Sarcoma and Small Bowel Tumors Quiz

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Questions and Answers

Which of the following is the most common type of sarcoma?

  • Leiomyosarcoma (correct)
  • Angiosarcoma
  • Lymphosarcoma
  • Hemangiopericytoma

How does leiomyosarcoma typically spread?

  • Primarily through the lymphatic system
  • Primarily through the bloodstream (correct)
  • Through direct invasion of adjacent tissues
  • All of the above

What is a characteristic macroscopic feature of leiomyosarcoma?

  • Firm, rubbery texture
  • Smooth, homogenous surface
  • Areas of hemorrhage and necrosis (correct)
  • Reddish-brown color

Which of the following is a characteristic of Kaposi's sarcoma?

<p>It is a type of lymphoma. (D)</p> Signup and view all the answers

Which of the following is a characteristic of a primary malignant lymphoma of the small intestine?

<p>The absence of liver or spleen enlargement. (D)</p> Signup and view all the answers

Which of the following is true of Western-type non-Hodgkin's lymphoma?

<p>It can present as multiple tumors in different segments of the small intestine. (A)</p> Signup and view all the answers

Hemangioendoendothelioma is considered a malignant vascular tumor because:

<p>It tends to metastasize early. (C)</p> Signup and view all the answers

Which type of malignant lymphoma is most common in the small intestine?

<p>Secondary malignant lymphoma (A)</p> Signup and view all the answers

What is the most common complication of tuberculosis of the small intestine?

<p>Stenosis (B)</p> Signup and view all the answers

What is the highest frequency of occurrence of small bowel tumors?

<p>Ileum (C)</p> Signup and view all the answers

What is the most common type of small bowel tumor?

<p>Benign tumor (C)</p> Signup and view all the answers

What is a characteristic sign of the ulcero-hypertrophic form of tuberculosis of the small intestine?

<p>A peritoneal reaction that forms a plastron (B)</p> Signup and view all the answers

What is the most helpful diagnostic tool for identifying tuberculosis of the small intestine?

<p>Tissue biopsy (B)</p> Signup and view all the answers

What are the general signs of tuberculosis of the small intestine?

<p>Fever, weight loss, and abdominal pain (A)</p> Signup and view all the answers

What is the best way to manage the ulcero-hypertrophic form of tuberculosis of the small intestine?

<p>Combination of antibiotics and surgery. (A)</p> Signup and view all the answers

What is the most likely cause of small bowel tumors?

<p>Unknown (C)</p> Signup and view all the answers

What is true about the development of benign tumors in the small intestine?

<p>They are always towards the lumen of the intestine (D)</p> Signup and view all the answers

Which of the following is NOT a type of benign tumor in the small intestine?

<p>Carcinoma (C)</p> Signup and view all the answers

What is the primary purpose of hypotonic duodenography?

<p>To temporarily paralyze the duodenum and improve visualization of its mucosa. (B)</p> Signup and view all the answers

Which of these imaging techniques is particularly useful for visualizing the small bowel below the Treitz angle?

<p>Enteroclysis (A)</p> Signup and view all the answers

What is the main function of Positron Emission Tomography (PET) in the context of small bowel pathology?

<p>To visualize the metabolism associated with neoplastic tissue. (D)</p> Signup and view all the answers

What is a significant limitation of a PET scan in the diagnosis of small bowel pathologies?

<p>It cannot differentiate between malignant tissue and acute inflammation. (B)</p> Signup and view all the answers

Which type of endoscope is typically used in a 'push endoscopy' procedure?

<p>A lung endoscope or a pediatric colonoscope (D)</p> Signup and view all the answers

What is the main limitation of using an endoscopic probe?

<p>It only allows visualization, not biopsy. (D)</p> Signup and view all the answers

In cases of intestinal bleeding, which imaging technique may be used to visualize the source of the bleeding?

<p>Arteriography (B)</p> Signup and view all the answers

Why are NMR (Nuclear Magnetic Resonance) techniques used less frequently in the assessment of the small bowel?

<p>Due to interference from intestinal gas. (D)</p> Signup and view all the answers

What is the primary aim of prophylaxis in medical treatment?

<p>To provide maintenance treatment (D)</p> Signup and view all the answers

Which area of the gastrointestinal tract is most commonly affected by intestinal tuberculosis?

<p>Small intestine (C)</p> Signup and view all the answers

What is a characteristic of the hypertrophic (sclerolipomatous) form of intestinal tuberculosis?

