GI Section VI: Solid Pancreatic Lesions

Question 1

Pancreatic Cancer basically comes in two flavors

Answer 1

1. DUCTAL AdenoCA - Hypovascular
2. Islet Cell/Nueroendocrine - Hypervascular

Question 2

Enlarged GB + Painless Jaundice

Answer 2

Ductal Adenocarcinoma

Question 3

Increases suspicion of Ductal AdenoCA when combined with Enlarged GB + Painless Jaundice

Answer 3

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)

Question 4

Peak incidence and risk factor of Ductal AdenoCA

Answer 4

70s-80s

Risk factore = smoking

Question 5

2/3 of ductal adenoCA arise from

Answer 5

the pancreatic HEAD

Question 6

Answer 6

Ductal AdenoCA

“Double duct sign”

obstruction of both the common bile duct and the pancreatic duct

Question 7

Answer 7

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)

Question 8

Answer 8

Ductal AdenoCA

Low T1 signal mass (pancreas is bright)

Question 9

Peak parenchymal enhancement of Pancreas and Liver

Answer 9

Question 10

The key to staging when assessing solid pancreatic tumores

Answer 10

SMA and Celiac Axis

Unresectable if involved

IF GDA is invovlved = whipple

Question 11

Tumor marker of Pancreatic CA

Answer 11

CA 19-9

Question 12

Hereditary Syndromes with Pancreatic CA

Answer 12

HNPCC, BRCA Mutation, Ataxia-Telangiectasia, Peutz-Jeghers

Question 13

Answer 13

Pancreatic CA

“Frostburg’s inverted 3 sign”

Question 14

Answer 14

Pancreatic CA

“Wide duodenal sweep”

Question 15

Periampullary Tumor

Answer 15

Defined as originating within 2cm of the major papilla.

Question 16

Periampullary Tumor can be cancers of?

Answer 16

The distal CBD
Pancreas
Duodennum

Question 17

Why is the periampullary tumor difficult to differentiate from a conventional pancreatic adenoCA?

What is the exam of choice?

Answer 17

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.

Question 18

here is an increased incidence of ampullary carcinoma in what syndrome?

Answer 18

Gardner’s Syndrome

develop hundreds and sometimes thousands of abnormal growths in their large and small intestines

Question 19

Islet Cell /Neuroendocrine can be thought as:

Answer 19

Functional or Non functional and is further divided based on the hormone they make

Question 20

Islet Cell /Neuroendocrine disease association

Answer 20

MEN I
Von Hippel Lindau

Question 21

Most common Islet Cell /Neuroendocrine tumor

Answer 21

Insulinoma (75%).

Always benign (90%) Solitary and Small

Question 22

Second most common type of Islet Cell /Neuroendocrine tumor

Answer 22

Gastrinoma (2nd most common) overall

Most common associated with MEN 1.

Malignant 30-60% of teh time.

Question 23

They can cause increased gastric acid output and ulcer formation (Zollinger-Ellison syndrome)

Answer 23

Gastrinoma

Question 24

Jenunal ulcer =

Answer 24

Zolilinger-Ellison syndrome

Question 25

The 3rd most common type of Islet Cell/Neuroendocrine tumor

Answer 25

Non-functional

Question 26

80% malignant
LARGE + METASTATIC at time of diagnosis

Answer 26

Non-functional neuroendocrine tumor

Question 27

I say “non-functional, ”

Answer 27

you say Large with Calcification

Question 28

The anatomical region where most (90%) of
gastrinomas arise.

Answer 28

Gastrinoma triangle

Sup: Cystic and CBD junction
Inferior: D3
Medial: Body of pancreas

Question 29

pancreatic mass that is actually just a piece of spleen

Answer 29

Intrapancreatic Accessory Spleen

Question 30

Intrapancreatic Accessory Spleen classic presentation

Answer 30

Post traumatic splenosis + absent of normal spleen

Question 31

Answer 31

Intrapancreatic Accessory Spleen

tiger striped mass on arterial phase (tiger striped like the spleen on arterial phase).