Practice question answers, intestinal tumors B
Practice question answers, intestinal tumors B
© Jun Wang, MD, PhD
1. D. Tubular
adenoma has tubular glands lined by columnar cells with elongated
hyperchromic nuclei. Hyperplastic
polyp has star-shaped lumen and no adenomatous changes (elongated
hyperchromic nuclei) or significant atypia. Intramucosal
adenocarcinoma is an adenocarcinoma limited to mucosa only, and has
irregular glands lined by atypical cells. Sessile
serrated adenoma has features of both hyperplastic
polyp and adenomatous
polyp. Villous
adenoma is an adenomatous polyp with more than 75% of villous components.
2. A. Numerous polyps with adenomatous changes, and
family history of early onset colon cancers is highly compatible with familial
adenomatous polyposis. Gardner
syndrome is a type of familial
adenomatous polyposis, with additional manifestations including
fibromatosis, osteomas, epidermal cysts, etc. Juvenile polyposis is
characterized by multiple organ involvement of juvenile
polyp, that has cystic dilation and inflammation. Lynch
syndrome is caused by MSI gene mutation and presents with carcinomas of breast,
endometrium,
ovary,
upper urinary tract and intestine including colon,
etc., but not polyposis. Peutz-Jegher
syndrome has cutaneous and mucosal macules, and/or family history and
multiple Peutz-Jeghers
polyps characterized by thick branching bands of smooth muscle forming a
Christmas tree pattern.
3. A. APC mutation is seen in familial
adenomatous polyposis. C-kit mutation is seen in gastrointestinal
stromal tumor. MSI mutation is seen in Lynch
syndrome, sessile
serrated adenoma and certain colon
cancers. SMAD4 mutation is seen in juvenile
polyposis, certain colon
and pancreatic adenocarcinomas. STK11 mutation is associated with Peutz-Jegher
syndrome.
4. A. APC mutation is associated with beta-catenin
degradation failure and subsequent nuclear translocation of active beta-catenin
that promotes transcription. DNA mismatch repair is seen in MSI mutation
associated colon
cancers and Lynch
syndrome. Abnormal p53 degradation is seen in various cancers, especially
high grade malignancies. Rb1 inactivation can be seen in HPV associated malignancies,
including cervical
and oral
cavity cancers. Telomerase activation can be seen in various neoplasms,
including nasopharyngeal
carcinoma and cervical
cancers.
5. C. History of osteoma and current presentation of
mesentery fibroma are suggestive of Gardner
syndrome, a type of familial
adenomatous polyposis. Bone marrow biopsy, flow cytometry of peripheral
blood and iron analysis are for hematopoietic disorders including anemia and
leukemia. Chest CT is indicated when intrathoracic disorders are in concerns.
None of these will detect colon polyps/neoplasms.
6. D. Tubular
adenoma has tubular glands lined by columnar cells with elongated
hyperchromic nuclei. Hyperplastic
polyp has star-shaped lumen and no adenomatous changes (elongated
hyperchromic nuclei) or significant atypia. Intramucosal
adenocarcinoma is an adenocarcinoma limited to mucosa only, and has
irregular glands lined by atypical cells. Peutz-Jeghers
polyps are characterized by thick branching bands of smooth muscle forming
a Christmas tree pattern.
Villous
adenoma is an adenomatous polyp with more than 75% of villous components.
7. A. Gardner
syndrome is a type of familial
adenomatous polyposis, with additional manifestations including
fibromatosis, osteomas, epidermal cysts, etc. Inflammatory bowel diseases have relevant
history and commonly have inflammatory
polyps characterized by severe acute and chronic inflammation and lack of
significant atypia. Juvenile polyposis is characterized by multiple organ
involvement of juvenile
polyp, that has cystic dilation and inflammation. Lynch
syndrome is caused by MSI gene mutation and presents with carcinomas of breast,
endometrium,
ovary,
upper urinary tract and intestine including colon,
etc., but not polyposis. Peutz-Jegher
syndrome has cutaneous and mucosal macules, and/or family history and
multiple Peutz-Jeghers
polyps characterized by thick branching bands of smooth muscle forming a
Christmas tree pattern.
8. A. See discussion of question 3.
9. C. Adenocarcinoma
has irregular glands lined by atypical cells. Endometrioid
adenocarcinoma frequently has squamous metaplasia. In addition, rectal
metastasis of endometrioid adenocarcinoma is rare. Peutz-Jeghers
polyp is characterized by thick branching bands of smooth muscle forming a
Christmas tree pattern. Tubular
adenoma has tubular glands lined by columnar cells with elongated
hyperchromic nuclei. Villous
adenoma is an adenomatous polyp with more than 75% of villous components.
10. C. Primary colorectal
carcinoma in a patient with history of endometrioid
adenocarcinoma is suggestive of Lynch
syndrome, with MSI mutations, especially in a patient younger than 50 and
have history of associated tumors. APC mutation is seen in familial
adenomatous polyposis, and various colorectal
carcinomas. BRCA mutations are associated with various malignancies,
especially those of breast
and endometrium,
but less likely colorectal
carcinoma. SMAD4 mutation is seen in juvenile
polyposis, certain colon
and pancreatic adenocarcinomas. STK11 mutation is associated with Peutz-Jegher
syndrome.
