Gastrointestinal Pathology Practice Questions

Q: A patient presented with colon type diarrhea with blood. On sigmoidoscopy, a cauliflower mass was found and excised. On genetic analysis of the mass, which finding does NOT have prognostic value?

Krans. In colorectal carcinoma (CRC), genetic markers are used for diagnosis, screening, and predicting prognosis or treatment response. This question tests the distinction between **predictive** and **prognostic** markers. **Why K-ras is the Correct Answer:** While **K-ras** (Kirsten rat sarcoma virus) mutations are present in approximately 40% of colorectal cancers (part of the Adenoma-Carcinoma sequence), they do **not** have independent prognostic value regarding the patient's overall survival or disease progression [1]. Instead, K-ras is a **predictive marker**: its presence indicates resistance to anti-EGFR monoclonal antibody therapies (like Cetuximab and Panitumumab). **Analysis of Incorrect Options:** * **c-myc:** Overexpression of this proto-oncogene is associated with poor prognosis and aggressive tumor behavior in CRC [1]. * **Microsatellite Instability (MSI):** This is a high-yield **prognostic** marker [1]. Patients with MSI-High (MSI-H) tumors generally have a **better prognosis** and higher survival rates compared to those with Microsatellite Stable (MSS) tumors, although they respond poorly to 5-Fluorouracil [1]. * **erbB2 (HER2/neu):** Amplification of erbB2 is associated with advanced stage, increased recurrence, and overall **poor prognosis** in colorectal malignancies. **NEET-PG High-Yield Pearls:** * **Vogelstein Model:** The classic sequence is *APC* (Gatekeeper) → *K-ras* (Signaling) → *p53* (Executioner) [1]. * **MSI-H CRC:** Typically right-sided, associated with Lynch Syndrome, and characterized by "dirty necrosis" and "Crohn-like" lymphoid reaction [1]. * **Predictive vs. Prognostic:** A *prognostic* marker tells you the likely outcome of the disease; a *predictive* marker tells you how the disease will respond to a specific drug. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 819-821.

Q: Linitis plastica is a type of which cancer?

Stomach cancer. **Explanation:** **Linitis plastica** (also known as "leather bottle stomach") is a morphological variant of **Stomach cancer**, specifically associated with the **Diffuse type of Gastric Adenocarcinoma** (Lauren classification) [1]. ### Why Stomach Cancer is Correct: In this condition, the tumor cells (often **Signet ring cells**) infiltrate the submucosa and muscularis propria extensively [1]. This triggers a massive **desmoplastic reaction** (fibrosis), which causes the stomach wall to become markedly thickened, rigid, and non-distensible [1]. On gross examination, the stomach resembles a rigid leather flask or bottle, hence the name [1]. Unlike the intestinal type, it does not usually form a discrete luminal mass. ### Why Other Options are Incorrect: * **Gallbladder cancer:** Typically presents as a mass in the gallbladder fossa or wall thickening, but does not exhibit the "leather bottle" diffuse infiltrative pattern. * **Pancreatic cancer:** Usually presents as a focal mass in the head of the pancreas leading to obstructive jaundice; it does not involve the diffuse structural rigidity seen in linitis plastica. * **Renal cell cancer:** Characterized by clear cell or papillary morphology within the kidney parenchyma; it spreads via the renal vein and does not involve the gastric wall. ### NEET-PG High-Yield Pearls: * **Microscopy:** Look for **Signet ring cells** (nucleus pushed to the periphery by a large mucin vacuole) [1]. * **Genetics:** Often associated with mutations in the **CDH1 gene**, which encodes for **E-cadherin** [1]. * **Radiology:** On a Barium swallow, it presents as a narrowed, rigid stomach with a lack of peristalsis. * **Classification:** It is the hallmark of the **Diffuse type** of gastric cancer, which has a poorer prognosis compared to the Intestinal type [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 779-780.

Question 1

A patient presented with colon type diarrhea with blood. On sigmoidoscopy, a cauliflower mass was found and excised. On genetic analysis of the mass, which finding does NOT have prognostic value?

Accepted Answer

Krans

Answer

c-myc

Answer

Microsatellite instability

Answer

erbB2

Question 2

Helicobacter pylori is associated with what percentage of gastric ulcers?

Accepted Answer

70%

Answer

10%

Answer

30%

Answer

50%

Question 3

Familial polyposis coli is associated with which genetic defect?

Accepted Answer

APC

Answer

MLH1

Answer

MSH2

Answer

RET

Question 4

Which of the following statements is incorrect?

Accepted Answer

Increased prostaglandin secretion is protective against stress ulcers.

Answer

Curling ulcers are associated with severe burns.

Answer

Stress ulcers can be caused by shock.

Answer

Central nervous system lesions can lead to the formation of stress ulcers.

Question 5

When carcinoma of the stomach develops secondarily to pernicious anemia, it is usually situated in which region?

Accepted Answer

Fundus

Answer

Pre-pyloric region

Answer

Pylorus

Answer

Body

Question 6

All of the following are features of early gastric carcinoma except?

Accepted Answer

Paradoxical aciduria

Answer

Mucosal involvement

Answer

Submucosal involvement

Answer

Muscularis propria not involved

Question 7

Which of the following conditions predisposes to esophageal adenocarcinoma?

Accepted Answer

Scleroderma

Answer

Achalasia

Answer

Corrosive intake

Answer

All of the above

Question 8

Which of the following is associated with an increased risk of gastric carcinomas?

Accepted Answer

Intestinal metaplasia

Answer

Gastric polyp (hyperplastic or adenomatous)

Answer

Atrophic gastritis

Answer

Corrosive antral stricture

Question 9

Linitis plastica is a type of which cancer?

Accepted Answer

Stomach cancer

Answer

Gall bladder cancer

Answer

Pancreatic cancer

Answer

Renal cell cancer

Question 10

In which one of the following salivary gland tumors, the tumor is composed of "intermediate cells" histologically?

Accepted Answer

Mucoepidermoid carcinoma

Answer

Adenoid cystic carcinoma

Answer

Pleomorphic adenoma

Answer

Warthin's tumour

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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