CIS Tieman - Pancreatic Neoplasia - 12.11.14

Question 1

case 67yo abdominal discomfort, jaundice, loss of appetite, weight loss

• recent diabetes onset
• fam hx - pancreatic ca
• smoker - 50 pack year
• alcohol - heavy for many years
• mass RUQ abdomen

Answer 1

DDx - pancreatic cancer, cholelithiasis, chronic pancreatitis, cholangiocarcinoma

work up - abdominal CT, CBC

elevated direct bilirubin - obstructive jaundice - with elevated alk phos and GGT

CA 19-9 - pancreatic cancer monitor tx

Question 2

majority of pancreatic cancer

Answer 2

in head - earlier picked up - obstructive jaundice

body and tail - tend to get diagnosed later

Question 3

diabetes type I

Answer 3

autoimmune - appears in adolescence

Question 4

family history of pancreatic cancer

Answer 4

yes, significant

Question 5

pancreatic cancer

Answer 5

typically hard - bc of desmoplasia - gets CT

Question 6

soft mass palpable in RUQ

Answer 6

gallbladder

Question 7

cholangiocarcinoma

Answer 7

of bile ducts

Question 8

CA 19-9

Answer 8

for monitoring the progress of pancreatic cancer

Question 9

tx of pancreatic adenocarcinoma

Answer 9

surgery is best**

Question 10

pancreatic cancer only cured by…

Answer 10

surgery**!

Question 11

CEA

Answer 11

often elevated with mucinous tumors

important - bc mucinous are premalignant

Question 12

resectable pancreatic cancer?

Answer 12

vessel invasion - if so, can’t resect it

extended outside pancreas to lymph nodes or invaded other organs - not resectable

look with a scope - biopsy nodes

Question 13

whipple procedure

Answer 13

take head of pancreas out

Question 14

57yo F left side upper abdominal pain and back pain 4 months

• nausea, weight loss
• diabetic type I
• had cholecystectomy for stones
• palpable mass in LUQ

Answer 14

DDx - splenomegaly, gastric ca, pancreatic ca

work up - abdominal CT, CBC

CA 19-9 and CEA normal

cyst on CT

mucinous cystadenoma of pancreas - most likely

Question 15

GIST

Answer 15

from cells of cajal

Question 16

mucinous cystadenoma of pancreas

Answer 16

often tail of pancreas

in older women

CEA positive - mucinous - premalignant

Question 17

pancreatic pseudocyst

Answer 17

occur after pancreatitis - so need hx of pancreatitis

caused by disruption of cyst architecture

Question 18

IPMN

Answer 18

intraductal papillary mucinous neoplasm

• can be in main duct or branch ducts
• either one - premalignant - need to resect

common cystic neoplasm of pancreatic

thought to be precursor lesion of pancreatic cancer

Question 19

only found in women

Answer 19

lined with ovarian epithelium

mucinous cystic neoplasm
-premalignant

Question 20

mucinous

Answer 20

premalignant - bad

Question 21

serous

Answer 21

benign

Question 22

serous cystic neoplasm

Answer 22

central scar
-don’t connect with ductal epithelium

ERCP - no connection to ducts - probably SCN

can leave alone - unless get bigger >3-4cm or become symptomatic

Question 23

pancreatic cystic lesions

Answer 23

link in PPT - check it out - overview of cystic pancreatic cancers

Question 24

55yo M epigastric abdominal pain, nausea, weight loss

• watery diarrhea
• gastric ulcer - 2 yrs ago
• no masses or organomegaly
• stool guaiac negative

Answer 24

hypertrophic rugal folds
-multiple small ulcers

DDx - gastrinoma

elevated gastrin levels
gastric pH 2.5 - very low

-looks like zollinger ellison

Question 25

diarrhea

Answer 25

lose potassium

Question 26

elevated gastrin levels and low pH in gastric

Answer 26

zollinger ellison - gastrinoma