Gastrointestinal Pathology Practice Questions

Q: A 40-year-old immunocompromised patient develops multiple ulcers in the esophagus leading to painful swallowing. The biopsy from the esophagus is shown below. What is the diagnosis?

CMV. ***CMV*** - **CMV esophagitis** shows characteristic **owl-eye intranuclear inclusions** in endothelial and stromal cells on histopathology, which is pathognomonic for CMV infection. - Common in **immunocompromised patients** (HIV, transplant recipients) presenting with **odynophagia** and multiple deep esophageal ulcers. *Candida* - Histopathology shows **pseudohyphae** and **budding yeast forms** invading the superficial squamous epithelium, not intranuclear inclusions. - Typically presents with **white plaques** on endoscopy rather than deep ulcerative lesions described in this case. *Eosinophilic esophagitis* - Characterized by **eosinophilic infiltration** (>15 eosinophils per high-power field) in the epithelium with **microabscesses**. - Usually occurs in **atopic individuals** with food allergies, not typically in immunocompromised patients with infectious etiology. *Herpes* - Shows **multinucleated giant cells** with **Cowdry A intranuclear inclusions** specifically in the **squamous epithelium**, not in stromal cells. - **HSV esophagitis** typically causes **vesicular lesions** that progress to shallow ulcers, different from the deep ulcerative pattern of CMV.

Q: Collar Button Ulcer is a feature of which condition?

Ulcerative colitis. **Explanation:** **Ulcerative Colitis (UC)** is the correct answer. The "Collar Button Ulcer" is a classic radiological and pathological feature of UC. It occurs when the inflammatory process causes deep ulceration that penetrates through the mucosa and spreads laterally into the submucosa [1]. On a barium enema, the narrow neck (at the mucosa) and the wide base (in the submucosa) resemble a shirt stud or a collar button. **Analysis of Incorrect Options:** * **Crohn’s Disease:** Characterized by "Cobblestone appearance" due to linear, fissuring ulcers and "Creeping fat." It involves transmural inflammation, but the specific collar-button morphology is not a hallmark. * **Ischaemic Colitis:** Typically presents with "Thumbprinting" on imaging, which represents submucosal edema and hemorrhage, usually at splenic flexure (Griffith’s point). * **Sigmoid Volvulus:** A surgical emergency characterized by a "Coffee bean sign" or "Omega sign" on X-ray due to the twisting of the sigmoid colon. **NEET-PG High-Yield Pearls for Ulcerative Colitis:** 1. **Distribution:** Always involves the rectum (Rectal sparing is seen in Crohn's) and spreads proximally in a continuous fashion [1]. 2. **Microscopy:** Crypt abscesses (neutrophils in crypt lumens) and Crypt distortions. 3. **Lead Pipe Colon:** Loss of haustrations in chronic cases due to mucosal thickening and longitudinal muscle contraction. 4. **Pseudopolyps:** Formed by regenerating mucosal islands amidst areas of ulceration. 5. **Complications:** Toxic megacolon and a significantly higher risk of Adenocarcinoma compared to Crohn's. 6. **Serology:** p-ANCA positive (whereas Crohn's is often ASCA positive). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 367-368.

Q: All of the following predispose to carcinoma of the stomach except?

Gastric erosion. **Explanation:** The development of gastric carcinoma is a multi-step process often involving chronic mucosal inflammation and precancerous lesions. **Why Gastric Erosion is the Correct Answer:** **Gastric erosions** are superficial mucosal defects that do not penetrate the *muscularis mucosae*. They are typically acute lesions caused by NSAIDs, alcohol, or severe physiological stress (e.g., Curling’s or Cushing’s ulcers). Because they heal rapidly without significant architectural remodeling or intestinal metaplasia, they carry **no malignant potential**. **Analysis of Incorrect Options (Precancerous Conditions):** * **Menetrier's Disease:** A hyperplastic gastropathy characterized by giant mucosal folds and protein loss. It carries a **10-15% risk** of transforming into adenocarcinoma due to excessive TGF-alpha expression. * **Chronic Gastritis:** Specifically **Chronic Atrophic Gastritis** (often due to *H. pylori* or Autoimmune Gastritis) leads to intestinal metaplasia and dysplasia, which are the hallmarks of the Correa pathway of gastric carcinogenesis. * **Gastric Polyps:** While most are benign, **Adenomatous polyps** have a high malignant potential (up to 40%). Even hyperplastic polyps, if larger than 2 cm, carry a small risk. **NEET-PG High-Yield Pearls:** * **Most common site** for gastric cancer: Antrum (though GE junction incidence is rising). * **Blood Group A** is associated with an increased risk of gastric cancer. * **Sister Mary Joseph Nodule:** Umbilical metastasis (common in gastric CA). * **Virchow’s Node:** Left supraclavicular lymphadenopathy. * **Krukenberg Tumor:** Metastasis to the ovaries (signet ring cells). * **Irish Node:** Left axillary lymph node involvement.

Question 1

A 40-year-old immunocompromised patient develops multiple ulcers in the esophagus leading to painful swallowing. The biopsy from the esophagus is shown below. What is the diagnosis?

Accepted Answer

CMV

Answer

Candida

Answer

Eosinophilic esophagitis

Answer

Herpes

Question 2

Which of the following statements about ulcerative colitis (UC) and colon carcinoma is FALSE?

Accepted Answer

The overall risk of carcinoma is less than 5%.

Answer

The risk of carcinoma increases with the duration of UC.

Answer

Cancer of the rectum is more common than that of the colon in UC.

Answer

Surgery is indicated if biopsy shows severe epithelial dysplasia.

Question 3

Which one of the following conditions commonly predisposes to colonic carcinoma?

Accepted Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Diverticular disease

Answer

Ischaemic colitis

Question 4

Jejunal biopsy is diagnostic in which of the following conditions?

Accepted Answer

Whipple's disease

Answer

Giardiasis

Answer

Tropical sprue

Answer

Radiation enteritis

Question 5

A 70-year-old man presents with fatigue, weight loss, abdominal pain, and blood in the stools. A complete blood count reveals anemia with hemoglobin of 10 g/dL. A colonoscopy and subsequent colonic biopsy reveal adenocarcinoma. Which of the following is the most likely predisposing lesion or disorder that led to this malignancy?

Accepted Answer

Tubular adenoma

Answer

Familial adenomatous polyposis syndrome

Answer

Hyperplastic polyp

Answer

Hereditary nonpolyposis colorectal cancer syndrome

Question 6

The APC gene is involved in which of the following conditions?

Accepted Answer

Colorectal carcinoma

Answer

Gastric carcinoma

Answer

Gastric lymphoma

Answer

Esophageal adenocarcinoma

Question 7

Collar Button Ulcer is a feature of which condition?

Accepted Answer

Ulcerative colitis

Answer

Crohn's Disease

Answer

Ischaemic Colitis

Answer

Sigmoid Volvulus

Question 8

All of the following predispose to carcinoma of the stomach except?

Accepted Answer

Gastric erosion

Answer

Menetrier's disease

Answer

Chronic gastritis

Answer

Gastric polyp

Question 9

What is the most common site of cancer in the stomach?

Accepted Answer

Antrum

Answer

Greater curvature

Answer

Lesser curvature

Answer

Fundus

Question 10

Greater risk of transformation into carcinoma is seen in:

Accepted Answer

Intestinal metaplasia

Answer

Prepyloric ulcer

Answer

Intestinal hyperplasia

Answer

Intestinal hypertrophy

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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