02-21 PATH LAB Pancreas and GB

Question 1

A 65 year-old man presents with chronic low grade upper abdominal and back pain and weight loss. After imaging and laboratory studies, an operation was performed with total pancreatectomy. The surgical pathologist receives the specimen shown in slide GI 31. What is the diagnosis?

Answer 1

Dx = In the chronic pancreatitis

look for:

• atrophy of some lobules of acinar tissue
  
  • if you zoom out you see some normal and some atrophied acinar lobules
• scarring, i.e., replacement by fibrous tissue
• “plugs” in ducts (but these are not always present)
• lymphocytic infiltrate in scattered areas
• islets and ducts persisting in areas of scarring

Question 2

A 65-year-old male presents with jaundice, and chronic low grade upper abdominal and back pain and weight loss. After imaging and laboratory studies, an operation was performed with subtotal pancreatectomy. The surgical pathologist receives the specimen shown in slide GI 32. What is the diagnosis?

Answer 2

Ductal adenocarcinoma

Look for:

• neoplastic ducts (see in front-side picture) usually associated with desmoplasia
• invasion of adjacent tissue (fat or duodenum)
• lymph node mets
• perineural invasion

Chronic pancreatitis may be present adjacent to a carcinoma because of duct obstruction by the tumor.

Question 3

What do you see here? Dx?

Answer 3

peri-neural invasion (dx = pancreatic ductal adenocarcinoma)

Question 4

What do you see here?

Answer 4

Normal-looking acinar pancreas tissue

Question 5

What do you see here?

Answer 5

Liquefactive acinar necrosis as seen in patient w/ acute pancreatitis

Question 6

What do you see here?

Answer 6

acute necrosis (i think) in patient with acute pancreatitis

Question 7

What do you see here?

Answer 7

Peripancreatic fat necrosis w/ some ghost cells as seen in actue pancreatitis

Question 8

What do you see?

Answer 8

Rokitansky-Aschoff sinus (herniation of the mucoas into the muscularis) of Chronic cholecytitis (mild)

Question 9

What do you see in this chronic cholecystitis specimen?

Answer 9

Cholesterolosis
—Foamy histiocytes in lamina propria
—process by which M0s/histiocytes acquire lipids)

Question 10

What do you notice about this gallbladder specimen?

Answer 10

1. it’s super thick
2. you can see:
   
   • hemorrhage
   • inflammation (if you zoon in you see PMNs)

Question 11

What do you notice about this gallbladder specimen?

Answer 11

Note haphazard arrangement of glands that is important for dx of cancer (not arranged into lobules)