11. D. Lynch
syndrome is caused by MSI gene mutation and presents with carcinomas of breast,
endometrium,
ovary,
upper urinary tract and intestine including colon,
etc., but not polyposis. Cowden syndrome is associated with PTEN mutation, and
usually have hamartomatous or inflammatory
polyps without a significantly increased risk for GI tract malignancy. Gardner
syndrome is a type of familial
adenomatous polyposis, with additional manifestations including
fibromatosis, osteomas, epidermal cysts, etc. Juvenile polyposis is
characterized by multiple organ involvement of juvenile
polyp, that has cystic dilation and inflammation. Peutz-Jegher
syndrome has cutaneous and mucosal macules, and/or family history and
multiple Peutz-Jeghers
polyps characterized by thick branching bands of smooth muscle forming a
Christmas tree pattern.
12. B. See discussion of question 4.
13. C. Mucinous
adenocarcinoma is characterized by abundant mucin production (mucin pools)
and less than 50% of the tumor cells are signet ring cells. Juvenile
polyp has cystic dilation and inflammation. Squamous cell carcinoma has
squamous differentiation with intercellular
bridges and/or squamous pearls. Tubular
adenoma has tubular glands lined by columnar cells with elongated
hyperchromic nuclei. Villous
adenoma is an adenomatous polyp with more than 75% of villous components.
14. B. This patient has iron deficiency anemia. In
older population, iron
deficiency anemia often is caused by gastrointestinal bleeding and requires
further investigation, especially
when GI bleeding is confirmed by positive fecal occult blood test. Bone marrow
biopsy, flow cytometry of peripheral blood and iron analysis are for
hematopoietic disorders including anemia and leukemia. Folate supplementation
is for megaloblastic anemia caused by folate deficiency. Iron supplementation
may be used, but this patient need to identify the cause of GI bleed, that is
subsequently causing anemia. Flow cytometry may be used for leukocyte
phenotyping to detect neoplasms, etc, but there is no relevant evidence in this
patient.
15. E. Signet
ring adenocarcinoma is diagnosed when more than 50% of tumor cells have
signet ring appearance. Adenocarcinoma,
NOS has irregular glands lined by atypical cells. Carcinoid
usually has nested or trabecular pattern and round nuclei with “salt and pepper”
pattern chromatin. Hyperplastic
polyp has star-shaped lumen and no adenomatous changes (elongated hyperchromic
nuclei) or significant atypia. Pulmonary
adenocarcinoma is usually positive for TTF-1.
16. A. Adenocarcinoma,
NOS has irregular glands lined by atypical cells. Hyperplastic
polyp has star-shaped lumen and no adenomatous changes (elongated hyperchromic
nuclei) or significant atypia. Inflammatory
polyp is characterized by severe acute and chronic inflammation, lack of
significant atypia and a history of chronic inflammation such as inflammatory bowel
disease. Juvenile
polyp has cystic dilation and inflammation. Mucinous
adenocarcinoma is characterized by abundant mucin production (mucin pools)
and less than 50% of the tumor cells are signet ring cells.
17. E. This is a basaloid
squamous cell carcinoma, characterized by irregular sheets of tumor cells
with scant to moderate amount cytoplasm. Condyloma has koilocytes
but not invasion. Melanoma is positive for S100 and HMB45. Small
cell carcinoma, regardless of the location, is positive for neuroendocrine
markers, such as chromogranin. Chronic
lymphocytic leukemia/Small lymphocytic lymphoma is positive for pan
leukocyte marker CD45, and B cell marker CD20.
18. D. Anal
canal squamous cell carcinoma is likely to be associated with HPV, similar
to cervical
cancers. EBV is associated with various tumors, including nasopharyngeal
carcinoma and certain lymphomas, such as Hodgkin
lymphoma, and primary
effusion lymphoma, and non-neoplastic conditions, such as infectious
mononucleosis and hairy
leukoplakia. HHV 2 is commonly associated with genital
herpes. HIV is associated with immunocompromised status, but unlikely
associated with neoplasms. Treponema pallidum causes syphilis.
19. B. Carcinoid
usually has nested or trabecular pattern and round nuclei with “salt and pepper”
pattern chromatin. Adenocarcinoma
has irregular glands lined by atypical cells. Chronic appendicitis has chronic inflammation
but not infiltrating type cords of epithelial cells. Endometriosis
has benign endometrial glands and stroma, as well as hemorrhagic changes. Small
cell carcinoma, regardless of the location, has sheets of crowded cells
with scant cytoplasm and is positive for neuroendocrine markers, such as
chromogranin.
20. E. Gelatinous material is usually suggestive of
mucinous lesions. When it is seen involving peritoneum, commonly caused by
mucinous neoplasms of appendix or ovary,
it is diagnosed as pseudomyxoma
peritonei. Carcinoid
usually has nested or trabecular pattern and round nuclei with “salt and pepper”
pattern chromatin, but not mucin production. Mucinous
adenocarcinoma is characterized by abundant mucin production (mucin pools)
and less than 50% of the tumor cells are signet ring cells, and cytological
atypia. Ovarian
borderline mucinous neoplasm has atypia, with or without invasion. Peritoneal
carcinomatosis usually has similar morphology as serous
carcinoma.
Back to intestinal
tumors
Back to contents
Comments
Post a Comment