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46 Cards in this Set

  • Front
  • Back
Normal mucosa looks like test tubes in _____
a rack
A normal variation of colonic mucosa are what kind of "grooves"
innominate
A normal variation of colonic mucosa appear as ployps endoscopically
lymphoid aggregate
polyps that do not have malignant potential
•hamartomatous polyps
•and hyperplastic polyps.
Give two types of hamartomous polyps
•Juvenile (Retention) Polyps
•Peutz-Jegher's Polyps
what are "juvenile polyps" called in adults
retention polyps
Juvenile Polyps are composed of colonic mucosa
containing cystically dilated glands. lnflammation is
often seen in the ______ _______.
Juvenile Polyps are composed of colonic mucosa
containing cystically dilated glands. lnflammation is
often seen in the lamina propria.
Peutz-Jegher's Syndrome:.
•An autosomal ________ syndrome in which
patients develop multiple P-J polyps in small
intestine +/-colon +/-stomach.
•These patients also develop cutaneous and
mucosal p____________ (perioral, palmar, oral
mucosa & external genitalia).
•Patients with PJ syndrome are at an increased risk
of developing carcinomas of the breast, lung,
pancreas, and gynecologic tract, and may develop
GI carcinoma from concomitant intestinal
adenomas
Peutz-Jegher's Syndrome:.
•An autosomal dominant syndrome in which
patients develop multiple P-J polyps in small
intestine +/-colon +/-stomach.
•These patients also develop cutaneous and
mucosal pigmentation (perioral, palmar, oral
mucosa & external genitalia).
•Patients with PJ syndrome are at an increased risk
of developing carcinomas of the breast, lung,
pancreas, and gynecologic tract, and may develop
GI carcinoma from concomitant intestinal
adenomas
• P-J polyps are large and pedunculated.
•Sporadic polyps occur singly
•Pathology: composed of mucosa containing
convoluted crypts along a b________ framework
of fibrous tissue and smooth muscle.
• P-J polyps are large and pedunculated.
•Sporadic polyps occur singly
•Pathology: composed of mucosa containing
convoluted crypts along a branching framework
of fibrous tissue and smooth muscle.
• ____________ polyps are small, common. usually
asymptomatic polyps.
• They are most often found in patients in their 6-7th decades.
• 80% of ____________ polyps occur in the rectum or sigmoid
colon.
• They arise due to delayed shedding of surface epithelial cells,
which results in crowding and infoldings of crypt epithelium.
• Hyperplastic polyps are small, common. usually
asymptomatic polyps.
• They are most often found in patients in their 6-7th decades.
• 80% of hyperplastic polyps occur in the rectum or sigmoid
colon.
• They arise due to delayed shedding of surface epithelial cells,
which results in crowding and infoldings of crypt epithelium.
Hyperplastic Polyps

Pathology:

• The colonic crypts have ________ (serrated) luminal
contours.
• There is no adenomatous/ dysplastic change of the
epithelium.
Hyperplastic Polyps

Pathology:

• The colonic crypts have sawtooth (serrated) luminal
contours.
• There is no adenomatous/ dysplastic change of the
epithelium.
Hyperplastic polyp loses the test tube in a rack look. The test tubes instead look how?
twisted
Adenomas are precursors of ______________. These polyps
are very common with a prevalence of 40-50% after age 60.
Adenomas are precursors of adenocarcinoma. These polyps
are very common with a prevalence of 40-50% after age 60.
Patients with one ___________ polyp are at increased risk
of developing other adenomas or carcinomas of the colon.
Patients with one adenomatous polyp are at increased risk
of developing other adenomas or carcinomas of the colon.
________ adenomas are the most common type of
adenoma.
•Tubular adenomas are the most common type of
adenoma.
Tubular adenoma:

•By definition more than __% the polyp has a
tubular architecture (less than 25% villous).
Tubular adenoma:

