Gastrointestinal Pathology Practice Questions

Q: Mallory-Weiss syndrome is characterized by a longitudinal tear occurring at which location?

Gastric cardia. **Explanation:** **Mallory-Weiss Syndrome (MWS)** is characterized by superficial longitudinal mucosal lacerations caused by severe vomiting, retching, or coughing (typically associated with chronic alcoholism or eating disorders). 1. **Why Gastric Cardia is Correct:** While the tears are often described as occurring near the gastro-oesophageal junction (GOJ), they are anatomically most frequent on the **gastric side of the junction (Gastric Cardia)** [1]. The mechanism involves a sudden increase in intra-abdominal pressure against a closed glottis, causing the gastric contents to overwhelm the cardia, leading to linear stretching and tearing of the mucosa. 2. **Analysis of Incorrect Options:** * **Oesophageal mucosa:** While the tear can extend into the distal oesophagus, the primary site of initiation and the most common location identified on endoscopy is the gastric cardia. * **Gastro-oesophageal junction:** This is a common distractor. Although the tears occur *across* or *near* the GOJ, standard pathology textbooks (like Robbins) specify that they are most commonly located in the proximal gastric mucosa. * **Gastroduodenal junction:** This area is unrelated to MWS; it is the site for peptic ulcers or Brunner gland pathology. 3. **NEET-PG High-Yield Pearls:** * **Clinical Presentation:** Painless hematemesis (usually follows an episode of non-bloody vomiting). * **Prognosis:** Most cases (80-90%) heal spontaneously without surgical intervention. * **Contrast with Boerhaave Syndrome:** MWS is a **mucosal/submucosal tear** (incomplete), whereas Boerhaave is a **transmural rupture** (complete) of the distal oesophagus, presenting with excruciating chest pain and mediastinitis. * **Association:** Frequently associated with hiatal hernias. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 346-347.

Q: Invasion of the perineural space is a characteristic feature of which of the following tumors?

Adenoid cystic carcinoma. ### Explanation **Correct Answer: D. Adenoid cystic carcinoma** **Why it is correct:** Adenoid cystic carcinoma (ACC) is notorious for its **neurotropic spread**, meaning it has a high propensity for **perineural invasion (PNI)**. The tumor cells track along the nerve sheaths, often extending far beyond the visible margins of the tumor. This characteristic explains several clinical features of ACC: * **Pain:** Early onset of pain is common due to nerve involvement. * **Nerve Palsy:** Facial nerve paralysis is a frequent presenting sign in parotid ACC. * **Skip Lesions:** The tumor can "jump" along the nerve, leading to high rates of local recurrence even after surgical excision. **Why the other options are incorrect:** * **A. Pleomorphic adenoma:** This is the most common *benign* salivary gland tumor. While it can have an irregular pseudocapsule, it does not invade nerves. * **B. Warthin’s tumor:** Also known as Papillary Cystadenoma Lymphomatosum, this is a *benign* tumor almost exclusively found in the parotid gland. It is associated with smoking and is often bilateral, but it is non-invasive. * **C. Mucoepidermoid carcinoma:** This is the most common *malignant* salivary gland tumor. While it is invasive, its hallmark is the presence of mucus-secreting, epidermoid, and intermediate cells. It does not show the same characteristic affinity for perineural spaces as ACC. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site for ACC:** Minor salivary glands (especially the palate). * **Histology:** Classic **"Swiss-cheese" appearance** (Cribriform pattern) is the most common histological subtype. * **Metastasis:** ACC is known for **distant metastasis to the lungs** (hematogenous spread), which can occur many years after the primary treatment. * **Prognosis:** It has a slow clinical course but a poor long-term prognosis due to late recurrences.

Q: A 40-year-old immunocompromised patient develops multiple ulcers in the esophagus leading to painful swallowing. The biopsy from the esophagus is shown below. What is the diagnosis?

