Pathology Notes

Practice question answers B Stomach pathology Updated: 03/08/2019 © Jun Wang, MD, PhD 1. D. Ulcer with indurated edge is likely tumor. Microscopic findings of irregular glands with cytological atypia (for this case, dark nuclei with various shape and size) is intestinal type adenocarcinoma . Curling ulcer occurs in patients with severe burn or trauma. Cushing ulcer is defined as esophageal, gastric and duodenal ulcers associated with intracranial disease. Diffuse type adenocarcinoma does not have discrete mass or ulcer, but has signet ring cells. Peptic ulcer has sharp edge without induration or atypical glands. 2. C. Risk factors for intestinal type adenocarcinoma include autoimmune gastritis , helicobacter gastritis , pickled vegetables, cigarette smoking, etc. For this patient, the only thing relevant is helicobacter gastritis . Coronary bypass, diabetes and hypertension are not known risk factors for stomach cancer. 3. A. Helicobacter promotes translocation

Practice question answers A Stomach pathology Updated: 03/08/2019 © Jun Wang, MD, PhD 1. A. The patient has acute onset of symptoms. Biopsy only reveals scattered neutrophilic infiltrate without any signs of chronic inflammation, such as lymphoplasmacytic infiltrate and stromal proliferation. This is consistent with acute gastritis . Autoimmune gastritis , although as suggestive by anemia found in this patient, has diffuse lymphoplasmacytic infiltration, intestinal metaplasia and glandular atrophy. Helicobacter gastritis has lymphoplasmacytic infiltration, neutrophilic infiltration and glandular atrophy and helicobacter identified by special stains. Curling ulcer occurs in patients with severe burn or trauma. Peptic ulcer has mucosa ulceration and is usually associated with helicobacter. 2. D. The history of NSAID usage is probably the cause of her acute gastritis . NSAID inhibit COX-1 and COX-2, resulting reduced protection of gastric mucosa. Autoantibody against intri

Practice questions B Stomach pathology Updated: 03/01/2019 © Jun Wang, MD, PhD 1. Use this case and this image for the next 4 questions . A 69-year-old man presents with intermittent epigastric discomfort for 4 weeks. He has a history of coronary heart disease and received bypass grafting 5 years ago. His past medical history also include diabetes, hypertension, and helicobacter gastritis. Physical examination, laboratory tests and complete cardiac tests are unremarkable. Gastroscopy examination reveals a 1.5 cm ulcer at the antrum. The ulcer has a raised irregular edge. Image of the ulcer biopsy is shown. What is the diagnosis? (Image credit: Kwz~commonswiki) A. Curling ulcer B. Cushing ulcer C. Diffuse type adenocarcinoma D. Intestinal type adenocarcinoma E. Peptic ulcer 2. A 69-year-old man presents with intermittent epigastric discomfort for 4 weeks. He has a history of coronary heart disease and received bypass grafting 5 years ago. His past med

Practice questions A Stomach pathology Updated: 03/01/2019 © Jun Wang,MD, PhD 1. Use this case for the next two questions . A 35-year-old woman presents with sudden onset of epigastric pain and hematemesis for 2 hours. She does not have fever or sweating. She has had severe headache two days ago and has been taking Ibuprofen since then. Her past medical history is unremarkable. Physical examination reveals a blood pressure of 95/55 mmHg, heart rate of 120 bpm, and her skin appears to be pale. Laboratory tests reveal a hemoglobin of 10.5 g/dl (normal 12-16 g/dl). No other abnormalities are noted. Gastroscopy exam reveals diffuse erythematous changes of gastric mucosa, with a few shallow ulcers. Biopsy reveal benign fundic type gastric mucosa with scattered neutrophilic infiltrate. No significant lymphoplasmacytic infiltrate nor glandular atrophy are noted. Silver stain reveals no evidence of bacteria. What is the diagnosis? A. Acute gastritis B. Chronic gastritis, type A