<p>Characterized by a hyperplastic neoformation (D)</p> Signup and view all the answers

Which group is most at risk for developing intestinal tuberculosis?

<p>The elderly (A)</p> Signup and view all the answers

How does primitive intestinal tuberculosis typically arise?

<p>From eating food contaminated with bovine Koch's bacillus (C)</p> Signup and view all the answers

What is the most common morphological category of intestinal tuberculosis?

<p>Ulcerative form (A)</p> Signup and view all the answers

What occurs during the initial tubercular process in intestinal tuberculosis?

<p>Localized granulations in lymph follicles (C)</p> Signup and view all the answers

What complication is rare during ulcerative forms of intestinal tuberculosis?

<p>Perforations in the peritoneal cavity (D)</p> Signup and view all the answers

What distinguishes villous adenoma from tubular adenoma?

<p>It is characterized by a unique finger-like projection. (B)</p> Signup and view all the answers

Which of the following statements about Brünner gland adenoma is correct?

<p>It is localized especially in the duodenum. (A)</p> Signup and view all the answers

What is a common complication of leiomyoma developing from external muscle layers?

<p>Hemorrhage. (A)</p> Signup and view all the answers

What type of tumor is lipoma primarily classified as?

<p>Proliferation of connective tissue. (A)</p> Signup and view all the answers

Which of the following is associated with Peutz-Jeghers syndrome?

<p>Hamartomatous polyps. (A)</p> Signup and view all the answers

Which benign tumor can develop from Schwan's sheath of nerve fibers?

<p>Schwannoma. (B)</p> Signup and view all the answers

What is the primary characteristic of fibroids?

<p>Develop from smooth muscle. (A)</p> Signup and view all the answers

What type of adenoma is described as having a multiplicity characteristic?

<p>Polypoid adenoma. (A)</p> Signup and view all the answers

What is the treatment of choice for Mediterranean-type non-Hodgkin's lymphoma?

<p>Chemotherapy (D)</p> Signup and view all the answers

Which symptom is NOT commonly associated with Mediterranean-type non-Hodgkin's lymphoma?

<p>Joint pain (D)</p> Signup and view all the answers

What is a primary characteristic of small bowel carcinoids?

<p>Originates from chromaffin cells (D)</p> Signup and view all the answers

Which demographic is more likely to develop small bowel carcinoids?

<p>Men in their 60s (D)</p> Signup and view all the answers

What is a common microscopic feature of small bowel carcinoids?

<p>Monomorphic small cells (B)</p> Signup and view all the answers

Which type of reaction is typically seen around small bowel carcinoid tumors?

<p>Expanding fibrosis reaction (C)</p> Signup and view all the answers

What physiological effect is primarily associated with serotonin released from carcinoid tumors?

<p>Cardiovascular changes (D)</p> Signup and view all the answers

Which of the following substances is NOT typically released by carcinoid tumors?

<p>Endorphins (A)</p> Signup and view all the answers

Flashcards

Treves' Avascular Zone

A specific area in the small intestine near the junction of the ileum and cecum, characterized by a lack of blood vessels and a higher risk of complications during surgery.

Standard Examination with Barium

A radiographic technique using barium contrast to visualize the small intestine's anatomy and function.

Hypotonic Duodenography

A radiographic procedure using glucagon to temporarily relax (paralyze) the duodenum, allowing better visualization of the duodenal lining.

Enteroclazis

A technique involving the insertion of a tube (endoscope) and injecting contrast material into the small intestine, allowing for diagnosis of conditions below the Treitz angle.

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Abdominal Computer Tomography

A medical imaging method using computer-generated images to visualize the abdomen, often used to diagnose tumors in the small intestine.

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Positron Emission Tomography (PET)

A medical imaging technique using radioactive tracers to detect metabolic activity, particularly useful for identifying tumor recurrence in the small intestine.

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Push Endoscopy

A minimally invasive procedure using a long flexible tube with a camera (endoscope) inserted through the mouth to visualize the small intestine.

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Diagnostic Laparoscopy

A type of surgical intervention where the abdomen is opened to directly view and treat conditions in the small intestine.

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Prophylaxis

Treatment aimed at preventing further relapses of a disease.

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Intestinal Tuberculosis (T.I)

The development of tuberculosis specifically in the intestines.

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Primitive Intestinal TB

Type of intestinal tuberculosis where there is no known pre-existing lung TB.