•By definition more than 75% the polyp has a
tubular architecture (less than 25% villous).
Tubulovillous adenoma:
• Mucosal polyp which contains both tubular glands
and areas with villous '______like' surface
projections in same polyp.
•The epithelium shows adenomatous changes.
•By definition, these polyps have 25-50% villous
architecture, and the Tubular adenoma rest is
tubular.
Tubulovillous adenoma:
• Mucosal polyp which contains both tubular glands
and areas with villous 'fingerlike' surface
projections in same polyp.
•The epithelium shows adenomatous changes.
•By definition, these polyps have 25-50% villous
architecture, and the Tubular adenoma rest is
tubular.
Villous adenoma:
•Mucosal polyps containing villous '______like'
projections of mucosa lined by adenomatous
epithelium along the luminal surface.
•Villous adenomas are the _____ common type of
adenoma.
•Large polyps are often sessile.
• By definition, more than __% of the architecture is
villous.
Villous adenoma:
•Mucosal polyps containing villous 'fingerlike'
projections of mucosa lined by adenomatous
epithelium along the luminal surface.
•Villous adenomas are the least common type of
adenoma.
•Large polyps are often sessile.
• By definition, more than 50% of the architecture is
villous.
Adenomatous Polyposis
Syndromes
•1.C_____’s syndrome
•2. Familial Adenomatous Polyposis [FAP]
(Familial Polyposis Coli)
•3. G______'s Syndrome
•4. T_____'s Syndrome
Adenomatous Polyposis
Syndromes
•1.Cowden’s syndrome
•2. Familial Adenomatous Polyposis [FAP]
(Familial Polyposis Coli)
•3. Gardner's Syndrome
•4. Turcot's Syndrome
Hereditary Nonpolyposis Colorectal Cancer
(_____) Syndrome
Hereditary Nonpolyposis Colorectal Cancer
(Lynch) Syndrome
Polyposis syndromes – Cowden’s
•Autosomal dominant
•10q23 (same as MEN II – MEN I 11q13)
•9q22.3
•Hamartomas/Juvenile polyps/Inflammatory
•Entire GI tract (no malignant potential)
•Increased risk of breast, thyroid CA
•Multiple facial ______lemommas
•Oral mucosal papillomas
•Lipomas, hemangiomas
35
Polyposis syndromes – Cowden’s
•Autosomal dominant
•10q23 (same as MEN II – MEN I 11q13)
•9q22.3
•Hamartomas/Juvenile polyps/Inflammatory
•Entire GI tract (no malignant potential)
•Increased risk of breast, thyroid CA
•Multiple facial trichilemommas
•Oral mucosal papillomas
•Lipomas, hemangiomas
35
Adenomatous Polyposis
Syndromes :
•Caused by a mutation of tumor suppressor
("gate______") gene "___" (Adenomatous Polyposis
Coli )on 5q21.
•All are autosomal dominant, except ______'s
syndrome which is autosomal recessive.
•Patients with these syndromes develop
adenomatous polyps in 2-3rd decades.
Adenomatous Polyposis
Syndromes :
•Caused by a mutation of tumor suppressor
("gatekeeper") gene "APC" (Adenomatous Polyposis
Coli )on 5q21.
•All are autosomal dominant, except Turcot's
syndrome which is autosomal recessive.
•Patients with these syndromes develop
adenomatous polyps in 2-3rd decades.
[FAP] (F_______ P________ C___):
•Patients with classic FAP develop 100-2500
adenomatous polyps of the colon +I-polyps in the
rest of the GI tract.
•A minimum of 100 adenomas is needed for
diagnosis.
•The frequency of developing colon cancer in FAP
patients is close to 100% by age 40 if not treated
with prophylactic _________.
•Attenuated FAP patients develop fewer polyps
(average 30) usually in the right colon and have a
lower cancer risk.
[FAP] (Familial Polyposis Coli):
•Patients with classic FAP develop 100-2500
adenomatous polyps of the colon +I-polyps in the
rest of the GI tract.
•A minimum of 100 adenomas is needed for
diagnosis.
•The frequency of developing colon cancer in FAP
patients is close to 100% by age 40 if not treated
with prophylactic colectomy.
•Attenuated FAP patients develop fewer polyps
(average 30) usually in the right colon and have a
lower cancer risk.
A variant of FAP syndrome with osteomas,
epidermal cysts, fibromatoses, dental abnormalities,
and a high frequency of duodenal adenomas/
cancer and thyoid cancer.
Gardner's Syndrome:
A variant of FAP syndrome + gliomas of the CNS.
Turcot's Syndrome:
HNPCC (______) Syndrome:
•An autosomal dominant familial syndrome due to a
mutation in one of four DNA mismatch repair genes
(MSH2, MLHI. MSH6. PMSI, PMS2) which
'proofread' DNA during DNA replication.
•This mutation leads to microsatellite instability.
•The patients with this syndrome tend to develop
adenomas at an earlier age than general population
and tend to develop multiple colon cancers that are
often not associated with a pre-existing ____oma.
•Patients are also at increased risk for extraintestinal
cancers such as __________ carcinoma.
HNPCC (Lynch) Syndrome:
•An autosomal dominant familial syndrome due to a
mutation in one of four DNA mismatch repair genes
(MSH2, MLHI. MSH6. PMSI, PMS2) which
'proofread' DNA during DNA replication.
•This mutation leads to microsatellite instability.
•The patients with this syndrome tend to develop
adenomas at an earlier age than general population
and tend to develop multiple colon cancers that are
often not associated with a pre-existing adenoma.
•Patients are also at increased risk for extraintestinal
cancers such as endometrial carcinoma.
Colorectal Adenocarcinoma:
•Epidemiology:
•Most cancers of the colon are _______________.
•Colon carcinoma is the ______ most common cause
of cancer deaths in the U.S. (after ____ cancer).
• Colon cancer most commonly occurs in patients
between 60-79 years old.
•There is a very high prevalence in US., Canada,
Europe, and Australia, with much lower incidence
of colon cancer in Japan, South America and Africa.
•Environmental and dietary factors may account for
some of the geographic differences in incidence.
Colorectal Adenocarcinoma:
•Epidemiology:
•Most cancers of the colon are adenocarcinomas.
