Gastrointestinal Pathology Practice Questions

Q: Most common malignant tumor of minor salivary glands

Adenoid cystic carcinoma. ***Adenoid cystic carcinoma*** - This is the **most common malignant tumor** originating from the minor salivary glands [1]. - It is characterized by **perineural invasion**, which contributes to its aggressive nature and predisposition to local recurrence and distant metastasis. *Pleomorphic adenoma* - This is the **most common benign tumor** of both major and minor salivary glands, not malignant. - It has a potential for malignant transformation, but in its primary form, it is benign. *Squamous cell carcinoma* - While squamous cell carcinoma can occur in the head and neck region, it is **rarely a primary tumor of salivary glands**. - It typically arises from surface epithelium, not glandular tissue. *Mucoepidermoid carcinoma* - This is the **most common malignant tumor of major salivary glands**, specifically the parotid gland, but not the most common for minor salivary glands [1]. - It is composed of mucin-producing cells, epidermoid cells, and intermediate cells. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 753-755.

Q: Hirschsprung disease is due to

Failure of migration of neural crest cells. ***Failure of migration of neural crest cells*** - Hirschsprung disease is characterized by the **absence of intramural ganglion cells** (Meissner's and Auerbach's plexuses) in the distal colon [1]. - This aganglionosis results from the **failure of neural crest cells to migrate** completely to the distal parts of the gastrointestinal tract during embryonic development [1]. *Mucosa thickening* - **Mucosal thickening** is not the primary pathophysiology of Hirschsprung disease. The core issue is aganglionosis in the bowel wall. - While there can be secondary changes in the colonic wall due to obstruction, primary mucosal thickening does not cause the disease. *Loss of crypts* - **Loss of crypts** is typically associated with conditions like **Crohn's disease** or **ulcerative colitis**, where there is inflammation and damage to the intestinal lining. - This is not a characteristic feature or the underlying cause of Hirschsprung disease. *None of the above* - This option is incorrect because the **failure of neural crest cell migration** is indeed the established cause of Hirschsprung disease [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 94-95.

Q: Inheritance of Gardner syndrome is

Autosomal dominant. ***Autosomal dominant*** - Gardner syndrome is a variant of **familial adenomatous polyposis (FAP)**, inherited in an **autosomal dominant** pattern. - It is caused by a germline mutation in the **APC gene** (adenomatous polyposis coli) on chromosome 5q21-q22. *Autosomal recessive* - Autosomal recessive disorders require **two copies of the mutated gene** (one from each parent) to manifest, which is not the inheritance pattern for Gardner syndrome. - Examples include **cystic fibrosis** or **sickle cell anemia**, where both parents are typically carriers. *X-linked recessive* - **X-linked recessive** disorders primarily affect males, as the mutated gene is located on the X chromosome, and females are usually carriers. - Gardner syndrome affects both sexes equally and is not linked to the X chromosome. *X-linked dominant* - In **X-linked dominant** inheritance, a single copy of the mutated gene on the X chromosome can cause the disorder, affecting both males and females, though often more severely in males. - However, Gardner syndrome is not X-linked, but rather an autosomal condition.

Q: Most common parotid gland tumour is

Pleomorphic adenoma. ***Pleomorphic adenoma*** - This is the **most common benign tumor** of the salivary glands, accounting for approximately **60-70%** of all parotid gland tumors [1]. - It is characterized by its **mixed stromal and epithelial components**, giving it a pleomorphic (varied) appearance [1]. *Monomorphic adenoma* - This is a **less common benign epithelial tumor** of the salivary glands compared to pleomorphic adenoma. - It lacks the **stromal component** seen in pleomorphic adenoma and typically affects older individuals. *Adeno adenocarcinoma* - This is a type of **malignant epithelial tumor** of the salivary glands, which is much less common than benign pleomorphic adenoma [1]. - While it can occur in the parotid gland, it constitutes a **minority of parotid tumors**, typically presenting with more aggressive features. *Primary lymphoma* - **Lymphomas** can occur in the salivary glands but are **rare** as primary tumors of the parotid gland itself. - They typically arise from **lymphoid tissue** within or adjacent to the gland, often presenting as firm, non-tender masses. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Head and Neck, pp. 751-755.

Q: Ischemic necrosis in alkali burn corresponds to which stage?

Stage II. ***Stage II*** - **Ischemic necrosis** in an alkali burn corresponds to Stage II, indicating a more severe and damaging effect on the tissue. - This stage involves significant cell death due to **loss of blood supply**, often seen in deeper tissue penetration by the corrosive agent [1]. *Stage I* - Stage I describes **edema** and **epithelial erosion** without significant tissue necrosis or ischemia [1]. - This stage is typically characterized by superficial damage, good perfusion, and a relatively rapid recovery without permanent scarring. *Stage III* - Stage III represents a severely advanced burn that progresses beyond necrosis to **perforation** of the esophagus or other affected organs. - At this stage, the tissue damage is extensive, leading to a high risk of complications like **mediastinitis** or **peritonitis**. *Stage IV* - While not a universally recognized stage for alkali burns, if used, Stage IV would imply **incurable damage** or **systemic complications** that threaten the patient's life, possibly involving multiple organ failure due to sepsis or other severe sequelae. - This stage would signify irreversible harm beyond localized tissue destruction, often leading to a fatal outcome. **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, pp. 53-56, 61-62.

