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Neoplasms Path WQ18 Exam 2 IN PROGRESS (Appendix (Acute appendicitis …

- - - - Epithelial dysplasia
        
        Malignancy:
        
        SIZE = most important characteristic
        
        4cm polyps = 50% have cancer
        
        Treatment:
        Colonoscopic removal of polyps
        Prevention:
        SCREENING
        
        Recommended for adults aged 60-75
        (younger with risk factors)
    - - FULL LENGTH of crypts
        
        Basal dilation
        
        Lateral growth
    - - Solitary Rectal Ulcer Syndrome
        
        Rectal bleeding
        
        Mucus discharge
        
        Polyp in anterior rectal wall
    - - Juvenile
        
        Syndromic =
        Juvenile Polyposis Syndrome
        
        Some polyps = dysplasia
        
        Molecular basis:
        
        Mutations in TGF-B pathway that downregulate proliferations by MYC, CDK4
        
        TGF-B receptor = BMPR1A
        
        Transduction protein = SMAD-4
        
        Young children
        
        Symptoms:
        
        Multiple polyps
        
        GI bleeding
        
        10-50% lifetime risk for GI cancers
        
        Sporadic
        
        Usually in rectum --> rectal bleeding
        
        Solitary = retention polyp
        
        Young children <5
      - Peutz- Jeghers
        
        Caused by: bowel obstruction due to intussusception
        
        Molecular basis:
        
        STK11 (serine/Threonine Kinase 11) mutation
        
        Tumor suppressor gene
        
        Older child (6-18 years)
        
        Symptoms:
        Mucocutaneous hyperpigmentation :star:
        
        LIPS + ORAL MUCOSA 👄
        
        Diagnosis:
        "Christmas Tree Polyps" :star:
        
        Arborizing pattern of glands with bands
        of disorganized muscularis mucosa
        
        VERY HIGH RISK OF CANCER
      - Cowden Syndrome
        Molecular basis:
        
        PTEN
        
        Tumor suppressor gene - inhibits
        PI3K/AKT of RAS (PI3K --> AKT --> mTOR --> MYC --> Cyclin)
        
        Symptoms:
        
        Macrocephaly
        
        Benign skin tumors
        
        Learning disabilities
        
        Intestinal polyps, fibroids
        
        Cancers = breast, thyroid, endometrium
      - Cronkhite-Canada syndrome
        Acquired mutation in LATE adulthood
        
        Symptoms: TRIAD 3️⃣
        
        Alopecia
        
        Nail atrophy💅🏻
        
        Hyperpigmentation 🖐🏿
        
        Also: diarrhea/GI complaints :poop:
        
        FATAL in up to 50%
        
        Older adult,
        Japanese
    - - MAP syndrome
      - Symptoms:
        
        THOUSANDS colorectal adenomatous polyps
        
        HIGH risk for colon cancer
      - Teenagers
      - Attenuated FAP
        APC is partially functional
        
        Older adults, 40-50
      - Gardner syndrome
      - Turcot syndrome
    - - Older adults, males
      - Irregular tufting of epithelium -->
        serrated (sawtoothed) contour
        
        UPPER 1/3 of crypt
    - - Pedunculated = pedicle, stalk
      - Tubular
      - Villous
      - Sessile = raised, broad based
      - Non-neoplastic
        
        Benign with no malignant potential
      - Neoplastic/Adenoma
        
        Bening with malignant potential
      - Malignant
  - - - RIGHT SIDED
        Grows as raised lesion INTO lumen
        --> ANEMIA (occult loss of blood)
        
        Work up iron deficiency anemia for
        COLON CANCER
      - LEFT SIDED
        Grows circumferentially (napkin ring) -->
        obstructive symptoms predominate
      - Diagnosis:
        
        Endoscopy with biopsy = GOLD STANDARD
        
        Screen of general population = age 50 (earlier if first degree relative with colon cancer)
        
        TNM staging:
        
        0 = in situ
        
        1 = invades submucosa
        
        2 = through muscularis propria
        
        3 = node metastasis
        
        4 = distant metastasis
      - Most common metastasis = LIVER
      - Treatment:
        
        Surgery
        
        Chemo
        
        Radiation
        
        CEA (oncofetal marker) to assess treatment results + monitor for recurrence
- - - - Treatment:
        
        Increase fiber, hydration
        
        Hemorrhoidectomy
- - - - Complications:
        
        Rupture --> peritonitis
        
        Guarding and rebound tenderness on exam
        
        MOST COMMON cause of acute abdomen
        
        Treatment:
        
        Appendectomy (laparoscopically)
        
        Conservative antibiotics
  - - - Mucosal hyperplasia
    - - Mucinous cystadenocarcinoma
      - Low grade mucinous neoplasm
      - Complication: Pseudomyxoma peritonei
        Rupture/invasion through serosa of appendix --> implant onto peritoneum --> secrete mucin into peritoneal cavity -->
        MUCINOUS ASCITES
        
        FATAL ☠️
        
        Bowel obstructions due to fibrosis/adhesions
        
        Peritoneal adenomucinosis:
        Peritoneal neoplasm of mucin + fibrosis
        
        Minimal cytologic atypia/mitoses
        
        Low grade tumor/adenoma
        
        BETTER PROGNOSIS
        
        Peritoneal mucinous carcinoma:
        
        Proliferative epithelium/glands/nests/cells with MARKED cytologic atypia
        
        MUCINOUS adenocarcinoma
        
        WORSE PROGNOSIS 👎🏼
  - - - Symptoms of Carcinoid Syndrome:
        
        Flushing
        
        Sweating
        
        Bronchospasm
        
        Diarrhea
        
        Endocardial/valvular fibrosis with valvular malfunction
      - Diagnosis:
        
        Carcinoid syndrome
        
        Carcinoid heart disease
        
        High urinary 5HIAA
        
        Plasma chromagranin A
    - - Appendix
        
        Common
      - Rectum
    - - Gastric
      - Small intestine
      - Colon