Histopathology 7 - Diseases of the pancreas and gall bladder

Question 1

Recall the mnemonic for the causes of acute pancreatitis

Answer 1

I GET SMASHED

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion sting
Hyperlipidaemia/hypercalcaemia/hyperparathyroidism 
ERCP
Drugs

Question 2

Recall two causes of pancreatitis via duct obstruction

Answer 2

Gallstones
Alcohol (via spasm/ oedema of Sphinter of Oddi)

Question 3

Recall the pathophysiology of injury seen in acute pancreatitis

Answer 3

1. Enzymes activated
2. Acinar necrosis
3. Enzyme release

Can cause anything from stromal oedema to haemorrhagic necrosis

Question 4

Why are yellow/white foci seen in acute pancreatitis?

Answer 4

Lipases cause fat necrosis

Calcium ions bind to free fatty acids forming soaps (which are white yellow)

Question 5

What is a pseudocyst?

Answer 5

Dilated space with no epithelial lining

Question 6

What is a cyst?

Answer 6

Dilated space lined by epithelium

Question 7

Recall 2 pancreatic and 3 systemic complications of acute pancreatitis

Answer 7

Pancreatic: pseudocyst + abscess
Systemic: shock, hypoglycaemia, hypocalcaemia

Question 8

Recall 4 complications of chronic pancreatitis

Answer 8

Malabsorption
Diabetes mellitus
Pseudocysts
Carcinoma of the pancreas

Question 9

What is contained within a pancreatic pseudocyst?

Answer 9

Pancreatic enzymes and necrotic material (which is why it’s so bad when they perforate - it causes peritonitis)

Question 10

Which immunoglobin is implicated in autoimmune acute pancreatitis?

Answer 10

IgG4

Question 11

What type of cancer makes up 85% of pancreatic neoplasms?

Answer 11

Ductal carcinoma

Question 12

What mutation is very common in ductal carcinoma?

Answer 12

K-Ras

Question 13

What are the 2 types of precancerous dysplastic ductal lesions in the pancreas?

Answer 13

1. PanIn (pancreatic intraductal neoplasm)

2. Intraductal mucinous papillary neoplasm

Question 14

Which type of tumour has a “gritty and grey” macroscopic appearance?

Answer 14

Ductal carcinoma

Question 15

Define adenocarcinoma

Answer 15

Mucin-secreting glands set in desmoplastic stroma (means: strong stromal reaction)

Question 16

Recall 3 complications of ductal carcinoma

Answer 16

1. Liver metastasis
2. Chronic pancreatitis
3. Venous thrombosis (“migratory thrombophlebitis”/ Trousseau syndrome) = mucin activating coagulation in circulatory system causing thrombosis

Question 17

Which type of pancreatic tumours are usually benign?

Answer 17

Cystic tumours

Question 18

Which type of pancreatic tumour is likely to contain neuroendocrine markers?

Answer 18

Pancreatic endocrine neoplasms

Question 19

Recall a neuroendocrine marker in pancreatic endocrine neoplasms

Answer 19

Chromogranin

Question 20

Which type of pancreatic tumour is associated with MEN1?

Answer 20

Pancreatic endocrine neoplasms

Question 21

What is the most common type of secretory pancreatic tumour?

Answer 21

Insulinomas

Question 22

In which portion of the pancreas are neuroendocrine tumours most common?

Answer 22

Tail

Question 23

What are the 2 types of gallstone?

Answer 23

Cholesterol

Pigment

Question 24

What do pigment gallstones contain?

Answer 24

Calcium salts of unconjugated bilirubin

Question 25

Which type of gallstones are radiolucent/radio opaque

Answer 25

Cholesterol: radiolucent Pigment: radio-opaque

Question 26

Recall 4 potential complications of gallstones

Answer 26

Bile duct obstruction Cholecystitis Gall bladder cancer Pancreatitis

Question 27

What is the most common cause of acute cholecystitis?

Answer 27

Gallstones (accounts for 90%)

Question 28

What is a key histopathological finding in chronic cholecystitis?

Answer 28

Diverticula Rokitansky-Aschoff sinuses

Question 29

What is the most common cause of gallbladder cancer?

Answer 29

Gallstones

Question 30

What are the 3 patterns of injury that may be seen in acute pancreatitis?

Answer 30

Periductal (necrosis of acinar cells near ducts) Perilobular (necrosis at the edges of lobules) Panlobular (develops from either of the above)

Question 31

What is IgG4 related disease?

Answer 31

A type of autoimmune disease that may affect the pancreas, surrounding structure or pretty much anywhere else in the body

Question 32

What are the 4 different types of pancreatic tumour?

Answer 32

``` Carcinomas: 1. Ductal 2. Acinar Cystic neoplasms: 1. Serous cystadenomas 2. Mucinous cystic neoplasms ```

Question 33

What is the typical microscopic appearance of ductal carcinoma of the pancreas?

Answer 33

Desmoplastic stroma