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Book - Molavi > Chapter 10 - Pancreas > Flashcards

Chapter 10 - Pancreas Flashcards

1
Q

What are the five margins of the Whipple?

A

Pancreatic neck

Uncinate

Common bile duct

Proximal duodenum (or stomach)

Distal duodenum

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2
Q

Describe the normal morphology of the exocrine and endocrine pancreas.

A

Exocrine: Acinar cells (wedge-shaped pink & purple granular cells) draining into ducts (low cuboidal epithelium).

Endocrine: Scattered nests of neuroendocrine cells (Islets of Langerhans)

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3
Q

Describe some features that can distinguish pancreatic adenocarcinoma from chronic pancreatitis.

A

Random, irregular distribution of glands (vs lobular architecture)

Incomplete lumina and luminal necrosis

More pronounced cellular pleomorphism (4:1)

Invasion of nerve, muscular vessels, or duodenum

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4
Q

Describe the morphologic appearance of PanIN1A/B

A

Flat layer of tall columnar cells with basal nuclei, apical mucin, and no atypia. PanIN1B has papillary or undulating appearance.

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5
Q

Describe the morphologic appearance of PanIN2.

A

Flat or papillary but with some nuclear atypia. Resembles a tubular adenoma or low-grade dysplasia.

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6
Q

Describe the morphologic appearance of PanIN3.

A

Carcinoma in situ; with cribriforming, papillary, or micropapillary architecture. Necrosis and pronounced atypia.

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7
Q

What is the significance of PanIN1/2 on a margin?

A

None; they can be safely called negative.

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8
Q

What is an IPMN? How can it be distinguished from its primary differential diagnosis?

A

A mucin-producing neoplasm arising from a pancreatic duct. Distinguished from mucinous cystic neoplasm by communication with the duct system.

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9
Q

How are IPMNs graded?

A

With low / moderate / high-grade dysplasia

(These follow PanIN1/2/3, roughly)

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10
Q

What features favor an IPMN over a large duct PanIN?

A

Long papillae

Blue mucin in the duct lumen

Continuity with main ducts

Gross or radiologic visibility

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11
Q

Name some variants of pancreatic ductal adenocarcinoma.

A

Adenosquamous

Colloid (mucinous)

Hepatoid

Medullary

Signet ring cell

Undifferentiated (Anaplastic)

Undifferentiated with osteoclast-like giant cells

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12
Q

Where and in whom do mucinous cystic neoplasms occur?

A

Middle-aged women

Tail of pancreas

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13
Q

Describe the morphologic appearance of a mucinous cystic neoplasm.

A

Multilocular cysts (non-communicating) with a rim of ovarian stroma

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14
Q

How are mucinous cystic neoplasms graded?

A

With low / moderate / high-grade dysplasia

Follows PanIN 1 / 2 / 3, roughly.

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15
Q

Describe the morphologic appearance of pancreatic serous cystadenomas.

A

Microcystic (unlike ovarian), with a central scar and radiating microcysts lined by cuboidal mucinous cells.

Areas of solid or trabecular growth can mimic metastatic RCC.

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16
Q

What is a solid pseudopapillary neoplasm? Who do they affect?

A

A lesion that starts solid but undergoes cystic degeneration.

Occurs in young women.

17
Q

Describe the morphologic appearance of a solid pseudopapillary neoplasm.

What stains are useful?

A

Noncohesive cells with a pseudopapillary growth pattern.

CD10+, nuclear beta-catenin.

18
Q

Describe the morphologic appearance and location of pancreatic pseudocysts.

A

Granulation tissue and fat necrosis with no epithelial lining. These are usually extrapancreatic.

19
Q

Describe the morphologic appearance of acinar cell carcinoma.

A

Nodules and sheets of densely packed amphophilic cells with uniform round nuclei. Prominent nucleoli!

20
Q

Who do acinar cell carcinomas usually affect?

What stain can help identify them?

A

Older adults, usually male.

Trypsin

21
Q

Describe the morphologic appearance of well-differentiated pancreatic endocrine neoplasm.

A

Well-circumscribed and cellular tumor with nests or trabeculae. Carcinoid cytology.

22
Q

What are well-diff pancreatic endocrine neoplasms also called?

What do they stain?

A

Islet cell tumors

Synaptophysin/chromogranin, CD56, and any functional peptides

23
Q
A

Normal pancreas

Arrow: Acini

Arrowhead: Duct

24
Q
A

Left: Chronic pancreatitis
Arrow: Lobular ducts and acini

Right: Invasive adenocarcinoma

1: Large, prominent, irregular ducts
2: Ducts next to vessel
3: Ducts next to nerve

25
Q
A

Adenocarcinoma

Arrow: Incomplete lumen
Arrowhead: Cribriforming
N: Perineural invasion

Inset: Marked pleomorphism

26
Q
A

Chronic pancreatitis with residual islets of langerhans (arrowheads)

27
Q
A

Pancreatic adenocarcinoma next to a vessel

28
Q
A

A: PanIN 1

B: PanIN 2

C: PanIN 3

29
Q
A

IPMN with moderate dysplasia and papillary projections.

30
Q
A

Mucinous cystic neoplasm with underlying ovarina stroma (arrow)

31
Q
A

Serous cystadenoma

Arrow: Small, dense nuclei with clear cytoplasm lining the cyst

32
Q
A

Solid pseudopapillary tumor

Arrow: Fibrovascular cores with dropout of cells

33
Q
A

Islet cell tumor

Note well spaced nuclei with speckled chromatin

Book - Molavi (29 decks)

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