Week 5: Stomach

Question 1

ID

Answer 1

Chronic Gastritis

Helicobacter pylori infection (yellow arrow). Neutrophils (cyan arrows) and plasma cells (orange arrows - eccentric nuclei and a hard to tell whitening for the ER) indicating an immune response.

Question 2

ID

Answer 2

Helicobacter pylori infection

Positive immunohistochemistry (IHC) stain for H. pylori in brown (yellow arrows)

Question 3

ID

Answer 3

Helicobacter pylori infection

Positive Giemsa stain for H. pylori (yellow arrows) showing the ‘gull-shaped’ bacteria

Question 4

H. pylori infections cause what?

Answer 4

• Gastric atrophy
• Gastric/Duodenal ulcers
• Risk for gastric adenocarcinoma and MALT lymphoma

Question 5

ID

Answer 5

Helicobacter pylori infection

Question 6

Answer 6

Question 7

Answer 7

Question 8

ID

Answer 8

Autoimmune Gastritis

Progressive loss of oxyntic (body) mucosa (less light pink parietal cells in mucsoa layer) and sometimes presents with lymphoid aggregates (dark purple grouping)

Question 9

ID

Answer 9

Diffuse Type Gastric Cancer (Adenocarcinoma)

Linitus Plastica - abnormally thickened gastric folds and reduced gastric distension

Question 10

ID

Answer 10

Intestinal Type Gastric Cancer (Adenocarcinoma)

Question 11

ID

Answer 11

Diffuse Type Gastric Cancer (Adenocarcinoma)

Numerous signet ring cells present

Question 12

What is the genetics of diffuse type gastric cancer?

Answer 12

mutation in the CDH1 or CTNNA1 gene

Question 13

ID

Answer 13

Intestinal Type Adenocarcinoma

Cribriform architecture (orange elipse)

Question 14

ID this histological patterning shown here

Answer 14

Cribriform Architecture (black circle)

Question 15

ID

Answer 15

Intestinal type adenocarcinoma

HER2 IHC + showing cribriform architecture (orange circle)

Question 16

ID

Answer 16

MALT Lymphoma

lymphocytes (yellow arrows) invade the mucosa. Based on the clinical condition, we can identify the cells as B-cells, but histologically we can not distinguish B/T-cells.

Question 17

What can a MALT Lymphoma transform into?

Answer 17

Diffuse Large B-Cell Lymphoma (DL BCL)

Question 18

What translocation is a MALT Lymphoma?

Answer 18

t(11;18)

11 - Cyclin Dependent Kinase 1 (CDK1)
18 - anti-apoptotic BCL-2

Question 19

What is the treatment for MALT Lymphoma

Answer 19

Antibiotics for H. pylori

Question 20

ID

Answer 20

Diffuse Large B-Cell Lymphoma (DL BCL)

Question 21

Most common mesenchymal tumor of the gut

Answer 21

Gastrointestinal Stromal Tumor (GIST)

Question 22

What cells do a Gastrointestinal Stromal Tumor (GIST) arise from?

Answer 22

Intestinal Cells of Cajal

Question 23

What sublayer of the Mucosa are Intestinal cells of Cajal located?

Answer 23

Muscularis Mucosae

Question 24

What 4 other conditions is Gastrointestinal Stromal Tumor (GIST) associated with?

Answer 24

Carney Triad and NF-1

Question 25

What is the genetics of Gastrointestinal Stromal Tumor (GIST)

Answer 25

Activation mutation in KIT or PDGFRA

Question 26

What is treatment for Gastrointestinal Stromal Tumor (GIST)

Answer 26

Imatinib (tyrosine kinase inhibitor)

Question 27

ID

Answer 27

Gastrointestinal Stromal Tumor (GIST)

Question 28

ID ## Footnote Cells in

Answer 28

Gastrointestinal Stromal Tumor (GIST)

Question 29

ID

Answer 29

Gastrointestinal Stromal Tumor (GIST) ## Footnote C-KIT positive Immunohistochemistry (IHC)

Question 30

ID

Answer 30

Fundic Gland Polyp

Question 31

Does a fundic gland polyp have dysplasia and can it metastasize?

Answer 31

No and No

Question 32

What are common associated conditions of a fundic gland polyp?

Answer 32

* Protein Pump Inhibitor (PPI) * Familial Adenomatous Polyposis (FAP) ## Footnote Its "fun"dic to FAP and Pump

Question 33

ID

Answer 33

Hyperplastic Polyp

Question 34

Does a hyperplastic polyp have dysplasia and can it metastasize?

Answer 34

No and No

Question 35

What are common associated conditions of a hyperplasticity polyp?

Answer 35

* Reactive Gastropathy * Infection * Gastritis ## Footnote RIG

Question 36

ID

Answer 36

Adenoma

Question 37

Does an adenoma have dysplasia and can it metastasize?

Answer 37

Yes and No

Question 38

What are common associated conditions of an adenoma?

Answer 38

* *Helicobacter pylori* * Familial Adenomatous Polyposis (FAP) * Lynch Syndrome

Question 39

ID

Answer 39

Carcinoid Tumor

Question 40

Does a carcinoid tumor have dysplasia and can it metastasize?

Answer 40

No and Yes

Question 41

What are common associated conditions of a carcinoid tumor

Answer 41

* MEN-1 * Autoimmune Gastritis

Question 42

ID

Answer 42

Zollinger-Ellison Syndrome ## Footnote Increased gastrin causes an increase in oxyntic glands (i.e. parietal cells that secrete HCl) so you have hyperchloria. Leads to severe GERD and ulcers.

Question 43

Zollinger-Ellison Syndrome is associated with what endocrinopathy

Answer 43

MEN-1

Question 44

ID

Answer 44

Menetrier's ## Footnote Foveolae enlarge and decreased oxyntic glands (i.e. parietal cells that secrete HCl) so you have achloria and possible B12 deficiency if chronic

Question 45

ID

Answer 45

Curling's ulcer

Question 46

ID

Answer 46

Cushing's ulcer

Question 47

What causes a Curling's ulcer?

Answer 47

physiologic stress (such as 30%+ body burns)

Question 48

What is the cause of Cushing's ulcer?

Answer 48

brain lesions (increased vagal stimulation, hyperchloria)

Question 49

ID

Answer 49

Peptic/Gastric ulcer

Question 50

**What feature present on an ulcer can be indicative of adenocarcinoma?**

Answer 50

Raised ulcer edges ## Footnote Looks like a meteor crater

Question 51

ID

Answer 51

Reactive Gastropathy

Question 52

ID

Answer 52

Gastric Adenocarcinoma