Q: All are true for pleomorphic adenoma except:

Always remains benign. ***Always remains benign*** - This statement is incorrect because **pleomorphic adenomas** have a recognized potential for **malignant transformation** into carcinoma ex pleomorphic adenoma. [1] - The risk of malignancy increases with the duration of the tumor and its size. [1] *May turn into malignant* - This is true; **pleomorphic adenomas** can undergo malignant transformation, leading to a more aggressive tumor known as **carcinoma ex pleomorphic adenoma**. [1] - The rate of malignant transformation is generally low but is a significant concern in the long-term management of these tumors. [1] *Minor salivary gland can be affected* - This is true; while often found in the parotid gland, **pleomorphic adenomas** can also arise in **minor salivary glands**, particularly those in the palate. - Tumors in minor salivary glands tend to have a higher malignant transformation rate and can present as asymptomatic masses. *Arises from parotid* - This is true; the **parotid gland** is the most common site for **pleomorphic adenomas**, accounting for approximately 80% of all cases. [1] - They typically present as a slow-growing, painless mass in the parotid region. [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: In celiac disease, all are true EXCEPT:

Increased brush border. ***Increased brush border*** - Celiac disease is characterized by **atrophy of the intestinal villi**, leading to a **decreased surface area** for absorption, not an increased brush border [1], [2]. This leads to malabsorption and its associated symptoms. - The inflammatory process in celiac disease causes destruction of the enterocytes and their microvilli, which constitute the brush border, thus reducing its integrity and function [2]. *Gliadin is the cause* - **Gliadin**, a component of gluten found in wheat, barley, and rye, is the primary trigger for the immune response in genetically predisposed individuals with celiac disease [1], [2]. - Digested gliadin peptides are recognized by immune cells, leading to an inflammatory reaction in the small intestine [2]. *Decreased villi to crypt ratio* - One of the hallmark histological findings in celiac disease is **villous atrophy**, which results in a significant **decrease in the villi to crypt ratio**, indicating loss of the absorptive surface and compensatory crypt hyperplasia [2]. - This architectural change is crucial for the diagnosis of celiac disease and reflects the damage to the small intestine lining. *Associated with HLA-DQ2 and HLA-DQ8* - Celiac disease is strongly associated with specific **HLA (Human Leukocyte Antigen) class II alleles**, primarily **HLA-DQ2 and HLA-DQ8**, which are found in over 95% of affected individuals [1]. - These genetic markers are essential for disease susceptibility, with **HLA-DQ2** present in approximately 90-95% of patients and **HLA-DQ8** in the remaining 5-10% [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 360-361. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 789-790.

Question 1

Most common malignant tumor of minor salivary glands

Accepted Answer

Adenoid cystic carcinoma

Answer

Pleomorphic adenoma

Answer

Squamous cell carcinoma

Answer

Mucoepidermoid carcinoma

Question 2

Hirschsprung disease is due to

Accepted Answer

Failure of migration of neural crest cells

Answer

Mucosa thickening

Answer

Loss of crypts

Answer

None of the above

Question 3

Inheritance of Gardner syndrome is

Accepted Answer

Autosomal dominant

Answer

X-linked recessive

Answer

X-linked dominant

Answer

Autosomal recessive

Question 4

Characteristic histopathological finding in Whipple's disease is?

Accepted Answer

PAS positive macrophages and rod shaped bacilli in lamina propria

Answer

Mononuclear infiltration at base of crypts

Answer

Shortened thickened villi with increased crypt depth

Answer

Blunting and flattening of mucosal surface and absent villi

Question 5

Most common parotid gland tumour is

Accepted Answer

Pleomorphic adenoma

Answer

Monomorphic adenoma

Answer

Primary lymphoma

Answer

Adenocarcinoma

Question 6

Skip lesions with non-caseating granulomas is characteristic of

Accepted Answer

Crohn's disease

Answer

Hodgkin's lymphoma

Answer

Ulcerative colitis

Answer

Sarcoidosis

Question 7

Which of the following agents causing acute infectious diarrhea can be paired with the pathogenic mechanism of destruction limited to the mature villus cells of small intestine?

Accepted Answer

Rotavirus

Answer

E. coli

Answer

Vibrio cholerae

Answer

Shigella

Question 8

Ischemic necrosis in alkali burn corresponds to which stage?

Accepted Answer

Stage II

Answer

Stage I

Answer

Stage III

Answer

Stage IV

Question 9

All are true for pleomorphic adenoma except:

Accepted Answer

Always remains benign

Answer

May turn into malignant

Answer

Minor salivary gland can be affected

Answer

Arises from parotid

Question 10

In celiac disease, all are true EXCEPT:

Accepted Answer

Increased brush border

Answer

Gliadin is the cause

Answer

Decreased villi to crypt ratio

Answer

Associated with HLA-DQ2 and HLA-DQ8

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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