Tumores del Tracto Gastrointestinal

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Questions and Answers

¿Cuál es la característica más común de los tumores GIST primarios en el estómago?

Son siempre múltiples en la cavidad abdominal.

La mayoría son de tipo epitelioide.

Su diámetro puede alcanzar hasta 30 cm. (correct)

PEueden ser del tamaño de una cereza.

¿Qué tipo de células suelen originar los tumores GIST?

Células B maduras.

Células intersticiales de Cajal. (correct)

Células epiteliales regulares.

Células del estroma mesodérmico.

¿Qué porcentaje de los GISTs tiene mutaciones ganadoras en el receptor de tirosina quinasa KIT?

75% a 80%. (correct)

Casi todos los casos.

Cerca del 90%.

Menos del 50%.

¿Cómo se clasifican los GISTs que están compuestos principalmente por células alargadas delgadas?

Tipo célula fusiforme. (C) Signup and view all the answers

¿Cuál de las siguientes afirmaciones es correcta sobre las lesiones linfoepiteliales diagnosticadas?

Surgen de MALTomas de bajo grado. (C) Signup and view all the answers

¿Qué tipo de metástasis es más común en GISTs?

Hígado. (B) Signup and view all the answers

¿Qué característica histológica ayuda a diagnosticar los linfomas como MALTomas?

Positividad para CD43 en muchos casos. (B) Signup and view all the answers

¿Cómo se describe la morfología típica de un tumor GIST en su superficie cortada?

Con una apariencia en espiral. (C) Signup and view all the answers

¿Cuál es el marcador diagnóstico más útil para los GIST gástricos?

CKIT/CD117 (D) Signup and view all the answers

¿Qué características histológicas son típicas de los pólipos hiperplásicos?

Células de goblet y superficie serrada (C) Signup and view all the answers

¿Cuál de las siguientes afirmaciones describe mejor a los adenomas tubulares?

Son neoplasias con al menos displasia de bajo grado. (D) Signup and view all the answers

¿Cuál es la principal diferencia entre adenomas serrados y pólipos hiperplásicos?

Los adenomas serrados tienen potencial maligno. (C) Signup and view all the answers

¿Qué aspecto histológico es característico de los adenomas serrados tradicionales?

Citoplasma eosinofílico prominente. (B) Signup and view all the answers

¿Cuál es el tamaño mínimo de los pólipos tubulares que se considera riesgo de sangrado?

Más de 1 cm (C) Signup and view all the answers

¿Cuál de las siguientes características histológicas no está asociada con la displasia?

Células llenas de lípidos. (C) Signup and view all the answers

¿Qué característica se observa en los adenomas serrados en comparación con los pólipos hiperplásicos?

Serración a lo largo de toda la longitud de las glándulas. (A) Signup and view all the answers

¿Cuál es una característica del cáncer gástrico difuso?

Presentan células discohesivas. (D) Signup and view all the answers

¿Qué aspecto tiene la morfología del MALToma gástrico?

Un infiltrado linfocítico denso en la propria laminar. (D) Signup and view all the answers

¿Qué tipo de cáncer gástrico se asocia con la gastritis atrófica?

Cáncer gástrico intestinal. (D) Signup and view all the answers

En términos de morfología, ¿cómo se consideran las células en el cáncer gástrico difuso?

Se presentan como células en anillo de sello. (D) Signup and view all the answers

¿Cuál es la apariencia característica de linitis plastica en cáncer gástrico difuso?

Paredes gástricas rígidas y engrosadas. (C) Signup and view all the answers

¿Qué tipo de tumor gástrico tiende a formar tumores ulcerados?

Tumores con morfología intestinal. (B) Signup and view all the answers

¿Cuál de las siguientes afirmaciones sobre los adenomas tubulares es correcta?

Pueden ser precursores de cáncer gástrico. (C) Signup and view all the answers

¿Qué tipo de células se pueden confundir con células inflamatorias en el cáncer gástrico difuso?

Células mononucleares. (A) Signup and view all the answers

Study Notes

Gastrointestinal Tract Tumors

Tumours of the gastrointestinal tract are a significant health concern.
The oesophagus is a critical part of the digestive system, playing a vital role in transferring food from the mouth to the stomach.
Oesophageal tumours, specifically adenocarcinoma, often originate as a result of Barrett's oesophagus.
Increased rates of oesophageal adenocarcinoma correlate with rising incidence of obesity-related gastroesophageal reflux disease and Barrett's oesophagus.
Other risk factors include tobacco use and radiation exposure.
The majority of oesophageal adenocarcinomas occur in the distal third of the oesophagus, frequently presenting near the junction with the gastric cardia.
These tumors frequently feature glands and exhibit an intestinal-type morphology in microscopic examinations.
A lesser occurrence of infiltrative signet ring cell tumors exists in some patients.
Esophageal squamous cell carcinomas commonly affect the upper and middle esophagus parts, primarily linked to smoking and alcohol usage.
Various other risk factors may influence the development of esophageal cancer, encompassing poverty, caustic injury or other injuries, achalasia, poor diet, and Plummer Vinson syndrome.
Risk factors for esophageal cancer should be identified to implement targeted preventative measures.

