13. Path Lab: Pancreas and Gallbladder Flashcards
What was the goal of this lab?
To distinguish between chronic pancreatitis and ductal adenocarcinoma of the pancreas.
What are some histo features of ductal adenocarcinoma?
- infiltrative growth pattern
- poorly-formed glands
- perineural/angiolymphatic invasion
- cytologic atypia (Anisonucleosis, hyperchromasia, nuclear pleomorphism, prominent nucleoli)
Carcinoma or chronic pancreatitis?
Carcinoma.
carcinoma or chronic pancreatitis?
Carcinoma
Carcinoma or chronic pancreatitis?
Notable features? arrows?
Carcinoma.
Less differentiated, ductal adenocarcinoma
Note clusters of cells at arrows.
Middle/left structure: nerve.
Sometimes see glandular structures around and in nerve -> perineural invasion, way to identify cancer.
Carcinoma or chronic pancreatitis? notable?
Carcinoma
No lobular arrangement of the glandular compartment.
Different from chronic pancreatitis: ductal structures arranged in lobules.
Chronic pancreatitis: what are the features?
- Fibrous tissue replaces exocrine tissue.
- Some lobules show atrophy of acinar parenchyma.
- A sparse lymphocytic infiltrate may be present
- Remnant ducts in lobular, orderly, well-circumscribed arrangement, surrounded by fibrosis.
- Islets tend to remain longer than acinar cells
carcinoma or chronic pancreatitis?
Chronic pancreatitis.
Lobule with some residual acinar tissue, but some atrophy
Overall lobular arrangement, central duct (biggest white)
carcinoma or chronic pancreatitis?
Chronic pancreatitis
Note ducts more resistant to atrophy than surroundings.
Carcinoma or chronic pancreatitis?
Chronic pancreatitis.
Note atrophic lobule.
Islets survive longer than acinar tissue
carcinoma or chronic pancreatitis?
chronic pancreatitis.
Islets can condense, look like neuroendogrine tumors but it’s just condensed islets.
Residual acinar tissue here between islets
severe acute pancreatitis: features?
- acinar necrosis
- peripancreatic fat necrosis
what is this?
severe acute pancreatitis
note necrosis of pancreatic tissue, liquefaction
(general features: Acinar necrosis, Peripancreatic fat necrosis)
What is this? what’s in the middle?
severe acute pancreatitis
Middle = area of necrosis
(general features: Acinar necrosis, Peripancreatic fat necrosis)
what is this? what is the upper left area?
severe acute pancreatitis.
upper left is fat necrosis.
(general features: Acinar necrosis, Peripancreatic fat necrosis)
Acute cholecystitis: how would it appear on histo?
PMNs, edema, hemorrhage, mucosal ulceration.
What is this? notable?
acute cholecystitis.
Note destruction of gallbladder wall by acute inflammation. Top - necrosis of GB wall, no normal epithelium. Mucosa are destroyed, inflammation goes deeper into muscularis propria (can’t tell that from this pic)
what is this? notable?
acute cholecystitis.
Fibrosis in the wall suggests an ongoing process (acute to chronic transition)
Healing can occur: this is an area of developing fibrosis, attempt to heal acute necrosis due to acute inflammation.
Fibrosis seen as proliferation of spindle cells (fibroblasts) and lots of connective type tissue (collagen, stains pink, amorphous material here.)
Features of chronic cholecystitis?
Fibrosis in the wall, mild chronic inflammation, Rokitansky-Aschoff sinuses
what is this? arrow points to what?
Chronic cholecystitis (mild)
arrow points to Rokitansky-Aschoff sinus
RA sinus: mucosa prolapses deep into the subserosal space. could be confused with an invasion, but here it is a benign prolapse.
What is this? arrows point to what?
Chronic cholecystitis (mild)
Histiocytes acquiring lipids, infiltrating mucosal folds
Right pic: pale cyto, central nuclei. Cholesterolosis.
Arrows: Foamy Macrophages
What is this? notable?
gallbladder adenocarcinoma
Haphazard arraangement, small glands,
Glands not arranged into lobules. May also see benign glands that are arranged.
What is this? notable?
Gallbladder adenocarcinoma
GB wall is thick because of chronic cholecystitis.
Infiltrating atypical glands, haphazard arrangement.
Stromal arrangement: desmoplasia. Reaction to infiltrating glands of adenocarcinoma.
What is this? notable? arrows?
gallbladder adenocarcimona.
Arrows to abnormal glands (due to invastion by adenocarcinoma)
Sig cytological differences, large nuclei, clumpy chromatin, crowding, loss of nuclear polarity.
What is this? notable?
Chronic pancreatitis.
Areas of necrosis from acute pancreatitis have been replaced by fibrotic tissue (pink, wavy)
L side of the pic: normal acinar cells, preserved normal tissue. Middle of the pic: ductal cells are preserved, though acini have atrophied. Ductal cells are NOT invading the islets so this is NOT carcinoma.
From the lab sheet: what am I looking for in chronic pancreatitis?
- atrophy of some lobules of acinar tissue
- scarring, i.e., replacement by fibrous tissue
- “plugs” in ducts (but these are not always present)
- lymphocytic infiltrate in scattered areas
- Islets and ducts may persist in areas of scarring.
From the lab sheet: what am I looking for with pancreatic ductal carcinoma?
- neoplastic ducts usually associated with desmoplasia (growth of fibrous or connective tissue, secondary to insult)
- invasion of adjacent tissue (fat or duodenum)
- lymph node metastasis, and perineural invasion
- Chronic pancreatitis may be present adjacent to a carcinoma because of duct obstruction by the tumor.
What organ, what’s going on?
Gallbladder. Invagination in the middle of the slide, due to mechanical pressure (possibly gallstones). Benign.
Lumen of the gallbladder is to the L side, R side is serosa/fat external to the gallbladder.
what organ, what’s going on?
gallbladder.
Cholesterol-filled macrophages in upper left: often seen in pts with high chol, or chol stones. Macrophages are in the lamina propria.
what organ, what’s going on?
gallbladder, adenocarcinoma.
The wall is invaded by neoplastic glands. This cancer can look very similar to carcinoma of the pancreas, i.e. a ductal adenocarcinoma. The prognosis is poor because many of these carcinomas extend directly through the thin gallbladder wall into the liver.
The pic below is a higher power: shows glands in the muscularis of the GB. should never see glands here so these are neoplastic.
