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.

Q: All are true about salivary gland tumors except:

Parotid tumors are mostly malignant.. ### Explanation The correct answer is **D**, as it is a false statement. In salivary gland pathology, there is an **inverse relationship** between the size of the gland and the likelihood of malignancy. **1. Why Option D is the correct answer (False statement):** While the parotid gland is the most common site for salivary tumors, approximately **75-80% of parotid tumors are benign** (most commonly Pleomorphic Adenoma). Only about 20-25% are malignant. Therefore, stating they are "mostly malignant" is factually incorrect [1]. **2. Analysis of other options:** * **Option A:** The **Parotid gland** is indeed the most common site, accounting for nearly 65-80% of all salivary gland neoplasms [1]. * **Option B:** **Warthin tumor** (Papillary Cystadenoma Lymphomatosum) is unique because it occurs almost exclusively in the parotid gland [1]. It is also associated with smoking and can be bilateral or multifocal. * **Option C:** According to the "Rule of Proportion," as the gland size decreases, the risk of malignancy increases. About **50-80% of minor salivary gland tumors are malignant** (most commonly Adenoid Cystic Carcinoma) [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common overall tumor:** Pleomorphic Adenoma (Benign Mixed Tumor). * **Most common malignant tumor (Adults & Children):** Mucoepidermoid Carcinoma [1]. * **Most common site for Mucoepidermoid Carcinoma:** Parotid gland [1]. * **Tumor with propensity for perineural invasion:** Adenoid Cystic Carcinoma (presents with pain/palsy) [1]. * **Hot spot on Technetium-99m scan:** Warthin Tumor. * **The "Rule of 80s" for Parotid:** 80% are in the parotid, 80% are benign, 80% are Pleomorphic Adenoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 750-755.

Question 1

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 2

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 3

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 4

Erythrophagia and Mononuclear cell infiltration ulcers are seen in which condition?

Accepted Answer

Typhoid ulcers

Answer

Necrotising colitis

Answer

Ulcerative colitis

Answer

Crohn's disease

Question 5

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

Question 6

Helicobacter pylori infection is associated with an increased risk of which of the following conditions, except?

Accepted Answer

Adenocarcinoma of the esophagus

Answer

Peptic ulcer disease

Answer

Gastric lymphoma

Answer

Antral gastric carcinoma

Question 7

Strong correlation with colorectal cancer is seen in which of the following conditions?

Accepted Answer

Familial polyposis coli

Answer

Peutz-Jeghers polyp

Answer

Juvenile polyposis

Answer

Hyperplastic polyp

Question 8

A 59-year-old man complains of progressive weakness and very dark stools. Physical examination demonstrates fullness in the right lower quadrant. Laboratory studies show iron deficiency anemia (serum hemoglobin 7.4 g/dL) and positive occult blood in stool specimens. Colonoscopy discloses an ulcerating lesion of the cecum. Which of the following serum tumor markers is most likely to be useful for monitoring this patient after surgery?

Accepted Answer

Carcinoembryonic antigen

Answer

Alpha-fetoprotein

Answer

Chorionic gonadotropin

Answer

Chromogranin

Question 9

All are true about salivary gland tumors except:

Accepted Answer

Parotid tumors are mostly malignant.

Answer

Parotid gland is the most common site of involvement.

Answer

Warthin tumor is almost always found in the parotid gland.

Answer

Minor gland tumors are mostly malignant.

Question 10

A 30-year-old male is diagnosed with Peutz-Jeghers syndrome. What findings are consistent with the diagnosis?

Accepted Answer

Hamartomas

Answer

Adenomas

Answer

Adenomatous polyps

Answer

Villoglandular polyps

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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