Gastrointestinal Pathology Practice Questions

Q: Mark the correct statement regarding inflammatory bowel disease.

Skip lesions are present in Crohn's disease. ***Skip lesions are present in Crohn's disease*** - **Skip lesions** refer to the characteristic patchy, discontinuous areas of inflammation seen in **Crohn's disease**, where affected segments of the bowel are separated by healthy areas. - This feature is a key differentiator from ulcerative colitis, which typically exhibits **continuous inflammation**. *Inflammatory bowel disease doesn't have a genetic predisposition* - **Genetic predisposition** plays a significant role in both Crohn's disease and ulcerative colitis, with multiple genes identified that increase susceptibility. - A family history of IBD is a well-established risk factor, indicating its genetic component. *Crohn's is curable through surgical resection of the affected segment* - Crohn's disease is a **chronic, relapsing condition** that can affect any part of the gastrointestinal tract, and while surgery can remove affected segments, it is not curative. - Disease often **recurs in other parts** of the GI tract even after surgical resection. *Mucosal layers are involved in Crohn's while transmural involvement seen in ulcerative colitis* - This statement is incorrect; **Crohn's disease** is characterized by **transmural inflammation** (involving all layers of the bowel wall). - **Ulcerative colitis** primarily affects the **mucosal and submucosal layers** of the large intestine.

Q: All of the following special histology stains are used to demonstrate H. pylori in gastric biopsies, except:

Fite's stain. ***Fite's stain*** - **Fite's stain** (or Fite-Faraco stain) is a modified acid-fast stain primarily used to detect **mycobacteria**, particularly **Mycobacterium leprae**, in tissue sections [2]. - It is not used for the identification of **Helicobacter pylori**. *Giemsa stain* - **Giemsa stain** is a common special stain used to visualize **Helicobacter pylori** directly in gastric biopsies due to its ability to stain the bacterial cytoplasm a characteristic **blue color**. - It works by staining the cytoplasmic and nuclear components of cells, making bacteria and inflammatory cells easily identifiable. *Modified Steiner's stain* - **Modified Steiner's stain** is a silver impregnation stain used to demonstrate spirochetes and other bacteria, including **Helicobacter pylori**, by staining them **black**. - It involves a silver solution that precipitates onto the bacterial surface, followed by a reducing agent to visualize the organisms. *Warthin-Starry stain* - The **Warthin-Starry stain** is another silver impregnation method widely employed for detecting spirochetes and bacteria like **Helicobacter pylori** in tissue [1]. - It renders the bacteria visible as **black** or dark brown structures against a pale yellow background, providing excellent contrast [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 771. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 385-386.

Q: Which of the following is true about carcinoid tumor?

Can occur throughout the gastrointestinal tract. ***Can occur throughout the gastrointestinal tract*** - Carcinoid tumors (neuroendocrine tumors) are most commonly found in the **gastrointestinal tract**, particularly in the small intestine, appendix, rectum, and stomach [2]. - They arise from **enterochromaffin cells** and can secrete various vasoactive substances. *Presentation is hypotension and diaphoresis* - The classic presentation of **carcinoid syndrome** includes episodes of **flushing**, **diarrhea**, and **bronchospasm**, often accompanied by **hypertension** rather than hypotension due to the release of serotonin and other vasoactive peptides [1]. - While diaphoresis can occur, **hypotension** is not a primary or characteristic feature. *Intestinal carcinoids are of high malignant potential* - The malignant potential of carcinoid tumors varies depending on their primary site and size but is generally considered to be of **low-to-moderate malignant potential**, particularly for appendiceal and rectal carcinoids [2]. - Liver metastases significantly increase morbidity and mortality, but many small intestinal carcinoids may grow slowly or remain localized for extended periods [1]. *Best diagnosed by elevated urinary vanillymandelic acid levels* - Elevated **urinary vanillymandellic acid (VMA)** levels are primarily used to diagnose **pheochromocytoma**, a tumor of the adrenal medulla that secretes catecholamines. - Carcinoid tumors are best diagnosed by measuring **urinary 5-hydroxyindoleacetic acid (5-HIAA)**, a breakdown product of serotonin.

