Path: esophageal and gastric neoplasms

What is a complication of GERD that is most common in white males age 40-60?

Barrett esophagus

what is characterized by intestinal metaplasia within esophageal squamous mucosa?

Barrett esophagus

with Barrett esophagus, an increase in dysplasia (high grade dysplasia) is associated with ____

increased risk of carcinoma

What is this?

we see patches of red, velvety mucosa extending from the GE junction (metaplastic mucosa) that alternates with smooth, pale, squamous mucosa

Barrett esophagus

what is this?

micro: intestinal-type metaplasia replacing squamous esophageal epithelium with goblet cells

Barrett esophagus

What type of carcinoma is associated with. arises from Barrett’s esophagus?

esophageal adenocarcinoma

some serotypes of Helicobacter are associated with decreased risk of ____ because they cause gastric atrophy which causes reduced acid production and reflux

esophageal adenocarcinoma

What is this?

pt can have pain, difficulty swallowing, weight loss, hematemesis, etc. and these are usually large masses of 5cm+ that may infiltrate diffusely, ulcerate, and invade deeply

esophageal adenocarcinoma

What is this? what hormone is most commonly produced?

salt and pepper chromatin

neuroendocrine tumor → histamine

what is this?

micro: tumors produce mucin and form glands often with intestinal-type morphology

esophageal adenocarcinoma

What is this?

usually 45+yrs old, males more then females, and african-americans more then caucasians

esophageal SCC

What is this?

risk factors: alcohol, tobacco, poverty, caustic esophageal injury (lye), achalasia, plummer-vinson syndrome, diet deficient in fruits and veggies, and consumption of very hot beverages

esophageal SCC

What is this?

associated with abnormalities in transcription factor gene SOX2

esophageal SCC

esophageal cancer staging: what is the T and the N

T: depth of invasion into walls

N: lymph node involvement

What subtype of gastric polyps are associated with cancer and must be resected?

adenomas

What is this?

sporadic or germ line mutations in APC gene or MUTYH

fundic gland polyp (type of gastric polyp)

what has increased because of increased use of proton pump inhibitors?

fundic gland polyps (type of gastric polyp)

What is this?

cystically dilated, irregular glands lined by parietal, chief, and foveolar mucus cells, and chief cells with very little or absent inflammation

fundic gland polyps (type of gastric polyp)

What is this?

premalignant neoplastic lesion; usually in the antrum

gastric adenoma

overall incidence of ___ is down in the US (due to decreased H pylori) but ____ is increasing because of barretts esophagus

decreased: gastric adenocarcinoma

increased: cancer of gastric cardia

what is associated with loss of function mutations in CDH1

gastric adenocarcinoma

where are gastric adenocarcinomas mostly located?

on lesser curvature, antrum

What type of gastric adenocarcinoma?

neoplastic cells contain apical mucin vacuoles

intestinal type

What type of gastric adenocarcinoma?

no or poorly formed glands composed of signet ring cells or linitis plastica

diffuse type

What is this?

leather bottle appearance of stomach → thickened wall of stomach

linitis plastica (type of diffuse gastric adenocarcinoma)

what are the 2 most important prognostic indicators of gastric adenocarcinomas?

depth of invasion and extent of lymph node involvement

What are these associated with?

left supraclavicular adenopathy (Virchow’s nodule), Krukenberg tumor, Blumer’s shelf, acanthosis nigricans, and sister mary joseph nodules

gastric carcinomas

If we see a stomach cancer, what is it most likely?

adenocarcinoma

How do we treat a MALToma?

H pylori eradication

what is this?

dense lymphocytic infiltrate in lamina propria; lymphocytes infiltrate the glands to create lymphoepithelial lesions

gastric MALToma

what is this?

CD19 and CD20 positive, CD5 and CD10 negative, and CD43 positive

gastric MALToma

what is derived from enterochromaffin like cells in the stomach?

neuroendocrine tumor

what is this?

histo: salt and pepper nucleus ( + for synaptophysin and chromogranin A)

neuroendocrine tumor

What arises from interstitial cells of Cajal (intestinal pacemaker cells for gut peristalsis)?

GI stromal tumors

What can be seen with Carney triad? (young woman)

GI stromal tumors

What is this?

IHC for c-KIT (aka CD117) usually positive

GI stromal tumors

What is associated with KIT or PDGFRA mutations?

GI stromal tumors

with GI stromal tumors, mutations in KIT or PDGFRA ____

respond to imatinib (a tyrosine kinase inhib)

*if the mutations are secondary/after tx then it can cause resistance)

What is this?

rare excessive secretion of TGF alpha and hyperactivation of EGF receptor

menetrier disease

What is this?

diffuse hyperplasia of foveolar epithelium, hypoproteinemia due to albumin loss, weight loss, peripheral edema, irregular enlargement of gastric rugae

menetrier disease

what is this?

histo: hyperplasia of foveolar mucous cells with elongated glands showing a corkscrew like appearance and cystic dilation

menetrier disease

what is this?

caused by gastrinoma

Zollinger-Ellison syndrome

what is this?

duodenal ulcers or chronic diarrhea, 5x increase in parietal cells (mucosal thickness), mucin hyperproduction, ad proliferation of endocrine cells

Zollinger-Ellison syndrome