Gastrointestinal Pathology Practice Questions

Q: Which of the following statements is false?

Cronkhite-Canada syndrome is due to SMAD-4 mutation.. **Explanation:** The correct answer is **D** because **Cronkhite-Canada syndrome (CCS)** is a **non-hereditary (sporadic)** polyposis syndrome [1]. Unlike the other options, it is not associated with a specific germline mutation. It is characterized by hamartomatous polyps throughout the GI tract, accompanied by unique ectodermal changes such as alopecia, nail dystrophy, and hyperpigmentation. **Analysis of Options:** * **A. Cowden Syndrome:** This is an autosomal dominant disorder caused by a mutation in the **PTEN** tumor suppressor gene [1]. It presents with multiple hamartomatous polyps and carries a high risk of breast, thyroid, and endometrial cancers. * **B. Gardner Syndrome:** This is a clinical variant of Familial Adenomatous Polyposis (FAP) caused by mutations in the **APC gene**. It is characterized by the triad of colonic polyposis, osteomas (usually of the mandible), and soft tissue tumors (desmoid tumors). * **C. Turcot Syndrome:** This involves colonic polyposis plus central nervous system tumors. It is genetically heterogeneous: Type 1 is associated with DNA mismatch repair genes (HNPCC), while Type 2 is associated with **APC gene** mutations (associated with Medulloblastoma). **NEET-PG High-Yield Pearls:** * **SMAD4/BMPR1A mutations** are actually associated with **Juvenile Polyposis Syndrome (JPS)**, not Cronkhite-Canada [1]. * **Peutz-Jeghers Syndrome** is associated with **STK11 (LKB1)** mutations and presents with perioral pigmentation [1], [2]. * **Remember:** Cronkhite-Canada is **acquired** and typically occurs in older adults (age >50) [1], whereas most other polyposis syndromes are congenital. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 813. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 813-814.

Q: Which of the following is a risk factor for malignancy in a colonic polyp?

Villous polyp. **Explanation:** The malignant potential of a colonic polyp is determined by three primary factors: **histological type, size, and degree of dysplasia.** **Why Villous Polyp is correct:** Adenomatous polyps are classified into three histological types: tubular, tubulovillous, and villous. **Villous adenomas** carry the highest risk of malignancy (approximately 40%), compared to tubular adenomas (5%). This is because villous architecture often correlates with larger size and a higher degree of cellular dysplasia. **Analysis of Incorrect Options:** * **A. Pedunculated polyp:** These polyps have a stalk. They are generally easier to resect and carry a lower risk of invasive malignancy compared to **sessile** (flat) polyps, which have a broader base and higher risk of harboring occult cancer. * **C. Tubular polyp:** These are the most common type of adenomatous polyps but have the **lowest** malignant potential among the adenomas. * **D. Single polyp:** The number of polyps is less significant than the pathology of the individual polyp. However, multiple polyps (as seen in FAP) increase the cumulative risk, but a single villous polyp is inherently more dangerous than a single tubular one. **High-Yield Facts for NEET-PG:** * **Size Matters:** Polyps 2 cm have a >35–50% risk. * **The Adenoma-Carcinoma Sequence:** Most colorectal cancers arise from adenomas over a period of 5–10 years. * **Hyperplastic Polyps:** Generally considered non-neoplastic and carry no significant malignant potential (except for large sessile serrated adenomas). * **Most common site:** The sigmoid colon and rectum are the most common sites for both polyps and colorectal cancer.

Q: Mucinous ascites is seen in which of the following conditions?

