Term
| Describe the anatomy of a pedunculated polyp vs. sessile |
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Definition
head is the bad part and is attached to the colonic wall through the stalk.
sessile has no stalk and looks like a plaque |
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Term
| Name the two development polyps |
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Definition
juvenile (retention)
hamartomatous (Peutz-Jeghers) |
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Term
| Juvenile polyps - describe histopath and the distribution in the GI tract |
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Definition
Class: Hamartoma
Excess lamina propria
Hardly any muscularis mucosae: a few branching fibers at the base
Distortion: budding, cystic tubules (crypts or pits)
Distribution: colon> small intestine> stomach |
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Term
Genetics of Juvenile Polyposis Syndrome:
which genes are involved, and which mutation confers a high risk of GI, pancreatic, biliary cancers? |
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Definition
~ 20% JPS families have mutations of SMAD4
~ 20% JPS families have mutations of BMPR1A. A few other JPS families have deletions of these genes or deletions of PTEN
Families with SMAD4 mutation have high risk for GI, pancreatic and biliary cancers (maybe 80%) |
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Term
| T/F: Most conditions in which there are multiple GI polyps, regardless of type of polyp, have a high cancer risk which usually involves both GI and non-GI sites. |
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Definition
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Term
| Peutz-Jeghers Polyps histopath, genetics, and distribution in GI tract? |
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Definition
Branched muscularis mucosae, redundant, distorted mucosa, normal or regenerative epithelium
Genetics: mutation of STK11 on 19p
in the syndrome
Distribution: SI > colon and stomach
Very high cancer risk not just GI tumors |
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Term
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Definition
| oral-perioral pigmented spots and inflammatory polyps |
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Term
What's the order in prevalence of colorectal mucosal polyps?
Adenomas: 66%
Peutz-Jeghers
Inflammatory Pseudo
Hyperplastic
Juvenile
Transitional mucosal
Misc, Hybrids, Zits, Newly-named |
|
Definition
1. Adenomas: 66%
2. Hyperplastic: 33%
3. Juvenile: 1%
a hamartoma
4. Transitional mucosal
5. Peutz-Jeghers
6. Inflammatory Pseudo
7. Misc, Hybrids, Zits,
Newly-named |
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Term
|
Definition
Any localized collection of in-situ dysplastic epithelium that is not post-inflammatory.
Its epithelium may closely caricature normal (low-grade dysplasia)
or deviate greatly from normal (high-grade dysplasia) |
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Term
| What are features of dysplastic (adenomatous) epithelium? |
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Definition
cell and nuclear crowding
enlarged, elongated nuclei, increased N:C,
weird architecture |
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Term
| What's the relationship between an adenoma and polyp? |
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Definition
| polp is a protrusion of an adenoma/epithelium |
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Term
| What is the sequence of Adenoma-carcinoma in teh colon? |
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Definition
Low-grade dysplastic epithelium
(adenomatous) is the precursor of
high-grade dysplastic epithelium
and invasive carcinoma
High-grade dysplasia
(carcinomatous epithelium)
is often found in adenomas with
otherwise low-grade dysplasia. |
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Term
| What features put Adenomas at risk to have carcinomatous epithelium (HGD) |
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Definition
large*****
villous architecture***
multiple
carcinoma-associated
flat |
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Term
| When do we call something a CARCINOMA? |
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Definition
when it can metastasize
Normal colonic mucosa has hardly any lymphatics. The lymphatics begin in the upper submucosa.
Invasive adenocarcinoma
(submucosal invasion)
in an adenoma.
Metastasis cannot occur until the neoplastic epithelium reaches the lymphatics, that is, the superficial submucosa |
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Term
|
Definition
At the U of M,
for the colon and rectum:
the diagnosis of “adenocarcinoma”
is limited to dysplastic epithelium
that invades into the submucosa.
The same epithelium confined
to the mucosa is called
“high-grade dysplasia”
The term“carcinoma-in-situ”
is not used for the colon and rectum! |
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Term
| Where do we find low-grade dysplastic adenomatous epithelium? |
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Definition
is frequently found
at the margins of
invasive carcinomas,
especially those that
are small
have compulsively
sampled margins |
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Term
|
Definition
Removal of gross polypoid
(adenomatous) rectal tissue
decreased the incidence of
rectal carcinomas by 85%.
Especially important in FAP where cancer risk is 100% so this requires COLECTOMY! |
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Term
| Colonic carcinogenesis sequence of mutations based on SIZE |
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Definition
Epithelium: FAP (5q deletion), First factor, Kras mutation
Small adenoma: second factor (Bacteria bile acid metabolity), DCC (18q deletion)
Large Adenoma: Third factor (ubiquitous), p53 (17p deletion)
===> CARCINOMA! |
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Term
| Hyperplastic colonic crypt serrated architecture and migration features of cells |
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Definition
You have EARLY maturation in the base of the crypt…
Cellular crowding > serrated lumens
Metaplasia to absorptive cells
Delayed loss of the cells at the surface so there is a communication gap between the surface and base.
Slower migration meaning they are hypermature. Slow migration => piling up on crypts leading to the serrated architecture! |
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Term
| Hyperplastic Polyps (serrated) features: age, location, link to carcinoma?, causes? |
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Definition
HPs increase with age
HPs more often distal
HPs have no direct link to carcinoma
some serrated polyps have a cancer link similar to that of typical adenomas
there are serrated polyps that are adenomas
HPs cause unknown
hyperplastic mucosa is sometimes
a type of regeneration or reaction to injury |
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Term
| Hyperplastic polyps vs Carcinoma-associated serrated polyps |
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Definition
| Carcinoma ass-serrated polyps are larger, right-sided, and architecturally complex |
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Term
| T/F: the serrated pathway to colorectal carcinoma involves deletions in the APC gene |
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Definition
| False: The serrated pathway to colorectal carcinoma is different from the typical pathway which involves deletions in the APC gene. The serrated pathway leads to carcinomas that are microsatellite unstable. |
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Term
| Is it worth doing esophageal squamous cancer screenings or colon cancer screenings in Crohn's...at a mass scale? |
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Definition
| No but you should keep an index of suspicion even though these are rare. |
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Term
| What cancer results from GERD in white men? |
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Definition
| Barret's adenocarcinoma mucosa - reflux-induced columnar metaplasia |
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Term
| You suspect a patient has a gastric cancer such as a tubular or signet ring cell adenocarcinoma. What is the cause of this? |
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Definition
H. Pylori/atrophic gastritis...
has declined in West (US) but high in other parts of the world (Asia)
Population at risk:
Far East, South America, pockets
Risk factors: H pylori, atrophic gastritis
Technic: endoscopy & biopsy; cytology
End-point: high-grade dysplasia |
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Term
| Causes of hepatocellular carcinoma |
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Definition
Hepatitis B only 12 (13%)
Hepatitis C only 39 (43%)
Hepatitis B + C 14 (15%)
Total 65% of px have either condition detected in serum/liver but NOT in the tumor... |
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Term
| Is there a benefit of hepatoma surveillance? |
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Definition
| No cost is way too high for each yr of life saved |
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Term
| Pancreas cancer - is it deadly? |
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Definition
yes, 3% incidence but 6% deaths
Kras mutation...and forms ducts... |
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