GIT Path: Intestinal Tumors

Question 1

colon adenocarcinoma can systemically metastasize to _____, _____, _____ and _____

Answer 1

liver, peritoneum, lungs, and bones

Question 2

the sporadic form of MSI cancers is associated with what mutation

Answer 2

methylation of MLH1 promoter

Question 3

serrations intraluminally on histology is indicative of ______

Answer 3

sessile serrated adenoma/polyp

it has a “saw tooth” appearance

Question 4

______ is a precursor lesion fo the MSI pathway colorectal cancer

Answer 4

sessile serrated adenoma

Question 5

_________ pathway for developing colorectal cancer arise from the adenoma-carcinoma sequence

Answer 5

chromosomal instability pathway

Question 6

adenomas are confined to the _______

Answer 6

lamina propria (INTACT MUSCULARIS PROPRIA)

Question 7

describe the accumulation of mutations that can lead to adenomas in the colon (FAP)

Answer 7

• start with an APC gene mutation
• accumulation of β catenin mutation
• accumulate KRAS mutation
• later: p53, telomerase, etc

Question 8

_____ grade neuroendocrine tumors are usually aggressive

Answer 8

high

Question 9

what are two major pathways for developing colon cancer? what is the more common pathway?

Answer 9

• chromosomal instability pathway: APC gene mutations, FAP/Gardner/ Turcot’s
• MSI pathway: defect in DNA mismatch repair genes MLH1 MSH2, most of these are sporadic and the familial form in HNPCC

chromosomal instability pathway is more common

Question 10

If an elderly man patient presents with iron deficiency anemia, what are you thinking?

Answer 10

Iron deficiency anemia in an elderly man is due to GI malignancy unless proven otherwise

Question 11

neuroendocrine tumors can occur in the stomach in what 3 settings?

Answer 11

1. type I: autoimmune gastritis
2. type II: Gastrinoma (rillinger Ellison) in which there is ↑ gastrin secretion
3. Type III: sporadic (more aggressive)

Question 12

PJ polyps (Peutz Jegher) have a germline mutation and are at risk for developing cancers of ______, ____, ___, ___, and ____

Answer 12

pancreas, breast, lung, ovary and uterus

Question 13

histologic patterns that indicate low grade dysplasia as that seen in adenomas

Answer 13

• enlargement of nuclei
• stratification of basal layer
• loss of mucin / goblet cells

Question 14

patients with celiac disease are at risk for what of tumors?

Answer 14

• T cell lymphoma (enteropathy associated including ulcerative jejunitis)

Question 15

CEA is used to monitor ______ carcinoma

Answer 15

colorectal carcinoma

Question 16

the tumor marker for colorectal cancers is ______

Answer 16

CEA

Question 17

what are some features of adenoma with high grade dysplasia

Answer 17

• cribiform glands (fusion of crypts)
• dyspolarity of nuclei

(all of this occurs in the lamina propria)

Question 18

FAP (familial adenomatous polyposis) has associated with a genetic defect in __________

Answer 18

APC gene (5q21)

Question 19

the most common site of primary GI lymphomas is the ____

Answer 19

stomach

Question 20

what are the 3 types of adenomas associated with adenomas and which one has the highest risk to undergo malignant transformation

Answer 20

3 types: tubular, villous, and tubulovillous

villous type has ↑ chance for malignancy

Question 21

what syndromes are associated with FAP (tubular adenomas)

Answer 21

• gardner syndrome: FAP (tubular adenomas) + osteomas, desmoid tumors and epidermal cysts
• Turcot syndrome: tubular adenomas with malignant CNS gliomas (TURcot = TURban)

Question 22

what is the treatment regimen for gastric lymphomas (MALToma)

Answer 22

• eradication of H. pylori with antibiotics
• 90% remission
• high stage and unresponsive cases treated with chemotherapy: ritixumab + chemo

Question 23

how can you tell the difference between juvenile polyp and PJ polyp

Answer 23

• juvenile has cystically dilated crypts
• the crypt in PJ is tightly packed, irregular and has little space for inflammatory infiltrates
• PJ has arborizing SM bundles

Question 24

describe the number and type of adenomas seen in FAP

Answer 24

100+ tubular adenomas and must do a prophylactic total colectomy due to high risk of colorectal cancer

Question 25

what are risk factors for colorectal carcinomas?

Answer 25

- obesity, decreased physical activity | - diet LOW in fiber and rich in animal fat

Question 26

what are the types of colonic polyps?

Answer 26

- hyperplastic - hamartomatous - adenomatous

Question 27

GI neuroendocrine tumors most commonly affects ______ and ______ and can metastasize to _______

Answer 27

small intestine and appendix; liver leading to carcinoid system with wheezing, diarrhea, flushing and ↑ 5HT can lead to right sided heart fibrosis

Question 28

sessile serrated adenomas are lesions seen in the _____ pathway for the cause of colon cancer

Answer 28

- MSI (microsatellite)

Question 29

are adenomas precancerous?

Answer 29

YES; they have low grade dysplasia

Question 30

a 3 year old boy has blood in hi story and has brown black discoloration on his lips, palm and genitals. His father had similar complaints. What is the most likely cause?

Answer 30

PJ polyps because he has the melanotic pigments but also his father has it juvenile usually only found in the rectum

Question 31

invasion into the ________ is indicative of invasive adenocarcinoma instead of high grade dysplasia

Answer 31

submucosa

Question 32

______ will have glands lined by non dysplastic eptihlum rich in goblet cells and have arborizing network of smooth muscle between glands

Answer 32

PJ syndrome (Peutz Jegher)

Question 33

primary gastrointestinal lymphomas person with _____

Answer 33

lymphoma in the GIT with or without continuous lymph nodes and there is NO liver, spleen or bone marrow involvement at the time of diagnosis

Question 34

fibrosis of the _____ side of the heart is associated with neuroendocrine tumors

Answer 34

right side

Question 35

- expanded lamina propria - abundantly cystically dilated glands - can potentially see inflammatory cells the above two are hsitological findings in ______

Answer 35

juvenile polyps

Question 36

what is the main difference between lymphocytic and collagenous colitis?

Answer 36

- thickness of collagenous band that supports the enterocytes: THICK = COLALGENOUS NO collagen band = lymphocytic

Question 37

the most common site of juvenile polyps (hamartomatous polyp) is the ______

Answer 37

rectum