•Colon carcinoma is the second most common cause
of cancer deaths in the U.S. (after lung cancer).
• Colon cancer most commonly occurs in patients
between 60-79 years old.
•There is a very high prevalence in US., Canada,
Europe, and Australia, with much lower incidence
of colon cancer in Japan, South America and Africa.
•Environmental and dietary factors may account for
some of the geographic differences in incidence.
Colonic (Colorectal)
Adenocarcinoma:
•Distribution of disease in colon:
•____ colon cancers tend to be annular lesions
causing "______ ring" constrictions and causing
symptoms of obstruction.
•_____ colon cancers tend to be ______ing masses
along one wall and become symptomatic later.
• Colon carcinomas at any site often cause bleeding
& anemia.
Colonic (Colorectal)
Adenocarcinoma:
•Distribution of disease in colon:
•Left colon cancers tend to be annular lesions
causing "napkin ring" constrictions and causing
symptoms of obstruction.
•Right colon cancers tend to be fungating masses
along one wall and become symptomatic later.
• Colon carcinomas at any site often cause bleeding
& anemia.
moderately differentiated adenocarcinoma
"looks really ____"
moderately differentiated adenocarcinoma
"looks really blue"
Poorly differentiated adenocarcinoma
"looks like a ____"
"looks more like a ____oma"
Poorly differentiated adenocarcinoma
"looks like a mass"
"looks more like a sarcoma"
I___________ Adenocarcinoma:
• The neoplastic glands invade into the lamina
propria (but not deeper). With this lesion there is
still little or no metastatic potential.
Intramucosal Adenocarcinoma:
• The neoplastic glands invade into the lamina
propria (but not deeper). With this lesion there is
still little or no metastatic potential.
Severe dysplasia /Carcinoma in Situ:
•The dysplastic/adenomatous epithelium shows
marked cytologic atypia and a complex back- to-
back glandular proliferation.
•Since there is no invasion of the lamina propria,
there is no possibility of __________.
Severe dysplasia /Carcinoma in Situ:
•The dysplastic/adenomatous epithelium shows
marked cytologic atypia and a complex back- to-
back glandular proliferation.
•Since there is no invasion of the lamina propria,
there is no possibility of metastases.
I_______ Adenocarcinoma:
•The neoplastic glands invade into the
Adenocarcinoma in situ submucosa or beyond
and have metastatic potential.
Invasive Adenocarcinoma:
•The neoplastic glands invade into the
Adenocarcinoma in situ submucosa or beyond
and have metastatic potential.
_____ is the classification of extent of tumor spread at the time
of diagnosis. _____ is the most important prognostic factor in
colon carcinoma.
Stage is the classification of extent of tumor spread at the time
of diagnosis. Stage is the most important prognostic factor in
colon carcinoma.
• Tis Carcinoma in situ or intramucosal adenocarcinoma
• T1 Invasion into _________
• T2 Invasion into __________ propria;
• T3 Invasion through muscularis propria into _________
• T4 Invasion into other organs or perforates visceral
peritoneum
- NX = lymph nodes not identified
• N0 regional lymph nodes negative
• N1 metastases in 1-3 lymph nodes
• N2 metastases in 4 or more lymph nodes
• Tis Carcinoma in situ or intramucosal adenocarcinoma
• T1 Invasion into submucosa
• T2 Invasion into muscularis propria;
• T3 Invasion through muscularis propria into subserosa
• T4 Invasion into other organs or perforates visceral
peritoneum
- NX = lymph nodes not identified
• N0 regional lymph nodes negative
• N1 metastases in 1-3 lymph nodes
• N2 metastases in 4 or more lymph nodes
Treatment:
•________ _____ ________ is adequate treatment for
adenomas including those with severe glandular
dysplasia / carcinoma in situ and intramucosal
adenocarcinoma.
Treatment:
•Complete local excision is adequate treatment for
adenomas including those with severe glandular
dysplasia / carcinoma in situ and intramucosal
adenocarcinoma.
•Complete local excision is also adequate for
invasive adenocarcinoma confined to a polyp [only
if the carcinoma: is not at or close to the stalk
margin, is not poorly differentiated, is without
vascular invasion, and is not s______.]
•Complete local excision is also adequate for
invasive adenocarcinoma confined to a polyp [only
if the carcinoma: is not at or close to the stalk
margin, is not poorly differentiated, is without
vascular invasion, and is not sessile.]
•Need subsequent surgical _________ for carcinomas
not confined to a polyp.
•Need subsequent surgical resection for carcinomas
not confined to a polyp.
Development of cancer in the colon is felt to be
the result of a "_____-___" process in which the
accumulation of multiple mutations is needed for
the development of cancer.
Development of cancer in the colon is felt to be
the result of a "multi-hit" process in which the
accumulation of multiple mutations is needed for
the development of cancer.
___ mutations are present in patients with FAP and in 80%
of sporadic colon cancers.
APC mutations are present in patients with FAP and in 80%
of sporadic colon cancers.
Sporadic colon cancers that lack an APC mutation often
have a mutation in B-_______.
Sporadic colon cancers that lack an APC mutation often
have a mutation in B-catenin.
Accumulations of mutations of the following genes are
common: ___, K-___, etc.
Accumulations of mutations of the following genes are
common: APC, K-ras, etc.
Most important gene mutation that lifts all regulation off of the cell cycle
17p loss (p53)
The ______________ instability Pathway
• Explains the development of colon cancer in patients
with HNPCC syndrome.
The Microsatellite instability Pathway
• Explains the development of colon cancer in patients
with HNPCC syndrome.
The Microsatellite instability Pathway

