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85 Cards in this Set
- Front
- Back
What do mucuous cells in the stomach secrete?
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Mucous
Pepsinogen II = converted to Pepsin by HCl |
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What kind of epithelium lines the stomach?
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Cuboidal glandular
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What do Parietal Cells of the stomach secrete?
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HCl
Intrinsic Factor |
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What do Chief Cells of the stomach secrete?
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Pepsinogen I and II
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What do the Endocrine cells of the stomach secrete?
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Peptide hormones
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Fill in the blanks
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-
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What is the function of Gastrin?
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Stimulates Parietal Cells to produce HCl
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1. Surface epithelial cell
2. Mucous cell 3. Parietal cell between a mucous cell and Chief cell 4. Chief cell 5. Muscularis Mucosa 6. Submucosa |
Label
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1. Surface epithelial cell
2. Mucous cell 3. Solitary Lymph node 4. Endocrine cell 5. Muscularis mucosa 6. Submucosa |
Labe these cells in the Antrum
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What is the frequency of Pyloric Stenosis?
What is the gender dominance? |
1:600 newborns
M:F = 4:1 |
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What is the pathology in Pyloric Stenosis?
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Hypertrophy of the pyloric sphincter muscle
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What are the clinical findings in Pyloric Stenosis?
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- Projectile vomiting of baby at 1-2 weeks of age***
- palpable abdominal "olive" ***TE fistula occurs earlier |
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What syndromes is Pyloric Stenosis associated with?
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Turner (XO) and Edwards (trisomy 18)
**also with Polyhydramnios |
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What is the therapy for Pyloric Stenosis?
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Surgical incision into the muscle
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How does Acute Erosive Gastritis clinically present?
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Epigastric burning, pain, nausea, and vomiting
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What are the causes of Acute Erosive Gastritis?
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1. Aspirin and NSAIDs
2. Alcohol 3. Cytostatic drugs 4. Shock 5. Sepsis 6. Stress 7. indwelling nasogastric tubes |
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Acute inflammation, erosion, and hemorrhage of the gastric mucosa due to a breakdown of the mucosal barrier and acid-induced injury
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Acute Erosive Gastritis
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Multiple mucosal erosions and ulcers that develop as a consequence of stress
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Stress ulcers
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What are possible causes of Stress Ulcers?
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1. Trauma, sepsis, surgery
2. Burns (Curling ulcers) 3. Brain trauma (Cushing ulcers) |
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Chronic inflammation of the gastric mucosa eventually leading to atrophy or intestinal metaplasia
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Chronic Gastritis
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What percent of the elderly have Chronic Gastritis?
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>50%
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Which type of Chronic Gastritis occurs more often?
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H. pylori >>> Autoimmune
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Describe the pathology of Chronic Gastritis
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Chronic inflammation of mucosa + Lymphoid follicles -> Atrophy of glands -> Intestinal metaplasia
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What is Chronic Type A Gastritis caused by?
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Autoimmunity = auto-ab's to Parietal Cells and/or Intrinsic Factor
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What part of the Stomach does Chronic Type A Gastritis affect?
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Body and Fundus
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What part of the stomach does Type B Chronic Gastritis typically affect?
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Antrum and Pylorus
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What are the clinical findings (Lab) of Type A Chronic Gastritis?
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1. Pernicious Anemia = megaloblastic anemia due to lack of intrinsic factor and B12 absorption
2. Achlorohydria = decreased acid secretion 3. Hypergastrinemia = due to loss of negative feedback |
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Which Chronic Gastritis' are diffuse and which are focal?
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Diffuse = Type A
Focal = Type B |
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What is Type B Chronic Gastritis most commonly due to?
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H. pylori
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What are the major properties of H. pylori?
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Gram -, curved rod
produces urease |
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T or F: H. pylori is invasive
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False: it is NOT invasive, it affects ells indirectly by releasing Vacuolating toxin and releasing enzymes
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What are the 3 histologic characteristics of Chronic Gastritis?
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1. Atrophy of gastric glands
2. Intestinal Metaplasia = goblet cells and paneth cells from intestine in the stomach 3. Lymphocytic follicles in the atrophic mucosa |
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What 4 diseases are related to H. pylori?
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1. Chronic Atrophic Gastritis
2. Duodonal and Gastric Peptic Ulcers 3. Gastric Adenocarcinoma 4. Gastric MALT lymphoma |
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Breach in the mucosa with extension into the submucosa or deeper
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Ulcer
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Breach in the epithelium of the mucosa
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Erosion
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Ulcers of the distal stomach and proximal duodenum caused by gastric secretions (HCl and Pepsin) and impaired mucosal defenses
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Peptic ulcer
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Which form of Chronic Gastritis is associated with a higher risk of cancer?
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-Type A gastritis is associated with a higher risk of gastric adenocarcinoma
- However, Type B is much more prevalent so it is thought to cause many more cancers |
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What is the lifetime risk of Peptic Ulcers in the US?
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10%
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List the 4 layers in sequence noted histologic sections of Peptic Ulcers
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1. Necrotic debris
2. Inflammation with predominance of neutrophils 3. Granulation tissue (repair tissue) 4. Fibrosis |
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What is the gross appearance of Peptic Ulcers?
