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GIR Test 3 > B5-028 GI Cancers, Non-Tubular > Flashcards

B5-028 GI Cancers, Non-Tubular Flashcards

1
Q

a tumor in the head of the pancreas is likely to involve the […]

A

biliary duct

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2
Q

normal pancreas

A
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3
Q

pancreatic adenocarcinomas arise from

A

ductal cells

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4
Q

pacreatic NETs arise from

A

islets of Langerhans

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5
Q
  • most common cancer of the pancreas
  • third leading cause of cancer deaths
A

pancreatic ductal adenocarcinoma

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6
Q

risk factors for pancreatic ductal carcinoma

A
  • smoking
  • chronic pancreatitis
  • diabetes
  • BRCA2 and CDKN2A mutations
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7
Q
  • older individuals
  • back pain, unexplained weight loss, fatigue
  • jaundice
  • new onset diabetes
A

pancreatic ductal carcinoma

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8
Q

pancreatic ductal carcinoma in the […] of the pancreas tend to present at a more advanced stage

A

tail/body

most are in head

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9
Q

mutations seen in pathogenesis of pancreatic ductal carcinoma

A

early: **KRAS **
later: SMAD4

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10
Q
A

pancreatic ductal carcinoma

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11
Q

proliferation of malignant glands with or without mucin production

A

pancreatic ductal carcinoma

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12
Q
A

fine needle biopsy of pancreatic ductal carcinoma

intital diagnosis by fine needle biopsy

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13
Q
  • precursor lesion
  • telomere shortening, KRAS mutation (low grade)
  • later, CDKN2A mutation (high grade)
A

pancreatic intraepithelial neoplasia

PanIN

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14
Q
A

high grade PanIN

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15
Q

2 types of cystic precursor lesions to pancreatic ductal carcinoma

A
  • intraductal papillary mucinous neoplasm
  • mucinous cystic neoplasm

always always curable early on

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16
Q

main pancreatic duct dilated and filled with mucin

A

intraductal papillary mucinous neoplasm

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17
Q

papillary structures lined by mucinous epithelium

A

intraductal papillary mucinous neoplasm

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18
Q
  • majority occur in pancreatic head
  • KRAS and GNAS mutations
  • more common in men
  • can be multifocal
A

intraductal papillay mucinous neoplasms

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19
Q
A

mucinous cystic neoplasm

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20
Q
A

mucinous cystic neoplasm

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21
Q
  • more common in females
  • occurs in body/tail
  • KRAS mutations
  • no connection to ductal system
A

mucinous cystic neoplasm

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22
Q

tumors associated with clinical syndromes caused by abnormal secretion of hormones by the tumor

A

functional PanNETs

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23
Q

insulinomas, gastrinomas, glucagonomas, somatostatinomas, VIPomas

A

functional PanNETs

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24
Q

may secrete peptide or biogenic substance at levels insufficient to cause symptoms or do not give rise to a clinical syndrome

A

non-functional PanNETs

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25
Q

incidentally discovered or become clinically apparent due to size, invasion or metastasis

A

non-functional PanNETs

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26
Q

tumors not associated with a clinical hormone hypersecretion syndrome

A

non-functional PanNETs

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27
Q

cause hyperinsulinemia and hypoglycemia

A

insulinoma

functional PanNETs

28
Q
  • palpitations, tremor
  • sweating, hunger, paraesthesia
  • severe weakness, psychiatric, and neurological manifestations
A

insulinoma

functional PanNETs

29
Q

deposits of amyloid in between stroma

A

insulinoma

functional PanNETs

30
Q

whipple triad:
hypoglycemia
low plasma glucose
symptom relief after glucose administration

A

insulinoma

functional PanNETs

31
Q

best diagnostic test for insulinoma

A

prolonged fasting measurement of blood glucose, insulin, C-peptide, and pro insulin

32
Q

gastrinomas are more common in the […] than the pancreas

A

duodenum

33
Q
  • leads to peptic ulceration, ZE
  • typical medical management of high gastrin levels does not work
A

gastrinoma

functional PanNETs

34
Q
  • usually asymptomatic unless blocking bile ducts
  • 55-75% behave in a malignant manner
A

non-functional PanNETs

35
Q
A

non-functional PanNETs

36
Q

MEN1 mutations increase the risk of

A

NETs

37
Q

pancreatic polypeptide secreting NETs are more commonly associated with a mutation in

A

MEN1

38
Q

solid, tan-red nodules

A

pancreatic NETs

39
Q

“salt and pepper” granular chromatin in uniform cells

A

NETs

40
Q

treatment for NETs

A

octreotide
resection

41
Q
  • common in women of childbearing age
  • linked to OCPs and anabolic steroids
  • often asymptomatic, may cause abdominal pain
A

hepatocellular adenoma

42
Q

hepatocellular adenoma are […] and arise in non-cirrhotic livers

A

benign

43
Q
  • strong female predilection
  • LOF mutation in trancription factor that regulates many genes in hepatocytes and pancreatic islets
  • low risk of transformation to HCC
A

HNF1a-inactivated hepatocellular adenoma

44
Q
  • commonly associated with obesity and metabolic syndrome
  • leads to constitutive JAK/STAT signaling
  • low risk of HCC
A

inflammatory hepatocellular adenoma

45
Q
  • activating mutation in gene
  • up to 40% in men
  • high risk for malignant transformation
  • type of hepatocellular adenoma
A

b-catenin activated hepatocellular adenoma

positive on B-catenin IHC

46
Q

most common subtype of hepatocellular adenoma

A

inflammatory

47
Q

least common subtype of hepatocellular adenoma

A

B-catenin

48
Q
A

hepatocellular adenoma

49
Q
A

hepatocellular adenoma

50
Q

if hepatocellular adenoma is larger than 5 cm…

A

risk for hemorrhage
consider resection

if smaller, watchful waiting

51
Q

treatment for B-catenin hepatocellular adenoma

A

resect

52
Q
  • young adult women
  • associated with Bud-Chiari syndrome, hemangiomas
  • usually asymptomatic, cause abdominal pain
  • non-neoplastic
A

Focal Nodular Hyperplasia

53
Q
A

focal nodular hyperplasia

54
Q
A

focal nodular hyperplasia

55
Q

central stellate scar
thick walled arteries

A

focal nodular hyperplasia

56
Q

most common benign tumor of the liver

A

cavernous hemangioma

57
Q
  • discrete nodule <5 cm
  • dilated, thin vessel walls
A

cavernous hemangioma

58
Q
A

cavernous hemangioma

59
Q
A

cavernous hemangioma

60
Q

most common cause of liver tumors

A

metastasis

61
Q

most common cancers that metastasize to liver

6

A
  • colorectal
  • stomach
  • breast
  • pancreas
  • lung
  • melanoma
62
Q

shows GNAS and KRAS mutations

A

intraductal papillary mucinous neoplasm

63
Q

localized vascular malformation leading to mass forming hyperplastic response of hepatocytes

A

focal nodular neoplasia

64
Q

are primary liver tumors common?

A

no
metastases to the liver are more common

65
Q

most common primary tumor to spread to the liver

6

A
  • colon
  • rectum
  • breast
  • stomach
  • pancreas
  • melanoma
66
Q

[…] occurs early in all pancreatic cancer and is thought to lead to multiple chromosomal abnormalities

A

telomere shortening

GIR Test 3 (16 decks)

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