Tumors of the GIT – Pathology seminar – Flashcards
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What types of tissue can form tumors in the GIT?
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Epithelium Mesenchyme Hamopoietic/lymphoid Neuroectodermal Germinal Mixed
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What are the 3 most common tumors of esophagus?
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Leiomyoma - benign Squamous cell carcinoma - malignant Adenocarcinoma - malignant (from Barrets!)
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Name two pseudotumors found in stomach?
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Hyperplastic polyp Fundic gland polyp
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What type of precancerous lesions are common in stomach?
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Intestinal metaplasia Adenomas
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What is the epithelial tumor of the stomach called?
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Adenocarcinoma
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Which other tumors can be found in stomach ?
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Neuroendocrine tumors Mesechymal - leiomyosarcoma, GIST MALToma
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Which geographical areas have a high prevalence for gastric adenocarcinomas?
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Japan, chile, Costa Rica
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What is the most common malignant tumor of the stomach?
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the adenocarcinoma
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What are some risk factors for gastric carcinoma?
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H.pylori infection Nitrosamines (smoked food) Atrophic gastritis, autoimmune gastritis Genetics - E-cadherin mutation
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What classification is used for gastric adenocarcinoma?
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Laurens classification
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What does Laurnes classification take into account?
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Morphology - intestinal type - diffuse type Depth of invasion - early - mucosa/submucosa - advanced - into muscularis propria Macroscopy - way of growing
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What are the macroscopic growth patterns?
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Polypoid adenocarcinoma Flat "Ca. patnaeforme" Ulcerating Diffuse or infiltrating Mucinous
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Common places for stomach cancer to metastasize ??
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Virchows node Hematogenous --> ovary "Kruckenbergs tumor" Cavitary -- > Peritoneal carcinoma
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Where does GIST tumor originate from?
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Cajal cells
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Where is the most common location of GIST?
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60% in stomach
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Two common mutations in GIST?
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c-kit mutation or PDGFRA activating mutation
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What is the common microscopy of the GIST?
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Two types of cells spindle shaped cells Epithelioid cells
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Markers often positive in GIST?
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CD117+ (c-kit) CD34+ Vimentin+
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Are the GIST benign or malignant?
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THey can be both, depending on tumor size and mitotic index
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Which GIST has the best prognosis, gastric or those more distally in GIT?
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The gastric one has better prognosis
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Are the neuroendocrine tumors in GIT benign or malignant?
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They are ALL malignant NET1, NET2, NEC
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How do you decide if a tumor is NET1, NET2 or NEC ?
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Mitotic count (Ki67 index)
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What are the neuroendocrine markers that are positive in these types of tumors?
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Chromogranin Synaptophysin CD57+
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Metastasis to which organ (neuroendocrine tumors) can cause carcinoid syndrome?
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Metastasis to liver --> Flushing, diarrhea, heart failure (Thick pulm. valve --> right heart failure) and bronchoconstriction
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What are some other common places of neuroendocrine tumors (except the GIT) ?
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Bronchus Appendix (most common GIT spot) Rectum (second most common GIT spot) Ileum - often multiple and agressive
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How is the macroscopy of these NET ?
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Submucosal nodules, usually covered by normal mucosa May also be larger tumors The cut surface is white/yellow May cause intestinal obstruction
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how is the microscopy of the NET ?
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Small round cells, forming nests, cords/rosettes Glandlike structures may be seen ncl are oftenr egular, mitoses are rare, salt and pepper cytoplasm "granules"
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How many % of primary gastric carcinomas are lymphomas?
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5%
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What are the two common types of lymphoma in stomach?
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MALToma Diffuse large B-cell lymphoma
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What are some important risk factors for lymphoma in stomach ?
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Chronic inflammation H. pylori infection --> treat the infection, tumor may regress
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What is a lymphoepithelial lesion?
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The neoplastic lymphocytes infiltrate the gastric glands
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3 familiar syndromes causing polyp formation in the small intestine and colon?
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Familial adenomatous polyposis Gardner syndrome Turcot
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What is the difference between a sessile and pedunculated tumor/polyp/adenoma?
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Sessile - no stalk, flat lesion Pedunculated - stalked
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Are all polyps neoplastic?
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No, some are just reactive lesions with any malignant potential
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4 types of polyps:
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1. Adenomatous polyp 2. Hyperplastic polyp 3. Serrated adenomas 4. Non-neoplastic polyp ¤ Juvenile polyp/retention polyp ¤ inflammatory polyp ¤ Lymphoid polyp
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What type of polyps are most common? Macroscopy of it's crypts?
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hyperplastic polyps Sawtooth/star pattern of the crypts
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Are the hyperplastic polyps in any risk of turning malignant?
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no premalignant risk
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Macrscopy of in inflammatory polyp ?
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Cystically dilated glands, and marked inflammatory cells
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What is a hamartomatous polyp?
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An abnormal polypoid growth, of an otherwise normal tissue
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What is Peutz Jeghers polyps?
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A polyp with a complex branching pattern of connective tissue and smooth muscles
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Are adenomatous polyps precancerous?
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Yes
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What is a serrated adenoma? Where are they often found ?
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Is has features of both adenomatous and hyperplastic polyps Usually found in caecum
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What is mutatied in FAP syndrome?
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APC gene AD disease
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What is the clinical picture of FAP ?
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multiple adenomtaous polyps in colon and duodenum 100% chance of malignancy Colectomy as a prophylaxis
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What is Gardner syndrome?
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Adenomatous polyps + fibromatosis, epidermoid cysts, osteoma of jaw
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What is Turcot syndrome?
