Gastrointestinal Pathology Practice Questions

Q: What is the most common type of cancer affecting the anus?

Squamous cell carcinoma. **Explanation:** The anal canal is lined by different types of epithelium depending on the anatomical level. The area below the pectinate (dentate) line is lined by **stratified squamous epithelium**, which continues as the perianal skin. Consequently, **Squamous Cell Carcinoma (SCC)** is the most common histological type of anal cancer, accounting for approximately 80–85% of cases. It is strongly associated with high-risk **Human Papillomavirus (HPV)** infection, particularly types 16 and 18. **Analysis of Options:** * **A. Squamous cell carcinoma (Correct):** As the anal canal distal to the transformation zone is squamous, this is the predominant malignancy. * **B. Basaloid carcinoma:** This is a histological variant of SCC that arises from the transitional (cloacogenic) zone. While characteristic of the anal canal, it is less common than pure SCC. * **C. Cuboidal cell carcinoma:** This is not a standard primary malignancy of the anus. The upper anal canal is columnar/glandular, leading to adenocarcinomas, not cuboidal cell carcinomas. * **D. Cloacogenic carcinoma:** This term refers to tumors arising from the transitional zone (the "cloacogenic" membrane remnant). Modern WHO classifications now categorize these as a subtype of squamous cell carcinoma rather than a distinct entity. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** HPV infection (most common), multiple sexual partners, receptive anal intercourse, and HIV infection. * **Precursor Lesion:** Anal Intraepithelial Neoplasia (AIN). * **Lymphatic Spread:** Above the pectinate line, drainage is to internal iliac nodes; below the line, it is to **superficial inguinal nodes** (frequently tested). * **Treatment:** Unlike rectal cancer (surgery), the primary treatment for anal SCC is the **Nigro Protocol** (Chemoradiotherapy).

Q: A 60-year-old male presents with dysphagia. A mucosal biopsy is provided. What does it show?

Columnar metaplasia. ***Columnar metaplasia*** - In a 60-year-old male with **dysphagia**, columnar metaplasia (Barrett's esophagus) is the most likely finding, showing **replacement of normal squamous epithelium** with **columnar epithelium**. - The biopsy would demonstrate **intestinal-type epithelium with goblet cells**, a hallmark of Barrett's esophagus associated with chronic **gastroesophageal reflux disease (GERD)**. *Squamous metaplasia* - This represents replacement of **columnar epithelium with squamous epithelium**, which is the opposite of what occurs in Barrett's esophagus. - Commonly seen in **respiratory tract** due to smoking or **vitamin A deficiency**, not typically in esophageal dysphagia cases. *Anaplasia* - Characterized by **loss of cellular differentiation** and **pleomorphic cells** with high nuclear-to-cytoplasmic ratios, indicating malignancy. - Would present with more severe symptoms and **irregular, atypical cellular architecture** rather than organized metaplastic changes. *Connective tissue metaplasia* - Involves replacement of epithelial tissue with **fibrous connective tissue** or **cartilage/bone formation**. - Not associated with **GERD-related dysphagia** and would show **mesenchymal tissue** rather than epithelial changes on biopsy.

Question 1

Which of the following colonic pathologies is thought to have no malignant potential?

Accepted Answer

Peutz-Jeghers syndrome

Answer

Ulcerative colitis

Answer

Villous adenomas

Answer

Familial polyposis

Question 2

Transmural inflammation with skip lesions in the colon are characteristic of which condition?

Accepted Answer

Regional ileitis (Crohn's disease)

Answer

Ischemic colitis

Answer

Ulcerative colitis

Answer

Nonspecific colitis

Question 3

What is the most common type of cancer affecting the anus?

Accepted Answer

Squamous cell carcinoma

Answer

Basaloid carcinoma

Answer

Cuboidal cell carcinoma

Answer

Cloacogenic carcinoma

Question 4

Diarrhea with acanthocytosis is seen in which of the following conditions?

Accepted Answer

Wolman's disease

Answer

Whipple's disease

Answer

Celiac sprue

Answer

Agammaglobulinemia

Question 5

A 40-year-old tobacco chewer undergoes a routine oral examination. Non-scrapable white patches are noticed on the left buccal mucosa. What histological examination findings are expected?

Accepted Answer

Hyperplastic cells

Answer

Normal cells

Answer

Dysplastic cells

Answer

Aplastic cells

Question 6

A 25-year-old male presents with a history of chronic diarrhea. Pathological examination reveals cryptitis and crypt abscesses. What is the likely diagnosis?

Accepted Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Giardiasis

Answer

Microscopic colitis

Question 7

A 61-year-old man presents with 5 months of increasing fatigue, early satiety, and nausea, and vomited dark granular material yesterday. Endoscopy reveals a large ulcerated mass in the gastric fundus. Biopsies show a mass composed of spindle cells positive for c-Kit by immunohistochemistry with frequent mitoses. A 10-cm circumscribed mass is resected from the gastric wall. Which of the following therapies is most likely to be a useful adjunct in the treatment of his disease?

Accepted Answer

Imatinib

Answer

Amoxicillin

Answer

Azathioprine

Answer

Cyclophosphamide

Question 8

Which of the following conditions is characterized by a cobblestone appearance of the oral mucosa?

Accepted Answer

Crohn disease

Answer

Ulcerative colitis

Answer

Whipple disease

Answer

All of the above

Question 9

Which of the following statements about Familial Polyposis Coli is false?

Accepted Answer

There are hamartomatous polyps, and at least 80 polyps are required for diagnosis.

Answer

It is an autosomal dominant condition leading to multiple polyp formation in the colon.

Answer

There is a 100 percent risk of carcinoma in the polyps.

Answer

Gardner syndrome is colonic polyposis associated with osteomas, fibromatosis, and cutaneous cysts.

Question 10

A 60-year-old male presents with dysphagia. A mucosal biopsy is provided. What does it show?

Accepted Answer

Columnar metaplasia

Answer

Squamous metaplasia

Answer

Anaplasia

Answer

Connective tissue metaplasia

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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