Gastrointestinal Pathology Practice Questions

Q: Cribriform, honeycomb, or swiss cheese histology pattern is seen in which of the following tumors?

Adenoid cystic carcinoma. **Explanation:** **Adenoid Cystic Carcinoma (ACC)** is the correct answer. The hallmark histological feature of ACC is the **cribriform pattern**, often described as "honeycomb" or "Swiss cheese." This pattern is formed by nests of small, uniform basaloid cells surrounding multiple round, cyst-like spaces [1]. These spaces are not true glandular lumens but are "pseudocysts" containing basement membrane-like material (excessive hyaline) or basophilic mucin. **Analysis of Incorrect Options:** * **Pleomorphic Adenoma:** Characterized by a mix of epithelial/myoepithelial cells and a **chondromyxoid stroma**. It is the most common salivary gland tumor but lacks the classic cribriform architecture. * **Acinic Cell Carcinoma:** Shows cells with granular basophilic cytoplasm (resembling serous acini) arranged in solid or microcystic patterns [1], but not the distinct Swiss cheese appearance. * **Clear Cell Carcinoma:** Defined by cells with abundant clear cytoplasm due to glycogen accumulation; it does not typically present with a cribriform arrangement. **High-Yield Clinical Pearls for NEET-PG:** * **Perineural Invasion:** ACC is notorious for its tendency to spread along nerves, leading to pain or facial nerve palsy. * **Location:** Most common malignant tumor of the **minor salivary glands** (especially the palate) [1]. * **Prognosis:** It is a slow-growing but relentless tumor with a high rate of late recurrence and distant metastasis (often to the lungs) [1]. * **Differential Diagnosis:** The cribriform pattern can also be seen in **Cribriform Morular Variant of Papillary Thyroid Carcinoma** and **DCIS (Ductal Carcinoma In Situ)** of the breast. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755.

Q: What is the characteristic microscopic finding in lymphocytic colitis?

Increased intraepithelial lymphocytes. **Explanation:** **Lymphocytic Colitis** is a subtype of **Microscopic Colitis**, a clinical-pathological entity characterized by chronic, non-bloody watery diarrhea in patients with a macroscopically normal-appearing colon on endoscopy. 1. **Why Option B is Correct:** The hallmark microscopic finding is a significant increase in **intraepithelial lymphocytes (IELs)**, typically defined as **>20 lymphocytes per 100 surface epithelial cells**. Unlike Collagenous Colitis, there is no significant thickening of the subepithelial collagen band. The underlying lamina propria also shows an inflammatory infiltrate consisting primarily of lymphocytes and plasma cells. 2. **Why Other Options are Incorrect:** * **Option A (Bloody diarrhea):** This is a feature of Ulcerative Colitis or infectious dysentery. Microscopic colitis classically presents with **watery, non-bloody diarrhea**. * **Option C (Lymphocytes in stools):** While inflammation exists, fecal analysis for lymphocytes is not a diagnostic standard or a characteristic microscopic finding for this pathology. * **Option D (Findings on ileoscopy):** In lymphocytic colitis, the endoscopic appearance of the colon and terminal ileum is typically **normal** (hence the name "microscopic"). Diagnosis relies entirely on histopathological examination of biopsies. **High-Yield NEET-PG Pearls:** * **Demographics:** Most common in middle-aged to elderly females. * **Associations:** Often linked to autoimmune diseases (Celiac disease, Rheumatoid Arthritis) and certain drugs (NSAIDs, PPIs, Sertraline). * **Differential:** **Collagenous Colitis** shares similar symptoms but is distinguished by a thick (>10 µm) subepithelial collagen table. * **Treatment:** Budesonide is the first-line medical therapy.

Question 1

Which statement is false regarding familial adenomatous polyposis?

Accepted Answer

Males are usually carriers.

Answer

Autosomal dominant inheritance.

Answer

If not treated, progresses to malignancy in 100% of cases.

Answer

Males and females are affected equally.

Question 2

A 45-year-old woman presents with increasing abdominal girth over the past 2 years. Physical examination reveals abdominal distension. A CT scan shows multiple nodules on peritoneal surfaces along with low-attenuation mucinous ascites. Cytological examination after paracentesis showed well-differentiated columnar cells with minimal nuclear atypia. From which site did this pathology most likely originate?

Accepted Answer

Appendix

Answer

Pancreas

Answer

Ileum

Answer

Jejunum

Question 3

Which of the following is NOT associated with colon carcinogenesis?

Accepted Answer

Mismatch repair

Answer

APC

Answer

k RAS

Answer

B-catenin

Question 4

Barrett's esophagus is commonly associated with which of the following malignancies?

Accepted Answer

Adenocarcinoma

Answer

Squamous cell carcinoma

Answer

Sarcoma

Answer

Gastrointestinal stromal tumor

Question 5

A segment of jejunum shows a nodular lesion in the submucosa. Histological examination reveals a tumor composed of uniform round cells arranged in trabeculae, with a "salt-and-pepper" chromatin pattern. Electron microscopy shows secretory granules, and immunohistochemistry is positive for serotonin. Which of the following parameters best correlates with the metastatic potential of this tumor?

Accepted Answer

Site and size

Answer

Architectural pattern

Answer

Cell pleomorphism

Answer

Hormonal production

Question 6

Which of the following is NOT true regarding typhoid ulcer?

Accepted Answer

Ulcers are typically placed longitudinally along the ileum

Answer

Perforation is less common in children below 5 years

Answer

Multiple ulcers are found in the terminal ileum

Answer

Perforation usually occurs in the third week

Question 7

Which organism is associated with fish consumption and also causes carcinoma of the gallbladder?

Accepted Answer

Clonorchis sinensis

Answer

Gnathostoma

Answer

Angiostrongylus cantonensis

Answer

Hymenolepis diminuta

Question 8

Which of the following is NOT a complication of Helicobacter pylori?

Accepted Answer

Gastroesophageal reflux disease (GERD)

Answer

Peptic ulcer disease

Answer

MALToma

Answer

Chronic gastritis

Question 9

Cribriform, honeycomb, or swiss cheese histology pattern is seen in which of the following tumors?

Accepted Answer

Adenoid cystic carcinoma

Answer

Pleomorphic adenoma

Answer

Acinic cell carcinoma

Answer

Clear cell carcinoma

Question 10

What is the characteristic microscopic finding in lymphocytic colitis?

Accepted Answer

Increased intraepithelial lymphocytes

Answer

Bloody diarrhea

Answer

Lymphocytes in stools

Answer

Findings on ileoscopy

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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