Cancer: Pancreas & GB

Question 0

Where does pancreatic adenocarcinoma rank as a cause of cancer death in the US?

Answer 0

4th.

Question 1

What is the most common pancreatic tumor?

Answer 1

Adenocarcinoma (80%).

Question 2

Where are adenocarcinomas most commonly found in the pancreas?

Answer 2

The head (75%).

Question 3

What are 10 histological features of pancreatic adenocarcinoma?

Answer 3

(1) disorganized glands
(2) presence of incomplete ductal lamina
(3) cribriform glands
(4) single cell infiltration
(5) cells adjacent to large vessels
(6) perineural infiltration
(7) nuclear size variation between ductal cells
(8) disorganized stroma
(9) mitoses
(10) necrotic debris

Question 4

What procedure is performed in treatable patients with adenocarcinoma in the head of the pancreas?

Answer 4

Whipple.

Question 5

What profile is at increased risk for pancreatic adenocarcinoma?

Answer 5

An aging, obese smoker with chronic pancreatitis, diabetes, and prolonged exposure to petroleum products.

Question 6

What are conditions associated with pancreatic adenocarcinoma?

Answer 6

(1) hereditary pancreatitis
(2) BRCA2 mutation
(3) familial atypical multiple melanoma
(4) p16 germline mutation
(5) HNPCC
(6) Peutz-Jeghers polyposis

Question 7

What is the clinical presentation of pancreatic adenocarcinoma?

Answer 7

(1) anorexia, nausea, vomiting, malaise
(2) weight loss
(3) epigastric pain
(4) obstructive jaundice
(5) Courvoisier’s sign
(6) Trousseau’s syndrome

Question 8

J: This refers to a distended palpable non-tender gallbladder.

Answer 8

What is Courvoisier’s sign?

Question 9

J: This refers to superficial and deep vein thrombosis associated with pancreatic adenocarcinoma.

Answer 9

What is Trousseau’s syndrome?

Question 10

If pancreatic tumors are suspected, what tests can be performed?

Answer 10

(1) ERCP
(2) endoscopic ultrasound
(3) CT

Question 11

What is the precursor lesion in pancreatic adenocarcinoma?

Answer 11

Pancreatic intraepithelial neoplasia.

Question 12

J: This refers to a pancreatitis-associated cyst with no lining.

Answer 12

What is a pseudocyst?

Question 13

What are the 2 most important types of pancreatic cysts?

Answer 13

(1) mucinous

(2) serous

Question 14

What is IPMN?

Answer 14

Intraductal papillary mucinous neoplasm.

Question 15

Where are IPMN most commonly found?

Answer 15

The head of the pancreas.

Question 16

What are the major differences between IPMN of the branch duct and of the main duct?

Answer 16

BD: frequently gastric cell type with no invasion
MD: frequently intestinal cell type with malignant transformation

Question 17

What is the characteristic finding of IPMN?

Answer 17

Thick mucin oozing into duodenum.

Question 18

What is the principal worry with IPMN?

Answer 18

Progression to adenocarcinoma.

Question 19

What gender is more likely to have a mucinous cystic neoplasm?

Answer 19

Female.

Question 20

What gender is more likely to have an IPMN?

Answer 20

Male.

Question 21

Where are mucinous cystic neoplasms most commonly found in the pancreas?

Answer 21

The body and tail.

Question 22

What are the histological features of a mucinous cystic neoplasm?

Answer 22

(1) mucin-secreting columnar or cuboidal cells
(2) possible squamoid cells
(3) denuded epithelium
(4) ovarian stroma (may be luteinized)

Question 23

What gender is more likely to have pancreatic serous cystadenoma?

Answer 23

Female.

Question 24

Where in the pancreas are serous cystadenomas most common?

Answer 24

The body and tail.

Question 25

What disease is associated with pancreatic serous cystadenoma?

Answer 25

Van Hipple Lindau disease.

Question 26

How is pancreatic serous cystadenoma treated?

Answer 26

It typically isn’t, as it is almost always benign.

Question 27

What are histological features of pancreatic serous cystadenoma?

Answer 27

(1) glycogen-rich clear cells
(2) small to large cysts
(3) frequently a central scar

Question 28

What are the common functional pancreatic NETs?

Answer 28

(1) insulinoma
(2) glucagonoma
(3) gastrinoma
(4) VIPoma
(5) somatostatinoma

Question 29

What is the clinical presentation of a gastrinoma?

Answer 29

(1) recurrent peptic ulcers
(2) abdominal pain
(3) dyspepsia
(4) diarrhea

Question 30

What is the clinical presentation of an insulinoma?

Answer 30

(1) headache
(2) irritability
(3) tachycardia
(4) dizziness, confusion
(5) hypoglycemia

Question 31

What is the clinical presentation of glucagonoma?

Answer 31

(1) diabetes
(2) necrolytic migratory erythema
(3) lipolysis
(4) hypoaminoacidemia
(5) anemia
(6) diarrhea
(7) weight loss

Question 32

What is the gross appearance of a pancreatic NET?

Answer 32

(1) well-demarcated
(2) solitary
(3) white, yellow
(4) soft, fleshy, or fibrotic
(5) possible hemorrhage or necrosis

Question 33

What other type of cancer does a high grade neuroendocrine carcinoma behave like?

Answer 33

Small cell lunger carcinoma.

Question 34

On histology, what other pancreatic tumors resemble NETs?

Answer 34

(1) solid pseudopapillary tumor

(2) acinar cell carcinoma

Question 35

What is the most common biliary tract cancer?

Answer 35

Gallbladder cancer.

Question 36

What gender is more likely to have gallbladder cancer?

Answer 36

Female.

Question 37

What is the pathway to gallbladder cancer that begins with a genetic predisposition?

Answer 37

(1) abnormal bile metabolism
(2) gallstones
(3) chronic inflammation
(4) dysplasia / carcinoma in situ
(5) invasive carcinoma

Question 38

What is the pathway to gallbladder cancer that begins with a congenital abnormality

Answer 38

(1) abnormal pancreaticobiliary junction
(2) reflux of pancreatic juice
(3) hyperplasia
(4) dysplasia / carcinoma in situ
(5) invasive carcinoma

Question 39

What is the most common type of metaplasia in gallbladder cancer?

Answer 39

Pseudo-pyloric (also gastric and intestinal).