Stomach: Anatomy and Histology

The stomach is a hollow organ involved in the initial stages of digestion.
Its anatomy comprises the cardia, fundus, body, and pylorus, each with a specific role.
The stomach's histology reveals distinct layers: mucosa, submucosa, muscularis externa, and serosa.
The mucosa, containing gastric glands, is essential for secretion and absorption.
The stomach's muscular layers facilitate churning and mixing of food.

Gastric Polyps

Gastric polyps are growths in the stomach lining.
Hyperplastic/inflammatory polyps typically arise in association with chronic gastritis.
These growths are usually small and numerous, exhibiting an ovoid shape and smooth surface.
Microscopically, foveolar glands in these polyps are frequently dilated and elongated while the lamina propria typically shows inflammation and possible surface ulceration.
Individuals with H. pylori gastritis may experience polyp regression after eradicating the bacteria.

Fundic Gland Polyps

Fundic gland polyps commonly arise in the stomach's fundus and body regions.
These lesions tend to exhibit a smooth surface and can be singular or multiple.
Microscopically, fundic gland polyps typically display irregular, dilated glands lined with flattened parietal and chief cells.
The development of these polyps is frequently linked to proton pump inhibitor treatment, which can alter stomach acid production.
Fundic gland polyps are typically not a cause for concern.

Gastric Adenoma

Gastric adenomas are precancerous lesions that frequently develop within the stomach's antrum.
They typically are solitary and less than 2 cm in size.
The risk for adenocarcinoma formation increases with larger lesion size, especially above 2cm in diameter.
High-grade dysplasia can be considered a more serious variant of gastric adenoma exhibiting significant cytological atypia and irregularities in glandular structure.

Gastric Adenocarcinoma

Adenocarcinoma is the prevailing stomach cancer type.
This arises frequently from a precursor lesion.
Early symptoms are often nonspecific (e.g., indigestion, nausea).
Advanced stages may show weight loss, anorexia, or bleeding.
Common metastatic sites include the sentinel lymph node and other organs.
Appropriate diagnostic procedures and management strategies are critical for minimizing complications and improving outcomes.

Gastric Lymphomas- MALT

A significant cause of stomach lymphomas is chronic gastritis, which often results from $H. pylori infection.
Commonly located in the mucosa associated lymphoid tissue of the stomach.
Lymphomas frequently display a dense lymphocytic infiltration of the lamina propria, where the neoplastic lymphocytes display infiltration into the gastric glands.
MALTomas are categorized as low-grade lymphomas and can potentially evolve into aggressive diffuse large B-cell lymphomas.
They can be identified by specific markers like B-cell markers such as CD19 and CD20 and CD43.

Gastrointestinal Stromal Tumor (GIST)

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors frequently originating in the stomach (more than half), and less commonly in the distal colon and rectum;
They're characterized by a significant portion (75-80%) harboring oncogenic mutations in the receptor tyrosine kinase KIT.
Primary gastric GISTs can attain considerable size (up to 30 cm).
GISTs are typically solitary and encased within the stomach lining.
Microscopic examination shows a notable diversity in the morphological patterns of GISTs, including spindle-cell type, epithelioid type, and mixed types.
Diagnosis relies on immunohistochemical staining using markers like CKIT/CD117.

Colon Anatomy

The human colon is a crucial component of the digestive system.
It comprises several distinct sections, chief among them being the ascending colon, transverse colon, descending colon, and sigmoid colon.

Colon Histology

Colon histology reveals distinct layers, including mucosa, submucosa, and muscularis propria.
Crypts are observed within the mucosal layer.

Colon Polyps (Hyperplastic, Sessile Serrated, and Tubular Adenomas)

Hyperplastic polyps are common, benign, non-neoplastic growths that are frequently multiple.
Sessile serrated adenomas (SSAs) are typically found in the right colon, displaying serrated architecture.
Tubular adenomas are more commonly found in the left side, characterized by packed tubular crypts.
All three subtypes have the potential to transform into cancerous lesions, emphasizing the importance of regular screening.

Adenomas—Epithelial Dysplasia

Low-grade dysplasia is a precursor to high-grade dysplasia, which, in turn, can lead to carcinoma.
Intramucosal carcinoma, where cancerous cells have invaded the lamina propria, arises from epithelial dysplasia.

Colorectal Cancer Progression, including Molecular Defects

Progression of colon polyps (adenomas) to cancer involves a molecular pathway involving mutations in important genes such as APC, KRAS, TP53, SMAD2 and 4, and MSH2 or MLH1.

Familial Adenomatous Polyposis (FAP)

A genetic predisposition often resulting in profuse, early-onset adenomatous polyps in the colorectal region.

Hereditary Non-Polyposis Colorectal Cancer (HNPCC)

A genetic susceptibility to colon cancer not associated with having numerous adenomas.
Caused by mutations in mismatch repair genes, like MLH1 and MSH2, which have implications for genetic counseling and increased risk of second primary tumors.

Appendiceal Tumors

Well-differentiated neuroendocrine tumors are the most frequent appendix tumors.
Appendix tumors are generally believed to be benign.
Mucoceles (dilated appendices) can result from obstruction.

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Description

Este cuestionario explora los tumores del tracto gastrointestinal, centrándose en el esófago y el adenocarcinoma esofágico. Se examinan factores de riesgo como la obesidad, la enfermedad por reflujo gastroesofágico y el tabaquismo. Además, se discute la morfología y presentación de estos tumores en diferentes áreas del esófago.