Gastrointestinal Pathology Practice Questions

Q: All of the following are true regarding Menetrier's disease, EXCEPT:

Exophytic growth. **Explanation:** **Menetrier’s Disease** is a rare, acquired hypertrophic gastropathy characterized by massive enlargement of the gastric rugae [1]. The correct answer is **Option B (Exophytic growth)** because Menetrier’s disease is characterized by **diffuse mucosal thickening** (resembling cerebral convolutions) rather than a localized, discrete exophytic or polypoid mass. **Analysis of Options:** * **Hypertrophy of gastric mucosa (Option C):** This is the hallmark of the disease. There is profound hyperplasia of surface mucous cells (foveolar cells), leading to the characteristic "giant rugal folds" that typically involve the body and fundus while sparing the antrum [1]. * **Protein loss (Option A):** The excessive secretion of mucus and the leakage of serum proteins across the altered epithelial junctions lead to **protein-losing enteropathy**. This clinically manifests as hypoalbuminemia and peripheral edema. * **Premalignant condition (Option D):** Menetrier’s disease is associated with an increased risk of developing **gastric adenocarcinoma** in adults (estimated risk is roughly 2–15%), necessitating regular endoscopic surveillance [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Pathogenesis:** Driven by excessive secretion of **TGF-α** (Transforming Growth Factor-alpha), which leads to overstimulation of the **EGFR** (Epidermal Growth Factor Receptor). * **Histology:** Shows "corkscrew" appearance of foveolar glands and **atrophy of parietal cells**, leading to **hypochlorhydria** (reduced acid production) [1]. * **Triad:** Giant rugal folds + Hypoalbuminemia + Hypochlorhydria. * **Pediatric cases:** Often associated with **CMV infection** and are usually self-limiting, unlike the chronic progressive course in adults [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 775-776.

Q: Which gene is involved in Gastrointestinal Stromal Tumors (GIST)?

C-KIT. **Explanation:** **1. Why C-KIT is Correct:** Gastrointestinal Stromal Tumors (GIST) are the most common mesenchymal tumors of the GI tract, arising from the **Interstitial Cells of Cajal (ICC)**—the "pacemakers" of the gut. Approximately **85-90%** of GISTs are driven by gain-of-function mutations in the **c-KIT (CD117)** proto-oncogene [1], which encodes a receptor tyrosine kinase. This mutation leads to constitutive activation of the kinase, promoting uncontrolled cell proliferation [1]. A smaller subset (approx. 5-10%) involves mutations in the **PDGFRA** gene [1]. **2. Why Other Options are Incorrect:** * **BRCA-1 & BRCA-2:** These are tumor suppressor genes involved in DNA repair (homologous recombination). Mutations are primarily associated with hereditary **Breast and Ovarian Cancer** syndromes, not mesenchymal GI tumors. * **p53:** Known as the "Guardian of the Genome," this is the most commonly mutated tumor suppressor gene in human cancers (e.g., Li-Fraumeni syndrome). While it may be involved in the progression of many tumors, it is not the primary diagnostic driver for GIST. **3. High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Marker:** **CD117** is the most sensitive and specific immunohistochemical (IHC) marker for GIST. **DOG1** (Discovered on GIST-1) is another highly specific marker. * **Morphology:** GISTs can show **Spindle cell** (most common) or **Epithelioid** patterns. * **Targeted Therapy:** The discovery of c-KIT mutations revolutionized treatment. **Imatinib mesylate** (a tyrosine kinase inhibitor) is the first-line targeted therapy for unresectable or metastatic GIST. * **Location:** The **Stomach** (60%) is the most common site, followed by the small intestine [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 782-783.

Question 1

All of the following are true regarding Menetrier's disease, EXCEPT:

Accepted Answer

Exophytic growth

Answer

Protein loss

Answer

Hypertrophy of gastric mucosa

Answer

Premalignant condition

Question 2

Which of the following is FALSE regarding Peutz-Jeghers syndrome?

Accepted Answer

Autosomal recessive inheritance

Answer

Presence of hamartomatous polyps

Answer

Presence of cutaneous pigmentation

Answer

Increased risk of developing breast, lung, and ovarian cancers

Question 3

Ectopic tissue in the stomach is most commonly of what organ's origin?

Accepted Answer

Pancreas

Answer

Spleen

Answer

Liver

Answer

Kidney

Question 4

A 50-year-old female patient complains of difficulty in swallowing. The patient has a history of multiple diagnostic CT-scans of the head and neck region. Which of the following salivary gland tumors is more likely in this patient?

Accepted Answer

Mucoepidermoid carcinoma

Answer

Pleomorphic adenocarcinoma

Answer

Adenoid cystic carcinoma

Answer

Acinic cell carcinoma

Question 5

A 35-year-old man undergoes gastrectomy for gastric carcinoma. Gross examination of the resected stomach reveals diffuse thickening without a discrete mass lesion. Microscopic examination shows an infiltration of signet-ring cells dispersed singly. Family history reveals that his father had a similar cancer at a young age. What gene is most likely to be mutated in this patient and his father?

Accepted Answer

CDH1

Answer

APC

Answer

PMS2

Answer

p53

Question 6

The most common histologic type of carcinoma of the oral cavity is?

Accepted Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Clear cell carcinoma

Answer

Large cell undifferentiated carcinoma

Question 7

Which gene is involved in Gastrointestinal Stromal Tumors (GIST)?

Accepted Answer

C-KIT

Answer

BRAC-1

Answer

p53

Answer

BRAC-2

Question 8

All of the following statements about Menetrier's disease are true EXCEPT?

Accepted Answer

Usually decreased acid secretion

Answer

It is a premalignant condition

Answer

May be confused with Zollinger Ellison Syndrome

Answer

Associated with protein-losing enteropathy

Question 9

Which of the following organs is the most common site of origin of the tumor associated with Zollinger-Ellison syndrome?

Accepted Answer

Duodenum

Answer

Lymph nodes

Answer

Spleen

Answer

Pancreas

Question 10

In Crohn's disease, which of the following findings is NOT typically seen?

Accepted Answer

Diverticulosis

Answer

Hyperplastic polyps

Answer

Fissuring ulcer

Answer

Epithelioid granuloma

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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