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- small, solitary ulcers
- round or oval shape - sharply demarcated, "punched-out" ulcers -overhanging margins -radiating mucosal folds |
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What are the common complications of Peptic Ulcers?
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1. Hemorrhage -> melena, iron deficiency anemia, hematemesis
2. Perforation -> peritonitis, paralytic ileus 3. Stenosis and obstruction 4. Penetration -> into pancreas -> dull pain, elevated serum amylase |
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Peptic Ulcers: What is Perforation associated with causing and what may be seen in an X-ray?
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- Peritonitis and Paralytic Ileus
- Air under the diaphragm |
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Describe Penetration into the Pancreas caused by Peptic Ulcers
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-Complication of posterior wall duodenal ulcers
- accompanied by dull pain and elevated serum Amylase |
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Where are Gastric Ulcers most often located?
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Lesser curvature of the Antrum
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Where are Duodenal Ulcers most commonly located?
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Proximal area just beyond the Pylorus
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What is Zollinger-Ellison Syndrome?
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Malignant Pancreatic Isle cells tumors
- secrete excess Gastrin = Hyperacidity = multiple intractable peptic ulcers - can cause Peptic Ulceration |
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What neoplasia is Zollinger-Ellison Syndrome associated with?
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Multiple Endocrine Neoplasia I (MEN I)
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What is the gross appearance of Menetrier Disease?
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Enlarged (giant) rugal folds in the body and fundus
-sparing of the antrum |
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What happens microscopically in Menetrier Disease?
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massive foveolar (mucus cells) hyperplasia with replacement of the Parietal and Chief Cells
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What is there a decreased production of in Menetrier disease?
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Acid
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What enteropathy does Meneterier disease cause?
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Protein-losing enteropathy = due to no pepsin from Chief cells
*also giant rugal folds |
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What is another name for Menetrier's Disease?
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Hypertrophic Gastrophy
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What are 3 benign Gastric Tumors?
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1. Hyperplastic Polyp (most common)
2. Fundic gland polyp 3. Adenomatous polyp |
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List the 3 Malignant tumors of the stomach
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1. Adenocarcinoma
2. Lymphoma 3. Carcinoid |
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What is the significance of Stomach Malignant Lymphomas?
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they are the most common site for "extra-nodal" malignant lymphomas
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In what countries is Gastric Carcinoma most common?
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Japan
Iceland Chile |
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What is the prognosis of Gastric Carcinoma?
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20% 5 year survival = POOR
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What is the cause of Gastric Carcinoma?
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Diet
Smoked food Nitrites |
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What is the most common benign tumor in the GI tract?
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Gastric Leiomyoma
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T or F: the incidence of Gastric Carcinoma has increased in the US over the past 70 years
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False, has decreased
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What correlates with the decreased incidence of Gastric Cancer in the US?
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Refrigerators
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What 3 diseases predispose to Gastric Cancer?
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1. H. pylori infection
2. Chronic Atrophic Gastritis with Intestinal Metaplasia 3. Gastric Adenomatous Polyps |
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What are the 2 variants of Gastric Carcinoma?
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Intestinal Adenocarcinoma
Diffuse Carcinoma = Linitus Plastica |
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T or F: Diffuse type Gastric Adenocarcinoma is associated with H. pylori
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False
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What type of cells are associated with Diffuse type gastric adenocarcinoma?
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Signet ring cells
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Describe Signet Ring Cells
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nucleus is displaced to the periphery by intracellular mucin
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What is the most common type of malignant stomach cancer?
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Adenocarcinoma
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What 3 organs commonly receive Gastric metastatic cancer cells
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Liver
Lungs Ovaries |
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Left supraclavicular lymph node where gastric cancer may metastasize to
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Virchow node
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Describe Krukenberg Tumors
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metastatic Signet-ring cell to both ovaries
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By what vessel does a metastatic stomach cancer cell reach Virchow's node?
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Thoracic duct
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What part of the stomach is most often involved in Gastric Carcinoma?
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Pylorus and Pyloric antrum, mostly on the lesser curvature
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What does GIST mean?
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GI Stromal Tumor
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What does GIST originate from?
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stromal stem cells that are precursors of Smooth Muscle or GI fibroblasts
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What is the most common clinical presentation with Gastric Carcinoma?
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Weight loss and anorexia due to early satiety
*also -Epigastric pain -occult bleeding (too little to be noticed) -Iron deficiency anemia |
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Petechial hemorrhages after shock = Acute Gastritis
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This is the stomach...what are you seeing?
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A 56 year old woman presents with vomiting coffee ground looking blood. She has epigastric pain. PMI is significant for Rheumatoid Arthritis, for which she has been taking Aspirin daily.
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Acute Gastritis
-coffee ground blood vomit -Aspirin -Epigastric pain |
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Stress Ulcers = small (<1 cm) black mucosal defects
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What is shown here?
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Peptic Ulcer
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What is this?
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Duodenal ulcer
H. pylori |
What is this showing?
What is the cause? |
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Hypertrophic gastritis
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What is this?
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Gastric Adenocarcinoma showing an irregular ulcer crater
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What is shown here?
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Diffuse Gastric Adenocarcinoma (Linitis Plastica) with Signet Ring tumor cells
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What is shown here?
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Gastric MALToma
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What is this?
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GI Stromal Tumor = GIST = have retained the phenotype of undifferentiated stromal cells
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What is this?
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