Q: Which among the following parotid tumors spreads through neural sheath

Adenocystic ca. ***Adenocystic ca*** - **Adenoid cystic carcinoma** is notoriously known for its propensity for **perineural invasion**, meaning it spreads along nerve sheaths, leading to high recurrence rates and difficulty in complete eradication. - This characteristic spread pattern allows the tumor to infiltrate adjacent tissues beyond its apparent margins, often resulting in **neurological symptoms** like pain or paralysis. *Sq cell ca* - **Squamous cell carcinoma** (SCC) of the parotid gland is typically aggressive and spreads through **lymphatic and hematogenous routes**, as well as direct extension, but perineural invasion is not its primary mode of spread. - While SCC can invade nerves, it is not as defining a feature as it is for adenoid cystic carcinoma, and its aggressiveness is more often related to its rapid growth and tendency for **lymph node metastasis**. *Mixed parotid tumour* - A **mixed parotid tumor**, also known as a **pleomorphic adenoma**, is typically a **benign tumor** that grows slowly and expansively. - While a malignant transformation (carcinoma ex pleomorphic adenoma) can occur, primary mixed tumors do not spread through **neural sheaths**. *Lymphoma* - **Lymphoma** in the parotid gland is a **hematopoietic malignancy** that primarily involves lymphoid tissue. - Its spread typically occurs via the **lymphatic system** to regional lymph nodes and other lymphoid organs, rather than direct perineural invasion.

Q: Hirschsprung disease has association with which of the following conditions?

MEN 2B. ***MEN 2B*** - **Hirschsprung disease** is associated with **Multiple Endocrine Neoplasia type 2B (MEN 2B)** due to mutations in the **RET proto-oncogene** [1]. - These patients often present with **pheochromocytoma**, **medullary thyroid carcinoma**, and characteristic **mucosal neuromas** and a **marfanoid habitus**. *Von Hippel-Lindau* - This syndrome is associated with the development of **hemangioblastomas**, **pheochromocytomas**, and **renal cell carcinoma**. - It is caused by mutations in the **VHL tumor suppressor gene** and does not have a direct association with Hirschsprung disease. *MEN 2A* - **MEN 2A** is characterized by **medullary thyroid carcinoma**, **pheochromocytoma**, and **primary hyperparathyroidism**. - While also caused by **RET proto-oncogene** mutations, it typically does not present with Hirschsprung disease [1]. *MEN 1* - **Multiple Endocrine Neoplasia type 1 (MEN 1)** is associated with **tumors of the parathyroid, pituitary, and pancreas** ("3 Ps"). - This syndrome is due to mutations in the **MEN1 tumor suppressor gene** and has no known association with Hirschsprung disease.

Q: Which of the following is not true regarding Whipple's Disease ?

It has autoimmune etiology.. ***It has autoimmune etiology.*** - Whipple's disease is caused by the **bacterium *Tropheryma whipplei***, not by an autoimmune process [1]. - While there may be an underlying genetic predisposition affecting the immune response, the disease itself is a **bacterial infection** [1]. *Foamy macrophages are characteristics.* - **Foamy macrophages**, which are macrophages distended with ingested bacteria and cellular debris, are a **hallmark pathological finding** in Whipple's disease [1]. - These cells are abundant in affected tissues, particularly the small intestine lamina propria. *Bacteria laden macrophages are present in lymphatic system.* - The lymphatic system, including **lymph nodes**, is commonly involved in Whipple's disease, with **macrophages laden with *T. whipplei*** found within them [1]. - This lymphatic involvement contributes to the malabsorption and systemic symptoms of the disease [1]. *PAS positive diastase resistant granules are present.* - The bacterial remnants within the macrophages in Whipple's disease stain strongly with **Periodic Acid-Schiff (PAS) stain**. - These PAS-positive granules are **diastase-resistant**, which helps distinguish them from glycogen and other PAS-positive substances. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 798-799.

Q: Following is true about the incidence of tumors of salivary glands except -

Oncocytoma - 5%. ***Oncocytoma - 5%*** - Oncocytomas are relatively rare, accounting for **less than 1%** of all salivary gland tumors, making 5% an overestimation. - While benign, they are much less common than other benign salivary gland neoplasms such as pleomorphic adenoma and Warthin's tumor. *Warthin's tumor - 5 - 10%* - Warthin's tumor is the **second most common benign salivary gland tumor** and typically accounts for 5-10% of all salivary gland neoplasms. - This incidence rate is generally considered accurate in various epidemiological studies. *Mucoepidermoid carcinoma - 15%* - **Mucoepidermoid carcinoma** is the most common malignant salivary gland tumor, representing approximately 10-15% of all salivary gland tumors [1]. - This percentage falls within the expected range for its incidence. *Pleomorphic adenoma - 50%* - **Pleomorphic adenoma** is the most common benign salivary gland tumor, accounting for approximately 50-60% of all salivary gland tumors [1]. - The stated incidence of 50% is well within the accepted range for this type of tumor [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753.

