atrophic gastritis
34
- most common form of gastritis (90%)
- antrum is most common site
- hypogastrinemia
- associated with increase in acid production
- DX: urease breath test
Chronic H. pylori gastritis
35
Duodenal: 95% H. pyolori; almost never malignant
Gastric: H. pylori or NSAIDs; can be caused by gastric carcinoma
Peptic ulcer disease
36
- usual site in antrum
- usually small (< 3cm)
- sharply demarcated, "punched out)
- smooth fibrin base
- flat mucosa at the margins, surrounded by radiating folds of mucosa
Benign Peptic ulcers
37
- large and irregular
- heaped up margins, with loss of normal mucosal folds
- shaggy, necrotic base
Malignant Ulcers
38
- malignant proliferation of surface epithelial cells (columnar)
- subclassified into intestinal and diffuse types
Gastric Adenocarcinoma
39
Gross: mucosal central polypoid mass or ulcerative growth
Micro: gland formation
Intestinal type Gastric Adenocarcinoma
40
Gross: submucosal and muscle infiltration (Linitis Plastica)
Micro: invasive, poorly differentiated mucin-containing cells (signet ring cells)
Infiltrative/Diffuse Type Gastric adenocarcinoma
41
- Involves the submucosa and muscle layers
- high density lymphoid infiltrate
- lymphoepithelial lesion: glands invaded and destroyed by lymphocytes
Extranodal Marginal zone B-cell Lymphoma (MALToma)
42
Leiomyoma: rare; involve esophagus
Schwannoma: rare; 1 Schwannoma every 50 gists)
Benign UGI Mesenchymal tumors
43
Malignant UGI mesenchymal tumor
- epicenter in muscularis propria
- white, yellow firm tumor with hemorrhage and cystic degeneration
- derived from intestinal cells of Cajal
- assoc with gain of function mutation in tyrosine kinase c-KIT (CD117)
- Micro: look like spindle cells with elongated nuclei
Gastrointestinal Stromal Tumor