Stomach carcinoma. **Explanation:** **Mucinous ascites** (also known as gelatinous ascites) occurs when there is an accumulation of mucus-secreting cells or mucin within the peritoneal cavity. This is most commonly associated with **Pseudomyxoma Peritonei**, which typically originates from an appendiceal mucinous neoplasm or a **Stomach carcinoma** (specifically the signet-ring cell variant or mucinous adenocarcinoma). These malignant cells implant on the peritoneal surface and produce large amounts of thick, jelly-like fluid. **Analysis of Options:** * **A. Stomach carcinoma (Correct):** Mucinous adenocarcinomas of the gastrointestinal tract (stomach, colon, appendix) can lead to the seeding of the peritoneum, resulting in the production of mucinous fluid. * **B. Tuberculosis:** Characteristically causes **exudative ascites** with high protein (>3g/dL), high SAAG (Serum-Ascites Albumin Gradient 1.1) due to portal hypertension and salt/water retention. **NEET-PG High-Yield Pearls:** * **Pseudomyxoma Peritonei:** Classically described as "Jelly Belly." The most common primary site is the **appendix**. * **SAAG Calculation:** SAAG = (Serum Albumin) – (Ascitic Fluid Albumin). * SAAG >1.1: Portal hypertension (Cirrhosis, CHF, Budd-Chiari). * SAAG <1.1: Non-portal hypertension (Malignancy, TB, Nephrotic syndrome). * **Chylous Ascites:** Milky appearance due to lymph/triglycerides; seen in lymphomas or thoracic duct trauma.

Question 1

Which of the following statements is false?

Accepted Answer

Cronkhite-Canada syndrome is due to SMAD-4 mutation.

Answer

Cowden syndrome is due to PTEN mutation.

Answer

Gardner syndrome is due to APC mutation.

Answer

Turcot syndrome is due to APC mutation.

Question 2

The chances of a gastric carcinoma are not increased in which of the following conditions?

Accepted Answer

Duodenal ulcer

Answer

Pernicious anemia

Answer

Atrophic gastritis

Answer

Achlorhydria

Question 3

Which of the following is a risk factor for malignancy in a colonic polyp?

Accepted Answer

Villous polyp

Answer

Pedunculated polyp

Answer

Tubular polyp

Answer

Single polyp

Question 4

In which of the following conditions of malabsorption is an intestinal biopsy diagnostic?

Accepted Answer

Whipple's disease

Answer

Celiac disease

Answer

Tropical sprue

Answer

Lactose intolerance

Question 5

Mucinous ascites is seen in which of the following conditions?

Accepted Answer

Stomach carcinoma

Answer

Tuberculosis

Answer

Nephrotic syndrome

Answer

Cirrhosis

Question 6

Multiple transverse small intestinal ulcers with undermined edges are commonly found in patients of which condition?

Accepted Answer

Tuberculosis

Answer

Typhoid

Answer

Amoebiasis

Answer

Regional ileitis (Crohn's disease)

Question 7

What is a highly sensitive and specific marker for detecting intestinal inflammation, as seen in ulcerative colitis?

Accepted Answer

Fecal lactoferrin

Answer

C-reactive protein (CRP)

Answer

Fecal calprotectin

Answer

Erythrocyte sedimentation rate (ESR)

Question 8

What are the characteristic features of a pleomorphic adenoma?

Accepted Answer

Epithelial cells in a chondroid matrix

Answer

Columnar cells enclosing lymphoid stroma

Answer

Exclusively myoepithelial cells

Answer

Nests of squamous cells and vacuolated cells containing mucin

Question 9

Which of the following is a risk factor for the development of gastric carcinoma?

Accepted Answer

Intestinal metaplasia type III

Answer

Blood group O

Answer

Duodenal ulcer

Answer

Intestinal hyperplasia

Question 10

A 55-year-old woman presents with fatigue and malaise which has been worsening over the last 2 months. She also noticed loss of appetite and early satiety. Evaluation finds an ulcerative mass located along the lesser curvature of the stomach along with bilateral ovarian masses. Which of the following is this patient most likely to have?

Accepted Answer

Krukenberg tumor

Answer

Gastric leiomyosarcoma

Answer

Meig syndrome

Answer

Ovarian dysgerminoma

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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