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Adenomatous polyps + CNS tumors (medulloblastoma, glioblastoma)
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Which cancers do you have increased risk to get, if you have hereditary nonpolyposis colorectal cancer syndrome?
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Colon cancer endometrial cancer gastric carcinoma mutation in DNA mismatch repair
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3 growth patterns of a adenomatous polyp?
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Tubular Villous Tubulovillous
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Which of those 3 growth patterns have the largest risk of malignant transformation?
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Villous
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The tubular adenomatous polyp grows how?
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In a papillary or cribriform pattern
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How does the villous adenomatous polyp look on the surface?
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Like a cauliflower
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what is the adenoma - carcinoma sequence?
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Mutation in APC/beta-catenin starting with one mutation, then accumulation, the cancer is progressing through various increasingly malignant stages
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What are some risks of colorectal adenoma?
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High age, earlier cancer of colon Ulcerative colitis, Crohn's FAP HNPCC Family history of colorectal cancer Diet low in fiber, high in animal fat Increased amount of anaerobic bacteria in intestine
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How is the colorectal adenocarcinoma graded?
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Dukes system A : tumor is only in mucosa ---> D: Distant metastasis
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How is the TNM staging of colorectal carinoma?
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T1 - submucosa T2 - into, but not through muscularis propria T3. into subserosa T4 - penetrates serosa, into other organs
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What cancer can be found in the Upper Middle Lower 1/3 of the anal canal?
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Upper 1/3 : Adenocarcinoma Middle 1/3: Basalioid/cloacogenic Lower 1/3: Squamous cell carcinoma (HPV) and melanoma
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What is mucocele?
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A pseudotumor of the appendix ¤Dilated mucus filled appendix ¤ obstruction - non-neoplasitc ¤ mucinous cystadenoma - neoplastic, but benign
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What can the mucinous cystadenoma develop into?
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Pseudomyxoma peritonei
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Where do we get carcinoid tumors in the intestine?
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In appendix, in the distal part of appendix! Rarely metastasize
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What type of tumors are common for the pancreas?
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Cystic tumors Carcinoma of pancreas
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What is pancreatoblastoma ?
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Tumor of children, malignant
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Where in pancreas do we find the mucinous cystadenomas?
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Body/tail
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Who gets cancers of pancreas?
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60-80 y old, males, jewish - smokers, high fat diet, chronic pancreatitis, DM, genetically predisposed
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Where is it most common to have tumors of pancreas?
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In the head --> body --> tail
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What is Trosseau syndrome?
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Migratory thrombophlebitis sign of pancreatic carcinoma
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What tumor is the most common of the endocrine pancreas? Symptoms?
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Insulinoma --> Hypoglycemia and amyloidosis
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Name the other endocrine pancreas tumors?
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Gastrinoma -- > Zollinger Ellison syndrome Glucagonoma Somatostatinoma --> steathorrhea, DM, ++
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What does MEN 1 consist of?
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Werner syndrome: pancreas, pituitary(prolactinoma) and primary hyperparathyrodism
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What is MEN2A ?
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Pheochromocytoma, medullary carcinoma, parathyroid hyerplasia
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What is MEN 2B ?
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Neuroma Marphanoid habitus Phemochromocytoma Medullary carcinomas
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Histology of neuroendocrine tumors of pancreas ?
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Uniform cells in organoid pattern
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What is focal nodular hyperplasia?
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It looks like cirrhosis Multiple fibrous septa and nodules young women (not ass. with birth controle)
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What is nodular regenerative hyperplasia?
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No fibrosis Small hyperplastic nodules, in an otherwise healthy liver Non-cirrhotic portal HTN
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How do the hamartomas of the liver look like?
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small cystic bile ducts in a fibrous stroma Lined by bile duct epithelium, may even contain bile.
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Name 3 benign tumors of the liver ?
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Hepatic adenoma - women on oral contraceptives - risk of intraabd. bleeding Choleangiogenic adenoma - no bile produced, <1cm, subcapsular Hemangioma - subcapsular, cavernous - bleeding risk!!
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What is the most common malignant tumor of the liver?
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Hepatocellular carcinoma Derived from the hepatocytes
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Some risk factor for hepatocellular carcinomas?
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HBV, HCV Alcoholism Aflatoxins NASH (???) Hemochromatosis, Alpha1antritrypsin deficiency
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Growth patterns of hepatocellular carcinoma?
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Trabecular, pseudoglandular, solid
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Immunohistochemistry of hepatocellular carinoma?
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Hepar + Glypicon 3+ AFP +
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Is there bile produced in cholangiocarcinoma ?
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no
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Two locations of cholangiocarcinoma ?
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Peripheral/extrahepatal --> Klatskin tumor (right+left hepatic duct bifurcation) Intrahepatal
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Who are in great risk of cholangiocarcinoma ?
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Elderly Asians People with liver fluke, thorotrast exposure or fibropolycystic disease or primary sclersoin cholangitis
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What is a hepatoblastoma?
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- Rare tumor in young childhood - can be 25 cm big, circumscribed, necrotic or hemorrhagic - the cells have a epithelial and a mesenchymal appearance Epithelial component : Resemble embryonal cells, small fusiform, have glycogen and fat inside, resembles primitive hepatocytes Mesenchymal elements: conn. tissue, cartilage, osteoid differentiation
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What chemical is cause of angiosarcoma?
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Vinyl chloride
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What is the most common malignancy of liver?
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Metastatic cancer from other places Melanoma, GIT, breast, Lung, pancreas --> weight loss, bleedings, portal HTN
