All Pathology *colorectal CA and CA genetics

• Outline


  • Introduction
  • Objectives
  • Pathology
  • Questions
  • Summary
  • Assignment
  • References
• Hepatitis


  • Acute - asymptomic
  • Acute symptomatic
  • Fulminant and Subfulminant
  • Chronic
• Hepatitis


  • Inflammation
  • Clinical presentations
• Chronic hepatitis


  • Stimulation of stellate cells
  • Liver cirrhosis
• Hepatocytes


  • Apoptosis and Regeneration
  • Stimulation of cytokines (IFN, IL, PDGF, TGF)
• Hepatocellular carcinoma
• Ground glass hepatocyte
• Liver cirrhosis
• Interface hepatitis
• Piecemeal necrosis
• Tumour


  An abnormal growth which is excessive and uncoordinated and it refuses to stop growing even when the stimuli are absent
• 3 common types of tumour in the colo-rectum

  • Polyps
  • Adenomas
  • Adenocarcinoma
• Polyp


  A tumorous growth that protrude through mucosae into the lumen of the gastro intestinal tract with or without stalk
• Types of polyps


  • Hyperplastic
  • Inflammatory
  • Lymphoid
  • Hamartomatous
  • Adenomatous
• Inflammatory polyps


  Inflammed mucosa pseudo polyps
• Lymphoid polyps


  Aggregate of intramucosal lymphocytes
• Hyperplastic polyps


  May have no malignant potentials, results from decreased epithelial cell turnover
• Hyperplastic polyps


  • Age occurrence 60-70yrs
• Polyps


  • Less than <5cm, have smooth contour, protruding into the mucosae as single or multiple, composed of well formed glands with cripts lined by epithelial cells (goblets)
• Hamartomatous polyps


  Collection of malformed glands and stroma
• Types of hamartomatous polyps

  • Juvenile - composed of mucosae glands and lamina propria, larger-1 to 3cm, occurs in less than 5years
  • Adults - Retention polyps, lesser in size, may be in rectum, or all the segment of colon, rounded, smooth contour with stalk
• Juvenile polyposis syndrome


  Rare autosomal dominant, 50-100 polyps in the GIT, carry risk of adenocarcinoma, have mutation in the gene that code TGF-B
• Peutz-Jeghers polyps


  Single or multiple polyp are seen throughout the GIT
• Peutz-Jeghers syndrome


  Multiple polyps, rare autosomal dominant
• Peutz-Jeghers polyps


  • May be pendiunculated or arborizing network, composed of glands and connective tissue and smooth muscle, have increased potential of developing ca of pancreas, breast, lung, ovary, uterus
• Peutz-Jeghers syndrome


  • Patients may have melanotic mucosae at the face and genital and palmar regions
• Polyps in GIT, oral mucosa, face genitalia, palmer area


  • Have increased tendency of causing intussusception, may arise from adenomatious lesions, increased risk of developing ca of pancreas, breast, lung, ovary and uterus
• Cowden syndrome


  Autosomal dominant, hamarmatous lesion derived from the 3 germinal layers, have increase tendency of developing Cancer of the thyroid, breast, and oral papillomas, acral keratosis and facial trichilemma, mutation in gene PTEN
• Cronkhite canada


  Non-hereditory disorder, nail atrophy, skin pigmentation, alopecia
• Adenomas

  Are intraepithelial neoplasms, pedunculated, sessile, occur within the age- groups of 40-60yrs, equal male to female ratio, may arise sporadically or genetic linkage
• Adenomas


  • The more familial genetic predisposition, the more risk of colorectal carcinoma
• Subtypes of adenomas based on epithelial cells

  • Tubular
  • Villous
  • Tubulovillous
• Adenomas


  • More common are the tubular types, all arise from increased epithelial proliferation, have dyspalsia graded as low, moderate and severe (carcinoma in-situ)
• Adenomas


  They are precursors to colorectal carcinoma, their precursors' risk are dependent on the size, histological architecture and severity of dysplasia
• Tubular adenoma


  • Single or multiple, stalked or sessile, approx. 2.5cm, distributed in the GIT, composed of fibromuscuar stroma, blood vessels, lined by tall columnar
• Villous adenomas


  • Larger in size-10cm, no stalk, multiple, velvety or cauliflower or frond-like, seen in rectum, colon, lined by dysplastic epithelium
• Tubulovillous adenomas


  • Intermediate, stalk or sessile, dysplastic cells
• Symptoms of adenomas


  Asymptomic, occult bleeding, symptomatic with presentation of anaemia, rectal bleeding, secretion of mucus rich with protein and potassium
• Familial syndromes


  • Peutz-Jegher
  • Juvenile polyposis syn
  • Cowden
  • Familial Adenomatous polyposis(FAP)
  • Hereditary nonpolyposis
• Familial syndromes


  Uncommon, autosomal dominant disorders, importance lies on occurrence of malignant transformation