Gastrointestinal Pathology Practice Questions

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.

Q: According to Borrmann's classification, linitis plastica is what type?

Type IV. **Explanation:** Borrmann’s classification is a widely used system for categorizing the macroscopic (gross) appearance of advanced gastric adenocarcinoma. It is a high-yield topic for NEET-PG as it correlates morphology with clinical behavior. **Correct Answer: Type IV (Diffuse Infiltrative)** Type IV refers to the **diffuse infiltrating type**, also known as **Linitis Plastica** ("leather bottle stomach"). In this type, the tumor cells (often signet-ring cells) infiltrate the entire stomach wall, causing marked thickening and rigidity without a distinct mass or ulcer [1]. This results in the loss of gastric rugae and a "shrunken" appearance on imaging. **Analysis of Incorrect Options:** * **Type I (Polypoid):** These are circumscribed, solitary, cauliflower-like masses that protrude into the lumen without significant ulceration. * **Type II (Ulcerated/Circumscribed):** These are well-defined, "saucer-like" ulcers with clearly demarcated, raised margins. They do not show extensive infiltration into the surrounding mucosa [1]. * **Type III (Ulcerated-Infiltrating):** These are ulcers with poorly defined margins where the tumor cells are seen infiltrating into the surrounding gastric wall. **Clinical Pearls for NEET-PG:** * **Linitis Plastica** is most commonly associated with **Lauren’s Diffuse type** gastric cancer and is linked to mutations in the **CDH1 gene** (E-cadherin) [1]. * It has the **worst prognosis** among all Borrmann types due to its aggressive spread and late presentation. * On Barium swallow, it presents as the classic **"Leather Bottle"** appearance due to restricted distensibility [1]. * **Virchow’s node** (left supraclavicular) and **Krukenberg tumor** (bilateral ovarian spread) are common distant involvements. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 779-780.

Q: What is the most common type of salivary gland neoplasm?

Pleomorphic adenoma. **Explanation:** **Pleomorphic Adenoma** (Option B) is the correct answer as it is the most common neoplasm of the salivary glands, accounting for approximately 60% of all tumors in the parotid gland. It is a benign mixed tumor characterized by a combination of epithelial, myoepithelial, and mesenchymal elements (often showing chondroid or myxoid stroma). It typically presents as a slow-growing, painless, mobile mass, most frequently located in the superficial lobe of the parotid gland [1]. **Analysis of Incorrect Options:** * **Adenoid Cystic Carcinoma (Option A):** While it is a common malignant tumor of the minor salivary glands, it is not the most common overall [1]. It is high-yield for its characteristic "Swiss-cheese" microscopic pattern and its tendency for perineural invasion. * **Epidermoid Carcinoma (Option C):** Also known as Squamous Cell Carcinoma, this is rare as a primary salivary gland tumor and usually represents metastasis or extension from overlying skin. * **Adenocarcinoma (Option D):** This is a broad category of malignant tumors. While Mucoepidermoid carcinoma is the most common *malignant* salivary gland tumor [1], "Adenocarcinoma" (NOS) is less frequent than Pleomorphic adenoma. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Parotid gland (80% of all salivary tumors). * **Most common benign tumor:** Pleomorphic Adenoma [1]. * **Most common malignant tumor:** Mucoepidermoid Carcinoma [1]. * **Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum):** Second most common benign tumor; strongly associated with smoking and often bilateral. * **Carcinoma ex pleomorphic adenoma:** Refers to the malignant transformation of a long-standing pleomorphic adenoma, signaled by sudden rapid growth [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753.

Question 1

Which of the following is a true statement about Peutz-Jeghers syndrome?

Accepted Answer

Associated with an increased risk of sex cord tumors

Answer

Autosomal recessive inheritance

Answer

Ileum is the most common site of polyps

Answer

Caused by a loss-of-function mutation in the STK11 gene

Question 2

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

Question 3

Which of the following is NOT a complication of typhoid ulcers?

Accepted Answer

Stricture formation

Answer

Perforation

Answer

Hemorrhage

Answer

Sepsis

Question 4

What is the etiology of type-A gastritis?

Accepted Answer

Autoimmune

Answer

Hypersensitivity reaction I

Answer

Bacteria

Answer

Viral etiology

Question 5

Increased serum amylase may be seen in all of the following conditions except?

Accepted Answer

Appendicitis

Answer

Pancreatic pseudocyst

Answer

Perforated peptic ulcer

Answer

Ruptured ectopic pregnancy

Question 6

What is the most common site of adenocarcinoma in the small intestine?

Accepted Answer

Duodenum

Answer

Jejunum

Answer

Ileum

Answer

Appendix

Question 7

According to Borrmann's classification, linitis plastica is what type?

Accepted Answer

Type IV

Answer

Type I

Answer

Type II

Answer

Type III

Question 8

What is the most common type of salivary gland neoplasm?

Accepted Answer

Pleomorphic adenoma

Answer

Adenoid cystic carcinoma

Answer

Epidermoid carcinoma

Answer

Adenocarcinoma

Question 9

A 14-year-old girl with a history of prolonged fever and abdominal discomfort is observed to have splenomegaly and leucopenia. In the course of the disease, she developed an acute abdominal event and died. Which of the following is the likely finding on autopsy?

Accepted Answer

Longitudinal ulcers

Answer

Transverse ulcers

Answer

Pinpoint ulcers

Answer

Pseudopolyps

Question 10

Which of the following is NOT a risk factor for gastric cancer?

Accepted Answer

Gastric atrophy

Answer

Helicobacter pylori infection

Answer

Adenomatous polyp

Answer

Alcohol consumption

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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