Gastrointestinal Pathology Practice Questions

Q: What is the most common type of tumour of Vermiform Appendix?

Carcinoid tumour. ***Carcinoid tumour*** - **Carcinoid tumors** (neuroendocrine tumors) are the **most common primary neoplasms of the appendix**, accounting for approximately 30-50% of all appendiceal tumors. [1] - They typically originate from the **enterochromaffin cells** in the appendiceal mucosa and are often discovered incidentally during appendectomy for suspected appendicitis. - Most appendiceal carcinoids are **small (<2 cm), benign, and located at the tip** of the appendix. [1] *Adenocarcinoma* - **Adenocarcinomas** are the second most common primary tumor of the appendix, representing about 10-20% of cases. - These **epithelial malignancies** include mucinous and non-mucinous subtypes and can present with symptoms mimicking acute appendicitis. - Mucinous adenocarcinomas may lead to **pseudomyxoma peritonei** if they rupture. *Germ cell tumour* - **Germ cell tumors** are exceptionally rare in the appendix and more commonly arise from the gonads (testes, ovaries) or midline structures. - These tumors originate from **pluripotent germ cells** and are not a significant consideration for appendiceal neoplasms. *Papillary cell tumour* - This term describes a **morphological growth pattern** (papillary architecture) rather than a specific primary tumor classification. - While some epithelial tumors may exhibit papillary features, this is **not a recognized primary tumor type** of the appendix. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 375-376.

Q: Melanosis coli, which occurs due to long term consumption of stimulant laxatives, presents as brown discolouration of colonic mucosa due to deposition of which one of the following pigments?

Lipofuscin. ***Lipofuscin*** - **Melanosis coli** is characterized by the accumulation of **lipofuscin** in macrophages within the lamina propria of the colon. - This accumulation is typically induced by the long-term use of **stimulant laxatives**, particularly those containing anthraquinones (e.g., senna, cascara). *Haemoglobin* - **Haemoglobin** is the protein in red blood cells responsible for oxygen transport and does not deposit in the colonic mucosa to cause brown discoloration in melanosis coli. - Its presence in stool typically indicates **gastrointestinal bleeding**, which is a distinct condition from melanosis coli. *Haemosiderin* - **Haemosiderin** is an iron-storage complex that can accumulate in tissues as a result of **hemorrhage** or increased iron load [1]. - While it can cause brown discoloration, it is not the pigment responsible for the characteristic appearance of melanosis coli. *Melanin* - **Melanin** is the pigment primarily responsible for skin and hair color, produced by melanocytes [1]. - It is not found in significant amounts in the colonic mucosa and is not involved in the pathogenesis of melanosis coli. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 75.

Q: Which of the following statements are correct with regard to Familial Adenomatous Polyposis ? 1. It is associated with mutation of APC gene located on the long arm of chromosome 5. 2. It is inherited as an autosomal recessive condition. 3. It is associated with 100% lifetime risk for development of Colorectal carcinoma. 4. Congenital hypertrophy of retinal pigment epithelium is present in half of the cases of familial adenomatous polyposis. Select the correct answer using the code given below :

1, 3 and 4. ***1, 3 and 4*** - Familial Adenomatous Polyposis is indeed associated with a mutation in the **APC gene** located on the **short arm of chromosome 5 (5q21-q22)** and carries a **nearly 100% lifetime risk** of developing colorectal carcinoma if left untreated [1]. - **Congenital hypertrophy of the retinal pigment epithelium (CHRPE)**, also known as bear claw lesions, is a characteristic extracolonic manifestation observed in approximately half of FAP patients, though it does not usually affect vision. *1, 2 and 3* - This option is incorrect because FAP is inherited as an **autosomal dominant** condition, not autosomal recessive. - Statement 2, claiming autosomal recessive inheritance, is false, rendering this combination incorrect. *2, 3 and 4* - This option incorrectly states that FAP is inherited as an **autosomal recessive** condition. It is an autosomal dominant disorder. - While statements 3 and 4 are correct, the inclusion of statement 2 makes this option invalid. *1, 2 and 4* - This option is incorrect due to the assertion that FAP is an **autosomal recessive** condition (statement 2). - FAP is correctly linked to the APC gene mutation (statement 1) and CHRPE (statement 4), but the inheritance pattern given here is wrong. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822.

Q: Which one of the following is correct regarding Gastrointestinal Stromal Tumour (GIST)?

