endocrine pancreas 2

Question 1

islet cell growth disorders

Answer 1

hyperplasia
tumours - pancreatic neuroendocrine tumours (NET)

all rare
usually small
some are MEN syndrome associated
may be functional, or non-functional and asymptomatic - mass effect not usual at presentation
solitary or multiple
benign or malignant - histological distinction difficult

Question 2

hyperinsulism

Answer 2

insulinoma
begin/low grade neuroendocrine tumours
episodic hypoglycaemia, may be precipitated by exercise or fasting, relieved by glucose

Question 3

Zollinger Ellison syndrome

Answer 3

excess gastrin secretion
gastrinoma of pancreas/duodenum/peripancreatic tissue
results in severe intractable peptic ulceration and diarrhoea
approx half are malignant
25% associated with MEN1 syndrome

Question 4

other functional syndromes (tumours Orr hyperplasia)

Answer 4

VIPoma, glucagonoma, somatostatinoma, multihornomal

Question 5

hyperplasia of neuroendocrine

Answer 5

usually incidenctal finding, can be a precursor to malignancy

Question 6

neoplasia of dispersed neuroendocrine

Answer 6

may produce hormones or hormone like peptides

• classical carcinoid tumours produce serotonin
• may be more than one produced
• may be expected or unexpected hormone for that site

malignant - neuroendocrine carcinomas
benign - carcinoid, and similar tumours

Question 7

low risk tumours

Answer 7

carcinoids,
well differentiated neuroendocrine tumour

can still invade and occasionally spread
most common in appendix, lung

Question 8

intermediate risk tumours

Answer 8

atypical carcinoid
well differentiated neuroendocrine carcinoma

can still invade and spread
based on mitotic count/proliferative activity rather than overt cytological changes
most common in lung