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Secondary Intestinal TB

Type of intestinal tuberculosis that originates from existing TB in the lungs.

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Ulcerative form of Intestinal TB

A specific form of intestinal tuberculosis characterized by ulceration and inflammation in the small intestine.

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Hypertrophic (Sclerolipomatous) form of Intestinal TB

A form of intestinal tuberculosis that involves thickening and scarring in the intestinal lining.

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Initial Stage of Intestinal TB

The initial stage of intestinal TB, where TB bacilli are localized in the lymph follicles.

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Granulation Formation in Intestinal TB

The formation of granular tissue in the intestinal walls during intestinal TB, leading to scarring and ulceration.

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Sarcoma

A type of cancer that originates from muscle tissue, but can also occur in lymphatic tissues.

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Leiomyosarcoma

The most common type of sarcoma affecting the small intestine, found equally in men and women.

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What does leiomyosarcoma look like?

The macroscopic appearance of leiomyosarcoma, characterized by whiteness with areas of hemorrhage and necrosis.

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Hemangioendoendothelioma

A rare malignant vascular tumor that spreads rapidly, requiring immediate surgical intervention.

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Benign metastatic hemangioma

A type of vascular tumor that is histologically benign, but can metastasize, making it a malignant vascular tumor.

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Kaposi's Sarcoma

A type of malignant lymphoma that affects the small inestine in 10% of cases

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Malignant lymphoma

A malignant tumor that accounts for 10-15% of small bowel tumors.

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What does Western-type non-Hodgkin's lymphoma look like?

Involving multiple tumor masses that are separate from each other.

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Adenoma

A type of benign tumor found in the intestinal tract that arises from glandular tissue. It can be classified into three forms: polypoid adenoma, adenoma of the Brünner glands, and insular adenoma.

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Tubular Adenoma

A form of adenoma that is characterized by multiple, finger-like projections extending into the intestinal lumen. It's the most common variant of adenoma and has a potential for malignancy.

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Villous Adenoma

A form of adenoma that is characterized by larger, villous projections into the intestinal lumen. It has a higher malignancy potential compared to tubular adenoma.

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Leiomyoma (Submucosal)

A benign tumor originating from smooth muscle layers of the intestinal wall, specifically the submucosa muscle. It can cause intestinal occlusion, bleeding, and invagination.

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Leiomyoma (External)

A benign tumor originating from smooth muscle layers of the intestinal wall, but arising from external muscles. It can grow large and be palpable, often presenting with bleeding.

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Fibroid

A benign tumor consisting of excessive connective tissue proliferation, primarily localized in the submucosa. It has the potential for malignant transformation, making it a concern.

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Lipoma

A benign tumor composed mostly of fat, usually located in the distal ileum. It's typically small, single, and often discovered incidentally. There is no associated malignancy potential.

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Hamartoma

A benign tumor characterized by disorganized growth of normal tissue, often appearing as polyps. It can be single or multiple and is associated with the Peutz-Jeghers syndrome.

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Ulcero-hypertrophic intestinal tuberculosis

A specific type of intestinal tuberculosis that features a peritoneal reaction forming a fibrous mass (plastron). This mass can become infected (abscess) and lead to intestinal fistulas.

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Bacillary impregnation syndrome

The general symptoms associated with intestinal tuberculosis, often developing gradually over an extended time. They include:

  • Deteriorating overall health
  • Pale appearance
  • Weight loss
  • Low-grade fever
  • Intermittent fever spikes
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Chronic, deaf, and embarrassing pain in intestinal tuberculosis

A type of abdominal pain characteristic of intestinal tuberculosis. It's described as:

  • Persistent
  • Dull
  • Uncomfortable
  • Cramp-like in the affected area
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Diarrhea in intestinal tuberculosis

The hallmark of intestinal tuberculosis, characterized by:

  • Large bowel movements
  • Dysentery-like appearance
  • Dark color
  • Foul odor
  • Rarely, signs of fermentation
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Inflammation tests (ESHV, C-reactive protein)

A laboratory test that measures inflammation in the body. Elevated levels in intestinal tuberculosis support the diagnosis.