Carcinomas arising from this pathway do not usually
arise in ________ and are often in the _____ colon.
The Microsatellite instability Pathway

Carcinomas arising from this pathway do not usually
arise in adenomas and are often in the right colon.
CARCINOID
• Neoplasms arising from ______________ cells.
• Tendency for aggressive behavior correlates with site of origin,
depth of invasion and size.
• Appendiceal and rectal carcinoids infrequently metastasize.
• 90% of ileal, gastric & colonic carcinoids that have penetrated
1/2 way through the muscle wall will have metastases.
• Carcinoid syndrome can be produced by _________ (secreting
carcinoids either metastatic to liver or in extraintestinal sites.
• _ ________________ ______ _____, can be detected in urine.
• Carcinoid syndrome produces cyanotic flushing, GI symptoms,
asthmatic attacks, intermittent HTN and palpitations.
CARCINOID
• Neoplasms arising from neuroendocrine cells.
• Tendency for aggressive behavior correlates with site of origin,
depth of invasion and size.
• Appendiceal and rectal carcinoids infrequently metastasize.
• 90% of ileal, gastric & colonic carcinoids that have penetrated
1/2 way through the muscle wall will have metastases.
• Carcinoid syndrome can be produced by serotonin (secreting
carcinoids either metastatic to liver or in extraintestinal sites.
• 5 hydroxyindoleacetic acid (5HIAA), can be detected in urine.
• Carcinoid syndrome produces cyanotic flushing, GI symptoms,
asthmatic attacks, intermittent HTN and palpitations.