Gastrointestinal Pathology Practice Questions

Q: What is a littoral cell angioma?

A tumor of the spleen. **Explanation:** **Littoral Cell Angioma (LCA)** is a rare, primary vascular neoplasm arising exclusively from the **spleen**. It originates from the "littoral cells" that line the splenic sinuses of the red pulp. These cells are unique because they possess both endothelial and histiocytic properties. 1. **Why Option A is Correct:** LCA is a spleen-specific tumor. Pathologically, it presents with anastomosing vascular channels lined by tall, plump cells (littoral cells) that often show hemophagocytosis. A key diagnostic feature is the **dual immunohistochemical profile**: they express both endothelial markers (CD31) [1] and histiocytic markers (CD68). 2. **Why Other Options are Incorrect:** * **Option B:** Angiomatous lesions of the skin include entities like cherry hemangiomas or pyogenic granulomas [1], but not LCA. * **Option C:** An angioblastic tumor of the cerebellum refers to a **Hemangioblastoma**, which is classically associated with Von Hippel-Lindau (VHL) syndrome. * **Option D:** A congenital vascular anomaly at the base of the brain typically refers to a **Berry Aneurysm** (Circle of Willis) or an Arteriovenous Malformation (AVM). **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Most patients present with splenomegaly, hypersplenism (anemia/thrombocytopenia), or are asymptomatic. * **Imaging:** Often shows multiple nodular lesions on CT/MRI (hypodense). * **Nature:** Usually benign, though rare malignant variants (Littoral cell angiosarcoma) exist. * **Key Marker:** CD68 positivity differentiates it from other splenic vascular tumors like splenic hemangioma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 523-528.

Q: What is the characteristic histological finding in solitary rectal ulcer syndrome?

Increased muscle layer proliferation. **Explanation:** **Solitary Rectal Ulcer Syndrome (SRUS)** is a chronic, non-neoplastic inflammatory condition often associated with pelvic floor dyssynergia and chronic straining. The core pathophysiology involves repeated mucosal prolapse and ischemia, leading to a characteristic histological pattern known as **fibromuscular obliteration**. **Why Option D is correct:** The hallmark of SRUS is the **proliferation of smooth muscle fibers** from the muscularis mucosae into the lamina propria [1]. This is accompanied by the replacement of the normal lamina propria with collagen (fibrosis). This "fibromuscular hyperplasia" is a diagnostic feature that distinguishes it from other inflammatory bowel diseases. **Analysis of Incorrect Options:** * **Option A:** A thick subepithelial collagen band (typically >10 μm) is the classic finding in **Collagenous Colitis**, a type of microscopic colitis, not SRUS. * **Option B:** Intraepithelial lymphocytosis is characteristic of **Lymphocytic Colitis** or Celiac disease. While some inflammation exists in SRUS, it is not the defining feature. * **Option C:** SRUS typically shows **crypt architectural distortion** (hyperplasia, branching, or "diamond-shaped" crypts) rather than hypoplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Triad:** Rectal bleeding, mucoid discharge, and a feeling of incomplete evacuation [1]. * **Endoscopy:** Despite the name, the lesion can be an ulcer, a polypoid mass, or simply erythematous mucosa; it is not always "solitary" or an "ulcer." * **Location:** Usually located on the **anterior rectal wall**, approximately 5–10 cm from the anal verge [1]. * **Key Histology Keyword:** "Fibromuscular obliteration of the lamina propria." **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 811-813.

Question 1

Colon carcinogenesis is associated with all of the following genetic mutations, EXCEPT:

Accepted Answer

HER2 gene

Answer

APC

Answer

kRAS

Answer

B-catenin

Question 2

Total capacity of the stomach is markedly reduced in which of the following conditions?

Accepted Answer

Linitis plastica

Answer

Cauliflower growth of the stomach

Answer

Hourglass stomach

Answer

Pyloric stenosis

Question 3

Which one of the following types of stomach cancers carries the best prognosis?

Accepted Answer

Superficial spreading

Answer

Ulcerative types

Answer

Linitis plastica type

Answer

Polypoidal type

Question 4

What is a littoral cell angioma?

Accepted Answer

A tumor of the spleen

Answer

An angiomatous lesion of the skin

Answer

An angioblastic tumor of the cerebellum

Answer

A congenital vascular anomaly at the base of the brain

Question 5

A clinical study of adult patients with chronic bloody diarrhea is performed. One group of these patients is found to have a statistically increased likelihood for antibodies to Saccharomyces cerevisiae but not anti-neutrophil cytoplasmic autoantibodies, NOD2 gene polymorphisms, TH1 and TH17 immune cell activation, vitamin K deficiency, megaloblastic anemia, and gallstones. Which of the following diseases is this group of patients most likely to have?

Accepted Answer

Crohn disease

Answer

Angiodysplasia

Answer

Diverticulitis

Answer

Ischemic enteritis

Question 6

Which of the following is FALSE about Barrett's esophagus?

Accepted Answer

Barrett's ulcer occurs just above the squamocolumnar junction.

Answer

In short-segment Barrett's, there is less than 3 cm of columnar epithelium.

Answer

If a peptic stricture occurs in Barrett's esophagus, it always occurs at the new squamocolumnar junction.

Answer

It is a premalignant condition.

Question 7

What is true about intestinal lymphoma?

Accepted Answer

It is involved in non-Hodgkin's lymphoma.

Answer

It is made up of predominantly T cells.

Answer

It is C-kit positive.

Answer

It is most common at the ileocecal junction.

Question 8

What is the characteristic histological finding in solitary rectal ulcer syndrome?

Accepted Answer

Increased muscle layer proliferation

Answer

Thick collagen band under the endothelial layer

Answer

Intraepithelial collection of lymphocytes

Answer

Crypt hypoplasia

Question 9

Histologic examination of a gastric lesion reveals fat-laden cells. What is the likely cause?

Accepted Answer

Atrophic gastritis

Answer

Lymphoma

Answer

Post-gastrectomy changes

Answer

Signet-cell carcinoma of the stomach

Question 10

Which of the following is false about celiac disease?

Accepted Answer

Villous hyperplasia

Answer

Crypt hyperplasia

Answer

Infiltration of lymphocytes

Answer

Villous atrophy

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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