Q: Most common tumor of submandibular gland is -

Pleomorphic adenoma. ***Pleomorphic adenoma*** - **Pleomorphic adenoma** is the most common tumor of **all salivary glands**, including the submandibular gland, accounting for **50-60% of submandibular tumors** [1]. - It is a **mixed tumor** containing epithelial and mesenchymal components [3]. - Overall, it represents 60-70% of parotid tumors and 40-60% of submandibular tumors [1]. *Oncocytoma* - **Oncocytomas** are rare benign tumors of salivary glands composed of oncocytes (cells with abundant eosinophilic, granular cytoplasm due to numerous mitochondria). - They are much less common than pleomorphic adenomas and predominantly occur in the parotid gland. *Adenolymphoma* - **Adenolymphoma**, also known as **Warthin's tumor**, is the second most common benign salivary tumor but is **almost exclusively found in the parotid gland** (>95% cases) [2]. - It is rarely seen in the submandibular gland. *Hemangioma* - **Hemangiomas** are benign vascular tumors that are more common in children and usually occur in the parotid gland. - While they can occur in the submandibular region, they are not the most common tumor type and are relatively rare overall in salivary glands. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-753. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, p. 753. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 274-276.

Q: Characteristic of amebiasis is:

Flask shaped ulcer. ***Flask shaped ulcer*** - The "flask-shaped" ulcer is a **pathognomonic lesion** of intestinal amebiasis, caused by the ***Entamoeba histolytica*** trophozoites invading the colonic mucosa [1]. - This characteristic shape results from the **pinpoint entry** through the mucosa, followed by **lateral extension** and undermining of the submucosa [1]. *Ulcers with raised margins* - Ulcers with **raised, heaped-up margins** are more characteristic of **malignant lesions**, such as neoplastic ulcers in the gastrointestinal tract. - While some inflammatory ulcers can have raised edges, the *distinct* flask shape is specific to amebiasis. *Skip lesion* - **Skip lesions** are discontinuous areas of inflammation, with sections of normal tissue in between affected areas. - This pattern is a hallmark finding in **Crohn's disease**, a type of inflammatory bowel disease, and is not typical of amebic colitis. *Longitudinal ulcer* - **Longitudinal ulcers** (ulcers that run along the length of the bowel) are commonly seen in **inflammatory bowel diseases**, particularly **Crohn's disease**. - They are often associated with fissures and deep ulcerations along the mesenteric border, distinct from the flask shape of amebic ulcers. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 364-365.

Question 1

Mark the correct statement regarding inflammatory bowel disease.

Accepted Answer

Skip lesions are present in Crohn's disease

Answer

Inflammatory bowel disease doesn't have a genetic predisposition

Answer

Crohn's is curable through surgical resection of the affected segment

Answer

Mucosal layers are involved in Crohn's while transmural involvement seen in ulcerative colitis

Question 2

A 24-year-old man presents with recurrent abdominal pain, diarrhea with fatty porridge-like stools and occasional blood up to 8 times per day, joint pain, and weight loss. Ileocolonoscopy shows regions of erythema, swelling, and cobblestone-like appearance of the ascending colon and terminal ileum. Targeted biopsies are taken for evaluation. One of the slides, which underwent histological assessment, is shown in the image. Which of the following best describes the histologic finding marked with the blue circle?

Accepted Answer

Cryptitis

Answer

Crypt ulcer

Answer

Granuloma

Answer

Epithelial cell dysplasia

Question 3

All of the following special histology stains are used to demonstrate H. pylori in gastric biopsies, except:

Accepted Answer

Fite's stain

Answer

Giemsa stain

Answer

Warthin-Starry stain

Answer

Modified Steiner's stain

Question 4

Which of the following is true about carcinoid tumor?

Accepted Answer

Can occur throughout the gastrointestinal tract

Answer

Presentation is hypotension and diaphoresis

Answer

Intestinal carcinoids are of high malignant potential

Answer

Best diagnosed by elevated urinary vanillymandelic acid levels

Question 5

Which among the following parotid tumors spreads through neural sheath

Accepted Answer

Adenocystic ca

Answer

Sq cell ca

Answer

Mixed parotid tumour

Answer

Lymphoma

Question 6

Hirschsprung disease has association with which of the following conditions?

Accepted Answer

MEN 2B

Answer

Von Hippel Lindau

Answer

MEN 2A

Answer

MEN I

Question 7

Which of the following is not true regarding Whipple's Disease ?

Accepted Answer

It has autoimmune etiology.

Answer

Bacteria laden macrophages are present in lymphatic system.

Answer

PAS positive diastase resistant granules are present.

Answer

Foamy macrophages are characteristics.

Question 8

Following is true about the incidence of tumors of salivary glands except -

Accepted Answer

Oncocytoma - 5%

Answer

Warthin's tumor - 5 - 10%

Answer

Mucoepidermoid carcinoma - 15%

Answer

Pleomorphic adenoma - 50%

Question 9

Most common tumor of submandibular gland is -

Accepted Answer

Pleomorphic adenoma

Answer

Oncocytoma

Answer

Adenolymphoma

Answer

Hemangioma

Question 10

Characteristic of amebiasis is:

Accepted Answer

Flask shaped ulcer

Answer

Ulcers with raised margins

Answer

Skip lesion

Answer

Longitudinal ulcer

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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