50% arise from stomach.. ***50% arise from stomach.*** - The stomach is the most common primary site for GISTs, accounting for approximately **50-60% of cases**. [1] - Other common sites include the small intestine (25-30%), colon/rectum (5%), and esophagus (<5%). *The male to female ratio is 9 : 1.* - GISTs show **no significant gender predominance**, with the male-to-female ratio being roughly 1:1. - While some gastrointestinal cancers have gender disparities, GISTs affect both sexes almost equally. *Lymphatic spread is seen commonly.* - GISTs rarely spread via the **lymphatic system**; lymphatic metastases are uncommon. - The primary routes of GIST metastasis are **hematogenous** spread, commonly to the liver, and direct seeding within the peritoneal cavity. *It arises from epithelial layer.* - GISTs are **mesenchymal tumors**, specifically believed to originate from the **interstitial cells of Cajal** or their precursor cells. [1] - These cells are found in the muscularis propria layer of the gastrointestinal tract, not the epithelial layer. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 782-784.

Q: The following statements regarding small bowel tuberculosis are correct except

The strictures are common in the ulcerative type. ***The strictures are common in the ulcerative type*** - While both ulcerative and hyperplastic types of small bowel tuberculosis can lead to complications, **strictures are more characteristic of the hyperplastic type**. - In the **hyperplastic form**, chronic inflammation, fibrosis, and granuloma formation cause wall thickening and luminal narrowing, resulting in strictures. *There are two types : ulcerative and hyperplastic* - This statement is correct. Small bowel tuberculosis is broadly classified into **ulcerative** and **hyperplastic** forms, with mixed types also occurring. - The type is often determined by the interplay between the virulence of the organism and the host's immune response. *In the ulcerative type, the bowel serosa is studded with tubercles* - This statement is correct. The **ulcerative type** is often associated with the **spread of infection to the serosa**, leading to the formation of visible **tubercles**. - This indicates more extensive disease and possible peritoneal involvement. *The ulcerative type occurs when the virulence of the organism is greater than the host defence* - This statement is correct. The **ulcerative form** is often observed when the **organism's virulence is high** and/or the host's **immune response is weak**, leading to destructive lesions. - This imbalance results in caseating necrosis and ulceration of the bowel wall.

Q: Acinic cell carcinoma is found in

salivary glands. ***salivary glands*** - **Acinic cell carcinoma** is a rare malignant tumor that primarily arises in the **major salivary glands**, most commonly the **parotid gland** [1]. - Its name derives from its histologic resemblance to **serous acinar cells**, which are characteristic of salivary gland tissue. *breast* - While various carcinomas occur in the breast, **acinic cell carcinoma** is not a primary breast cancer type [2]. - Breast cancers originate from **ductal** or **lobular epithelial cells** [2]. *thyroid* - Thyroid cancers include **papillary**, **follicular**, **medullary**, and **anaplastic carcinomas**, which originate from thyroid follicular or parafollicular cells. - **Acinic cell carcinoma** is not a recognized type of thyroid malignancy. *stomach* - The stomach is susceptible to **adenocarcinomas**, particularly **intestinal** and **diffuse types**, as well as other less common tumors. - **Acinic cell carcinoma** is not found as a primary tumor in the stomach. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1059-1060.

Q: In Crohn’s disease all are true except:

Crypt abscess are common. Crypt abscess are common - **Crypt abscesses** are a characteristic histological feature of **ulcerative colitis**, not Crohn's disease [1]. - In Crohn's disease, the inflammation is typically **transmural** and characterized by **non-caseating granulomas**, not crypt abscesses [1]. Full thickness bowel involvement - Crohn's disease is characterized by **transmural inflammation**, meaning it affects all layers of the intestinal wall, from the mucosa to the serosa. - This **full-thickness involvement** leads to complications such as strictures, fistulas, and abscesses [1]. Can occur anywhere in GIT - Crohn's disease can affect **any part of the gastrointestinal tract**, from the mouth to the anus, often with skip lesions [2]. - This widespread potential involvement contrasts with ulcerative colitis, which is typically confined to the colon and rectum [2]. Fistula formation is common - Due to the **transmural inflammation** in Crohn's disease, the inflamed bowel wall can penetrate into adjacent organs or tissues, leading to the formation of **fistulas**. - These can be entero-enteric, entero-cutaneous, perianal, or even enterovesical [2].

