GI Section VI: Solid Pancreatic Lesions Flashcards
Pancreatic Cancer basically comes in two flavors
- DUCTAL AdenoCA - Hypovascular
- Islet Cell/Nueroendocrine - Hypervascular
Enlarged GB + Painless Jaundice
Ductal Adenocarcinoma
Increases suspicion of Ductal AdenoCA when combined with Enlarged GB + Painless Jaundice
Migratory Thrombophlebitis
Troussesu’s syndrome (acquired blood clotting disorder that results in migratory thrombophlebitis (inflammation of a vein due to a blood clot) in association with an often undiagnosed malignancy)
Peak incidence and risk factor of Ductal AdenoCA
70s-80s
Risk factore = smoking
2/3 of ductal adenoCA arise from
the pancreatic HEAD
Ductal AdenoCA
“Double duct sign”
obstruction of both the common bile duct and the pancreatic duct
Ductal AdenoCA
typically a hypo-enhancing mass which is poorly demarcated and low attenuation compared to the more brightly enhancing background parenchyma.
Opitmal timing (Pancreatic Phase- 60 seconds)
Ductal AdenoCA
Low T1 signal mass (pancreas is bright)
Peak parenchymal enhancement of Pancreas and Liver
The key to staging when assessing solid pancreatic tumores
SMA and Celiac Axis
Unresectable if involved
IF GDA is invovlved = whipple
Tumor marker of Pancreatic CA
CA 19-9
Hereditary Syndromes with Pancreatic CA
HNPCC, BRCA Mutation, Ataxia-Telangiectasia, Peutz-Jeghers
Pancreatic CA
“Frostburg’s inverted 3 sign”
Pancreatic CA
“Wide duodenal sweep”
Periampullary Tumor
Defined as originating within 2cm of the major papilla.
Periampullary Tumor can be cancers of?
The distal CBD
Pancreas
Duodennum
Why is the periampullary tumor difficult to differentiate from a conventional pancreatic adenoCA?
What is the exam of choice?
both can obstruct the bile duct, and present as a mass in the region of the pancreatic head.
MRCP/MRI is the exam of choice to try and get a good look at this region.
here is an increased incidence of ampullary carcinoma in what syndrome?
Gardner’s Syndrome
develop hundreds and sometimes thousands of abnormal growths in their large and small intestines
Islet Cell /Neuroendocrine can be thought as:
Functional or Non functional and is further divided based on the hormone they make
Islet Cell /Neuroendocrine disease association
MEN I
Von Hippel Lindau
Most common Islet Cell /Neuroendocrine tumor
Insulinoma (75%).
Always benign (90%) Solitary and Small
Second most common type of Islet Cell /Neuroendocrine tumor
Gastrinoma (2nd most common) overall
Most common associated with MEN 1.
Malignant 30-60% of teh time.
They can cause increased gastric acid output and ulcer formation (Zollinger-Ellison syndrome)
Gastrinoma
Jenunal ulcer =
Zolilinger-Ellison syndrome
