Gastrointestinal Pathology

For each of the following clinical histories, match the most closely associated gastrointestinal tract neoplasm:

1. A 70-year-old man has a routine checkup with his primary care physician. The patient is found to have a stool specimen positive for occult blood. Next, a colonoscopy is performed and there is a 4 cm diameter sessile mass located at the splenic flexure 50 cm above the anal verge. The mass is resected at laparotomy and reveals elongated colonic glands lined by crowded columnar cells with hyperchromatic nuclei. This process is above the basement membrane:

2. A 63-year-old man has a 10 year history of gastroesophageal reflux disease. He has had increased difficulty with swallowing for the past 3 months. An upper endoscopy reveals an irregular area of mucosal ulceration and nodularity just above the gastroesophageal junction. No lesions are present in the stomach:

3. A 61-year-old woman develops marked abdominal pain over the past day. On examination her abdomen is distended and tympanitic. At laparotomy multiple mass lesions from 1 to 5 cm in size are found involving small and large bowel; one of them obstructs the ileum:

4. A 55-year-old man notes early satiety for the past 7 months. Upper GI endoscopy reveals a large mass below the mucosa of the lesser curvature of the stomach. The mass is resected and microscopically shows spindle cells positive for CD117 (an epitope of KIT):

5. A 48-year-old woman undergoes CT imaging of the abdomen. A 1 cm circumscribed mass is seen in the wall of the small bowel. The mass is uniformly very darkly attenuated:

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A. Adenocarcinoma B. Carcinoid tumor C. Gastrointestinal stromal tumor D. Kaposi's sarcoma
E. Leiomyoma F. Leiomyosarcoma G. Lipoma H. Metastatic carcinoma
I. Mucinous cystadenoma J. Neuroendocrine carcinoma K. Neurofibroma L. Non-Hodgkin's lymphoma
M. Peutz-Jeghers polyp N. Squamous cell carcinoma O. Tubular adenoma P. Villous adenoma


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