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CT scan in intestinal tuberculosis

A radiographic technique that provides detailed internal images of the body. In intestinal tuberculosis, it might reveal:

  • Thickening of the intestinal wall
  • Enlarged lymph nodes in the abdomen
  • Possible ulcerations
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Colonoscopy in intestinal tuberculosis

A procedure where a camera-equipped tube is inserted into the colon to visualize the lining of the digestive tract. This helps to:

  • Directly view lesions
  • Take a biopsy
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Intestinal stenosis in intestinal tuberculosis

A serious complication of intestinal tuberculosis that can lead to blockage of the intestinal tract. It occurs when the intestinal walls narrow due to the disease.

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Small bowel tumors

Tumors of the small intestine, which are relatively rare, accounting for a small percentage of all digestive tract tumors.

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Benign small bowel tumors

Tumors in the small intestine that are less aggressive than cancerous growths. They often arise from the inner layer of the intestine and grow towards the intestinal lumen.

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Mediterranean-type Non-Hodgkin's Lymphoma

A type of lymphoma that affects the intestines, characterized by the absence of healthy tissue and widespread proliferation of abnormal immune cells. This makes it a severe form of lymphoma.

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Small Bowel Carcinoid

A type of tumor that originates from cells responsible for producing hormones in the small intestine, often associated with the A.P.U.D. system, which controls hormones.

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Common Symptoms of Small Bowel Carcinoid

The most common symptoms associated with small bowel carcinoid, which often mimic those of other intestinal conditions.

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Microscopic Appearance of Small Bowel Carcinoid

The typical appearance of a small bowel carcinoid under a microscope, characterized by small, uniform cells with infrequent cell division, suggesting slow growth.

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Fibrosis and Intestinal Narrowing in Small Bowel Carcinoid

The process where the tumor causes an increase in fibrous tissue around it, which can lead to narrowing of the intestine, making it difficult for food to pass through.

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Effects of Serotonin Release in Small Bowel Carcinoid

The impact of serotonin, a substance released by the tumor, on blood vessels and other tissues. This can cause problems like abnormal heartbeats, reduced blood flow to kidneys, and scar tissue formation.

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Treatment Options for Small Bowel Carcinoid

The types of treatments used in Small Bowel Carcinoid, which aim to remove or reduce the tumor and control any spread.

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Serotonin and Its Role in Small Bowel Carcinoid

A substance secreted by the tumor and other cells, but found in elevated levels in Small Bowel Carcinoid. This substance can cause problems like changes in blood pressure and heart rate, and can affect the body's ability to filter waste.

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Study Notes

Surgical Pathology of the Small Bowel

  • Divided into duodenum, jejunum, and ileum, 4-7 meters long.
  • Attached to the rear wall by mesentery (15-18 cm).
  • Contains blood vessels like the superior mesenteric artery and vein.

Paraclinical Exploration

  • Radiologic: Barium exams, hypotonic duodenography for duodenal visualization.
  • Enteroclazis: Contrast infusion to detect tumors or bleeding.
  • CT & PET: Detect tumors and metastasis.
  • Endoscopy: Examines small intestine, no biopsy.
  • Arteriography: For intestinal bleeding.
  • Ultrasound & NMR: Diagnostic tools, less common for small bowel.
  • Laparoscopy: Surgical diagnostic tool.

Small Bowel Diverticula

  • Small pouch-like wall extensions; congenital (young) or acquired (older).
  • Caused by increased intraluminal pressure.

Meckel's Diverticulum

  • Embryonic remnant in the ileum, often asymptomatic.
  • Complications: pain, hemorrhage, inflammation, obstruction.

Crohn's Disease

  • Granulomatous inflammation, often in the terminal ileum.
  • Epidemiology: Most common small bowel disorder, affects young adults.
  • Complications: Occlusion, perforation, abscess, fistulas.
  • Treatment: Symptomatic treatment, surgery for complications.
  • Prognosis: Poor due to complications.

Intestinal Tuberculosis

  • Caused by tuberculous infection, common in immunocompromised.
  • Signs: Weight loss, fever, diarrhea.
  • Treatment: Tuberculostatic drugs, surgery for complications.

Small Bowel Tumors

  • Benign: Adenomas, leiomyomas, fibroids, lipomas.
  • Malignant: Adenocarcinomas, lymphomas, sarcomas.
  • Carcinoid tumors: Neuroendocrine, release serotonin, cause carcinoid syndrome.
  • Diagnosis: Imaging, endoscopy, biopsy.
  • Treatment: Surgery, chemotherapy for advanced cases.

Prognosis

  • Early detection improves prognosis; complications lead to worse outcomes.

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