Histo: Diseases of the Pancreas and Gallbladder Pt.2

Question 1

What are the two types of pancreatic carcinomas and which is more common?

Answer 1

• Ductal (85% of all pancreatic neoplasms)
• Acinar

Many ductal carcinomas may actually arise from acini after a process called acini-ductal metaplasia (these ductal carcinomas have a different natural history to truly ductal carcinomas)

Question 2

Name two types of cystic neoplasm of the pancreas.

Answer 2

• Serous cystadenoma - contains serous secreting epithelium
• Mucinous cystadenoma - contains mucous secreting epithelium

Usually benign

Question 3

List some risk factors for pancreatic cancer.

Answer 3

• Smoking
• BMI and dietary factors
• Chronic pancreatitis
• Diabetes mellitus

Question 4

Name two types of dysplastic precursor lesion that ductal carcinoma can arise from.

Answer 4

• Pancreatic intraductal neoplasia (PanIN)
• Intraductal mucinous papillary neoplasm

Question 5

Which mutation is very common in ductal cancer?

Answer 5

K-ras (95% of cases)

Question 6

Describe the macroscopic appearance of ductal carcinoma?

Answer 6

• Gritty and grey
• Invades adjacent structures

Question 7

How does tumour location affect latency period in ductal carcinoma?

Answer 7

Tumours affecting the head of the pancreas present earlier (with biliary obstruction)

Question 8

Describe the microscopic appearance of ductal carcinoma.

Answer 8

• Adenocarcinomas (secrete mucin and form glands)
• Mucin-secreting glands are set in desmoplastic stroma

Question 9

What is the most common site of ductal carcinoma?

Answer 9

Head (60%) > Body > Tail>diffuse

NOTE: opposite for neuroendocrine tumours (more common in the tail)

Question 10

What are the usual sites of metastasis of ductal carcinoma?

Answer 10

• Direct: bile ducts, duodenum
• Lymphatic: lymph nodes
• Blood: liver (most common site of metatasis)
• Serosa: peritoneum

Perineural spread is common

Question 11

List some complications of ductal carcinoma.

Answer 11

• Metastasis
• Chronic pancreatitis
• Venous thrombosis (migratory thrombophlebitis) - Trosseau sign of malignancy

Question 12

By what mechanism does pancreatic cancer cause migratory thrombophlebitis?

Answer 12

• Circulating pancreatic cancer cells release mucous which activates the clotting cascade

Question 13

List some key features of pancreatic neuroendocrine neoplasms.

Answer 13

• Usually non-secretory
• Contains neuroendocrine markers (e.g. chromogranin) - can be measured as a screening test for neuroendocrine tumours
• May be associated with MEN1

Question 14

What is the most common type of functional (secretory) neuroendocrine tumour?

Answer 14

Insulinoma (derived from beta cells)

Question 15

List some factors that increase the likelihood of developing gallstones.

Answer 15

• Obesity
• Age
• Gender (females)
• Ethnic factors
• Hereditary
• Drugs (e.g. oral contraceptive)
• Rapid weight loss

Question 16

What are the two types of gallstone and what are their distinguishing features?

Answer 16

Cholesterol (>50% cholesterol)

• May be single
• Mostly radiolucent (NOT seen on AXR)

Pigment

• Often small with multiple stones
• Contain calcium salts of unconjugated bilirubin
• Mostly radio-opaque

Question 17

List some complications of gallstones.

Answer 17

• Bile duct obstruction
• Acute and chronic cholecystitis
• Gallbladder cancer
• Pancreatitis

Most are asymptomatic

Question 18

What is the main cause of acute and chronic cholecystitis

Answer 18

Gallstone (associated in 90% of cases)

Question 19

What is the term used to describe diverticula of the gallbladder? How do they form?

Answer 19

Rokitansky-Aschoff sinuses - form as a result of the gallbladder contracting against an obstruction

Question 20

Which type of cancer is gallbladder cancer?

Answer 20

Adenocarcinoma

NOTE: it is technically a type of cholangiocarcinoma

90% associated with gallstones