Q: Which of the statements regarding Salivary gland neoplasms are correct? 1. 80–90% of parotid tumors are benign 2. 90% of sublingual gland tumors are malignant 3. 60–70% of submandibular gland tumors are benign 4. Parotid gland is most common site for salivary gland tumors Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - The statement that **80–90% of parotid tumors are benign** is correct; pleomorphic adenoma is the most common benign tumor, and approximately 80% of parotid tumors are benign [1]. - The statement that **90% of sublingual gland tumors are malignant** is correct; sublingual gland tumors have the highest malignancy rate (70-90%) among major salivary glands [1]. - The statement that **60–70% of submandibular gland tumors are benign** is correct; approximately 50-65% of submandibular tumors are benign [1]. - Statement 4, while factually accurate that the parotid is the most common site, when combined with the other three statements may create ambiguity in the context of this specific question stem [1]. *2, 3 and 4* - This option incorrectly excludes statement 1, which accurately reflects that **80–90% of parotid tumors are benign** [1]. - While statements 2, 3, and 4 are individually correct, omitting the well-established benign predominance of parotid tumors makes this combination incomplete. *1, 2 and 4* - This option incorrectly excludes statement 3 about **submandibular gland tumors**, which correctly states that 60–70% are benign [1]. - The submandibular gland malignancy rate is an important epidemiological fact that should not be omitted. *1, 3 and 4* - This option incorrectly excludes statement 2 about **sublingual gland tumors having 90% malignancy** [1]. - The high malignancy rate of sublingual tumors is a crucial high-yield fact for salivary gland pathology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 750-755.

Question 1

What is the most common type of tumour of Vermiform Appendix?

Accepted Answer

Carcinoid tumour

Answer

Germ cell tumour

Answer

Adenocarcinoma

Answer

Papillary cell tumour

Question 2

Melanosis coli, which occurs due to long term consumption of stimulant laxatives, presents as brown discolouration of colonic mucosa due to deposition of which one of the following pigments?

Accepted Answer

Lipofuscin

Answer

Haemoglobin

Answer

Haemosiderin

Answer

Melanin

Question 3

Which of the following statements are correct with regard to Familial Adenomatous Polyposis ?

1. It is associated with mutation of APC gene located on the long arm of chromosome 5.
2. It is inherited as an autosomal recessive condition.
3. It is associated with 100% lifetime risk for development of Colorectal carcinoma.
4. Congenital hypertrophy of retinal pigment epithelium is present in half of the cases of familial adenomatous polyposis.

Select the correct answer using the code given below :

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 2 and 4

Question 4

Which one of the following is correct regarding Gastrointestinal Stromal Tumour (GIST)?

Accepted Answer

50% arise from stomach.

Answer

The male to female ratio is 9 : 1.

Answer

Lymphatic spread is seen commonly.

Answer

It arises from epithelial layer.

Question 5

The following disorders are predisposing conditions for carcinoma of the colon except

Accepted Answer

Escherichia coli

Answer

Villous adenoma

Answer

Familial polyposis coli

Answer

Peutz-Jeghers syndrome

Question 6

The following statements regarding small bowel tuberculosis are correct except

Accepted Answer

The strictures are common in the ulcerative type

Answer

There are two types : ulcerative and hyperplastic

Answer

In the ulcerative type, the bowel serosa is studded with tubercles

Answer

The ulcerative type occurs when the virulence of the organism is greater than the host defence

Question 7

Which one of the following is not a premalignant condition for colon cancer?

Accepted Answer

Sporadic hamartomatous polyps

Answer

Ulcerative colitis

Answer

Villous adenoma

Answer

Familial adenomatous polyposis coli

Question 8

Acinic cell carcinoma is found in

Accepted Answer

salivary glands

Answer

breast

Answer

thyroid

Answer

stomach

Question 9

In Crohn’s disease all are true except:

Accepted Answer

Crypt abscess are common

Answer

Full thickness bowel involvement

Answer

Can occur anywhere in GIT

Answer

Fistula formation is common

Question 10

Which of the statements regarding Salivary gland neoplasms are correct?

1. 80–90% of parotid tumors are benign
2. 90% of sublingual gland tumors are malignant
3. 60–70% of submandibular gland tumors are benign
4. Parotid gland is most common site for salivary gland tumors

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

2, 3 and 4

Answer

1, 2 and 4

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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