89. Which of these statements is least correct?

2. The photograph shows a lesion on the lower lip. Which of the following statements is most correct? (a) It is a large viral lesion (‘cold sore’). (b) It is a benign tumor derived from the salivary tissue in the lip. (c) It is most common in young adult men. (d) It will resolve with antibiotic therapy. (e) It is malignant and may metastasize to lymph nodes in the neck.

3. This photograph shows a distended and discolored loop of sigmoid colon found at autopsy. Which of the following statements is most correct? (a) The discoloration of the colon is due to melanosis coli. (b) The discoloration of the colon is due to arterial infarction following a mesenteric thromboembolus. (c) The discoloration of the colon is due to venous infarction secondary to torsion. (d) The discoloration of the colon is due to severe Crohn’s disease of the colon. (e) This disease is a well-recognized complication of diverticular disease of the colon.

4. This photograph shows the mucosa of the small intestine. Which of the following statements is most correct? (a) The structures labeled (U) are linear deep fissured ulcers. (b) The raised areas labeled (M) represent malignant infiltration of mucosa and submucosa by small intestinal malignant lymphoma. (c) The abnormalities are most likely confined to the mucosal and submucosal layers of the small bowel. (d) The abnormalities are most likely to involve the entire small intestine. (e) The abnormalities are cured by antibiotic treatment.

5. This photograph shows a mass protruding into the colon in a patient who passed blood per rectum on a number of occasions. Which of the following statements is most correct? (a) The lesion is a metaplastic (hyperplastic) polyp. (b) The lesion (A) is a tubular adenoma. (c) The lesion (A) is a villous adenoma. (d) The lesion (A) is a colonic adenocarcinoma Dukes’ Stage B. (e) The lesion (A) is a post-inflammatory polyp following chronic ulcerative colitis.

6. 88. A 32-year-old man is seen because of severe abdominal pain, pyrexia, and abdominal swelling. He has a mass in the right iliac fossa and a laparotomy is performed. This reveals a thickened, red terminal ileum, enlarged lymph nodes in the adjacent small bowel mesentery and some thickening in the cecum. Which of these statements is least correct? (a) Ileocecal tuberculosis should be considered as a possible diagnosis. (b) Crohn’s disease is a strong possibility. (c) Yersinia enterocolitica infection is a diagnostic possibility. (d) Localized ulcerative colitis is a probable diagnosis. (e) A small bowel lymphoma may be the cause of these findings.

7. 89. Which of these statements is least correct? (a) Carcinoid tumors of the small bowel are derived from neuroendocrine cells and may secrete endocrine hormones. (b) Lymphoma of the small bowel may be a complication of celiac disease. (c) Hyperplastic polyps of the large bowel are a precursor lesion of carcinomas. (d) In Peutz–Jegher’s syndrome multiple hamartomatous polyps develop in the bowel. (e) Adenocarcinoma of the colon is predisposed by long-standing ulcerative colitis.

8. Which of the following statements is least correct? (a) In celiac disease, the small bowel mucosa shows crypt hyperplasia with villous atrophy. (b) In celiac disease serum antibodies to gliadin are found. (c) Deficiency of vitamins D and A may occur as a complication of pancreatic atrophy in cystic fibrosis. (d) In celiac disease, biopsy assessment of mucosal architecture is not helpful in diagnosis. (e) Disaccharidase enzymes are located on the brush border of small bowel enterocytes.

9. Esophagus, dysplasia – Highpower: This image shows dysplastic glands and a gland showing dysplasia and metaplastic columnar epithelium. About 50% of patients with an esophageal mass and dysplasia have a coexistent adenocarcinoma.       What are the major complications of reflux esophagitis? The potential complications of severe reflux esophagitis are (a) ulcer; (b) bleeding; (c) development of stricture; (d) development of Barrett esophagus.

10. Esophagus, squamous cell carcinoma Gross, mucosal surface   The middle portion of the esophagus shows a large necrotic ulcer that can excavate deeply into surrounding structures, eg, tracheobronchial tree and aorta. Three morphologic patterns are described: (1) protruded (60%); (2) flat (15%); (3) ulcerated (25%). These tumors are more frequent in black men and produce dysphagia (difficulty in swallowing) and obstruction. These tumors are lethal; the five-year survival rate is about 9% for all patients with esophageal squamous cell carcinoma.

11. Salivary gland, Warthin tumor - Gross, cut surface • Grossly, most Warthin tumors are round-to-oval encapsulated masses, 2 to 5 cm in diameter. The cut surface reveals cystic spaces filled with a mucinous or serous secretion.

12. 3 - Stomach, chronic peptic ulcer - Gross, mucosal surface • This autopsy specimen from another patient shows a large, round, sharply punched-out mucosal defect or ulcer. The gross features of a benign gastric ulcer are sufficiently different from an irregular ulcerated gastric carcinoma with heaped-up borders to help differentiate them radiographically in the vast majority of cases. It is important to confirm the diagnosis by endoscopy and multiple biopsies.

13. Small bowel, carcinoid tumor - Very low power • Symptomatic small bowel carcinoid tumors frequently cause angulation or kinking sufficient to cause obstruction

14. Gastric hyperplastic polyp - Gross • Most (90%) gastric polyps are non-neoplastic hyperplastic polyps. Most hyperplastic polyps are single, small, and sessile; however, some may approach 2-3 cm in size. Twenty-five percent are multiple. The low-power view shows cystically dilated glands, characteristic of hyperplastic polyps. The high-power view shows cystically dilated glands lined by hyperplastic surface epithelium (foveolar epithelium).

15. Stomach, early carcinoma - Gross, mucosal surface • This is an example of an early gastric carcinoma. An ulcer with surrounding nodularity is observed on the lesser curvature of a gastric resection specimen. Low-power histologic examination reveals that the tumor involves only the mucosa and submucosa; thus, it fits the definition of early gastric carcinoma. High-power examination shows that the tumor forms glands. Thus, histologically, this is an example of the intestinal type of gastric adenocarcinoma.  

16. Stomach, advanced carcinoma - Gross, mucosal surface • In this image of an advanced gastric carcinoma, the radiating folds and relatively smooth margins might suggest a benign, chronic, peptic ulcer; however, a carcinoma can be seen histologically. It extends through the entire gastric wall and into serosal fat.

17. Colon, chronic ulcerative colitis - Medium power The lamina propria shows an increase in acute and chronic inflammatory cells. A mucosal crypt is distended by a collection of neutrophils, known as a crypt abscess. Because ulcerative colitis is a diffuse mucosal disease process, crypt abscesses are common. Crypt abscesses are also seen in Crohn disease, but are not as common.

18. Bowel, Crohn disease, noncaseatinggranulomas - Medium power Noncaseatinggranulomas are present in the lamina propria of an uninvolved region of colonic mucosa. Noncaseatinggranulomas are present in about half of Crohn disease cases in all tissue layers, both within areas of active disease and in uninvolved regions of the bowel. Granulomas have been documented throughout the alimentary tract, from mouth to rectum.