CMV. ***CMV*** - **CMV esophagitis** shows characteristic **owl-eye intranuclear inclusions** in endothelial and stromal cells on histopathology, which is pathognomonic for CMV infection. - Common in **immunocompromised patients** (HIV, transplant recipients) presenting with **odynophagia** and multiple deep esophageal ulcers. *Candida* - Histopathology shows **pseudohyphae** and **budding yeast forms** invading the superficial squamous epithelium, not intranuclear inclusions. - Typically presents with **white plaques** on endoscopy rather than deep ulcerative lesions described in this case. *Eosinophilic esophagitis* - Characterized by **eosinophilic infiltration** (>15 eosinophils per high-power field) in the epithelium with **microabscesses**. - Usually occurs in **atopic individuals** with food allergies, not typically in immunocompromised patients with infectious etiology. *Herpes* - Shows **multinucleated giant cells** with **Cowdry A intranuclear inclusions** specifically in the **squamous epithelium**, not in stromal cells. - **HSV esophagitis** typically causes **vesicular lesions** that progress to shallow ulcers, different from the deep ulcerative pattern of CMV.

Question 1

A non-caseating granuloma is seen in which of the following conditions?

Accepted Answer

Crohn's disease

Answer

Tropical sprue

Answer

Celiac sprue

Answer

Ulcerative colitis

Question 2

Which of the following is NOT associated with gastric carcinoma?

Accepted Answer

Blood group B

Answer

H. pylori infection

Answer

Smoking

Answer

Nitrates

Question 3

A 45-year-old alcoholic male with a history of hypertension presents with hematemesis and hypotension. He denies any history of vomiting nonblood material or retching prior to vomiting blood. Based on his history and physical findings, which of the following is most likely to be revealed in a histologic section from his esophagus?

Accepted Answer

Dilated blood vessels in the submucosa

Answer

Columnar epithelium in the distal esophagus

Answer

Decreased ganglion cells in the myenteric plexus

Answer

Mucosal outpouchings in the distal esophagus

Question 4

Mallory-Weiss syndrome is characterized by a longitudinal tear occurring at which location?

Accepted Answer

Gastric cardia

Answer

Oesophageal mucosa

Answer

Gastro-oesophageal junction

Answer

Gastroduodenal junction

Question 5

A 57-year-old female presented with mid-sternal chest pain, with a history of NSAID use for joint pain. Gastric mucosa shows multiple punctate hemorrhagic areas with no mucosal ulceration. Biopsy reveals mucosal erosions with edema and hemorrhage. What is the most likely diagnosis?

Accepted Answer

Acute gastritis

Answer

Autoimmune gastritis

Answer

Peptic ulcer disease

Answer

Watermelon stomach

Question 6

Invasion of the perineural space is a characteristic feature of which of the following tumors?

Accepted Answer

Adenoid cystic carcinoma

Answer

Pleomorphic adenoma

Answer

Warthin's tumor

Answer

Mucoepidermoid carcinoma

Question 7

Small intestinal stricture is not seen in which of the following conditions?

Accepted Answer

Lymphoma

Answer

Typhoid

Answer

Tumour

Answer

Tuberculosis

Question 8

A small intestinal biopsy is specific for which of the following conditions?

Accepted Answer

Whipple's disease

Answer

Tropical sprue

Answer

Celiac sprue

Answer

All of the above

Question 9

The mother of a 4-year-old child notes blood when laundering his underwear. Physical examination reveals a rectal mass. On proctoscopy, there is a smooth-surfaced, pedunculated, 1.5-cm polyp. It is excised and microscopically shows cystically dilated crypts filled with mucin and inflammatory debris, but no dysplasia. What is the most likely diagnosis?

Accepted Answer

Juvenile polyp

Answer

Familial adenomatous polyposis

Answer

Gardner syndrome

Answer

Lynch syndrome

Question 10

A 40-year-old immunocompromised patient develops multiple ulcers in the esophagus leading to painful swallowing. The biopsy from the esophagus is shown below. What is the diagnosis?

Accepted Answer

CMV

Answer

Candida

Answer

Eosinophilic esophagitis

Answer

Herpes

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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