Chapter 19- The Pancreas

Question 1

What are the two components of the pancreas and what cells are the made up of?

Answer 1

1. Exocrine- acinar cells

2. Endocrine- islets of Langerhans

Question 2

What congenital anomalies can affect the pancreas?

Answer 2

Pancreas divisum- failure of duct system fusion

Annular pancreas- ring of normal pancreas encircling the duodenum (ventral buds split)

Ectopic pancreas

Agenesis

Question 3

What is the most common pancreatic congenital anomaly?

Answer 3

Pancreas divisum

Question 4

Where are ectopic pancreases most commonly found?

Answer 4

Stomach > duodenum > jejunum

Question 5

What is the cause of pancreatitis?

Answer 5

Autodigestion by pancreatic enzymes

Question 6

What are the two primary causes of acute pancreatitis?

Answer 6

Biliary tract disease (obstruction- gallstones)

Alcoholism

Question 7

What is the pathology of acute pancreatitis?

Answer 7

Inappropriate release and activation of enzymes

Inflammation and thrombosis damage acinar cells and increase enzyme activation (enzymes are released when cells are damaged)

Question 8

How does alcoholism cause pancreatitis?

Answer 8

CYTP450 receptors are found on the ducts epithelium

Targeted by acetaldehyde

Question 9

What are the effects of acute pancreatitis?

Answer 9

Edema

Inflammation

Fat necrosis

Proteolysis

Hemorrhage

Question 10

What differentiates chronic and acute pancreatitis?

Answer 10

Chronic- irreversible parenchymal destruction and fibrosis

Acute- damage is reversible

Question 11

What can cause chronic pancreatitis?

Answer 11

Repeated bouts of acute pancreatitis

Long term alcohol abuse

Long standing obstruction

Autoimmune disorder

Hereditary syndromes

Question 12

What is the morphology of chronic pancreatitis?

Answer 12

Dense, fibrous tissue

Islets spared until late stages

Question 13

What can chronic pancreatitis lead to?

Answer 13

Malabsorption

Diabetes mellitus

Psuedocysts

Question 14

What are the two forms of nonneoplastic pancreatic cysts?

Answer 14

1. Congenital

2. Psuedocysts

Question 15

What is the morphology of pancreatic congenital cysts?

Answer 15

Unilocular, thin walled with cuboidal epithelium

Question 16

What causes congenital cysts in the pancreas?

Answer 16

Abnormal pancreatic duct development

Polycystic kidney disease

Von Hippel-Lindau disease

Question 17

What are pancreatic pseudocysts?

Answer 17

Cystic collections of necrotic, hemorrhagic material

No epithelium

Question 18

What is the most common form of pancreatic cysts?

Answer 18

Pseudocysts

Question 19

What types of pancreatitis can develop psuedocysts?

Answer 19

Acute and chronic

Question 20

What are the different forms of pancreatic cystic neoplasms and where are they located?

Answer 20

1. Serous- pancreatic tail
2. Mucinous- pancreatic rail
3. Intraductal papillary mucinous neoplasms (IPMNs)- head of pancreas
4. Solid pseudopapillary tumour

Question 21

What is the characteristic architecture of serous pancreatic cysts?

Answer 21

Microcystic/spongey

Question 22

What kind of fluid is in serous pancreatic cysts?

Answer 22

Watery/transparent

Question 23

Are serous cysts more often benign or malignant?

Answer 23

Benign

Question 24

What epithelial type is present in serous pancreatic cysts?

Answer 24

Cuboidal

Question 25

What is the morphology of mucinous pancreatic cysts?

Answer 25

Multiloculated Mucin-producing columnar cells Multicystic cut surface

Question 26

One third of mucinous pancreatic cysts harbour what form of cancer?

Answer 26

Invasive adenocarcinoma

Question 27

What is the morphology of IPMNs?

Answer 27

Dilated ducts with papillae

Question 28

What can IPMNs progress to?

Answer 28

Invasive cancer

Question 29

What is the morphology of solid pseudopapillary tumours of the pancreas?

Answer 29

Round, well circumscribed with solid and cystic areas Large size

Question 30

What is curative for solid pseudopapillary tumours?

Answer 30

Complete resection

Question 31

What precursor lesion is believed to cause pancreatic carcinoma?

Answer 31

Pancreatic intraepithelial neoplasia (PanIN)

Question 32

What is PanIN?

Answer 32

Well defined, no invasive lesion of the pancreatic ducts

Question 33

What is a Whipple procedure?

Answer 33

Removal of the head of the pancreas and part of the duodenum

Question 34

Where are the majority of pancreatic carcinomas found?

Answer 34

Head > diffuse > body > tail

Question 35

What kind of response do pancreatic carcinomas elicit?

Answer 35

Strong desmoplastic response (intense surrounding fibrosis)

Question 36

How can cancers in the head of the pancreas cause jaundice?

Answer 36

Obstruct duct

Question 37

Pancreatic cancers in what location can remain clinically silent?

Answer 37

Body and tail

Question 38

What syndrome can occur in pancreatic carcinoma?

Answer 38

Trousseau

Question 40

Where do the majority of acinar cell carcinomas occur?

Answer 40

Head > tail > body

Question 41

What is the morphology of acinar cell carcinoma?

Answer 41

Solid, fleshy, circumscribed

Question 42

What type of component is found in 40% of acinar cell carcinomas?

Answer 42

Endocrine

Question 43

Pancreatoblastoma is found in what type of patient?

Answer 43

Children

Question 44

What is the morphology of pancreatoblastoma?

Answer 44

Squamous islands, mixed with acinar cells

Question 45

How do insulin producing tumours and other neuroendocrine tumours of the pancreas differ?

Answer 45

Insulin producing- 90% benign Other- 60-90% malignant

Question 46

What is the most common neuroendocrine tumour of the pancreas?

Answer 46

Insulin producing

Question 47

What is the morphology of pancreatic endocrine tumours?

Answer 47

Less than 2cm Encapsulated/sharply circumscribed Pale-red/brown