Histopathology 7 - Diseases of the pancreas and gall bladder Flashcards
Recall the mnemonic for the causes of acute pancreatitis
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids Mumps Autoimmune Scorpion sting Hyperlipidaemia/hypercalcaemia/hyperparathyroidism ERCP Drugs
Recall two causes of pancreatitis via duct obstruction
Gallstones Alcohol (via spasm/ oedema of Sphinter of Oddi)
Recall the pathophysiology of injury seen in acute pancreatitis
- Enzymes activated
- Acinar necrosis
- Enzyme release
Can cause anything from stromal oedema to haemorrhagic necrosis
Why are yellow/white foci seen in acute pancreatitis?
Lipases cause fat necrosis
Calcium ions bind to free fatty acids forming soaps (which are white yellow)
What is a pseudocyst?
Dilated space with no epithelial lining
What is a cyst?
Dilated space lined by epithelium
Recall 2 pancreatic and 3 systemic complications of acute pancreatitis
Pancreatic: pseudocyst + abscess
Systemic: shock, hypoglycaemia, hypocalcaemia
Recall 4 complications of chronic pancreatitis
Malabsorption
Diabetes mellitus
Pseudocysts
Carcinoma of the pancreas
What is contained within a pancreatic pseudocyst?
Pancreatic enzymes and necrotic material (which is why it’s so bad when they perforate - it causes peritonitis)
Which immunoglobin is implicated in autoimmune acute pancreatitis?
IgG4
What type of cancer makes up 85% of pancreatic neoplasms?
Ductal carcinoma
What mutation is very common in ductal carcinoma?
K-Ras
What are the 2 types of precancerous dysplastic ductal lesions in the pancreas?
- PanIn (pancreatic intraductal neoplasm)
2. Intraductal mucinous papillary neoplasm
Which type of tumour has a “gritty and grey” macroscopic appearance?
Ductal carcinoma
Define adenocarcinoma
Mucin-secreting glands set in desmoplastic stroma (means: strong stromal reaction)
Recall 3 complications of ductal carcinoma
- Liver metastasis
- Chronic pancreatitis
- Venous thrombosis (“migratory thrombophlebitis”/ Trousseau syndrome) = mucin activating coagulation in circulatory system causing thrombosis
Which type of pancreatic tumours are usually benign?
Cystic tumours
Which type of pancreatic tumour is likely to contain neuroendocrine markers?
Pancreatic endocrine neoplasms
Recall a neuroendocrine marker in pancreatic endocrine neoplasms
Chromogranin
Which type of pancreatic tumour is associated with MEN1?
Pancreatic endocrine neoplasms
What is the most common type of secretory pancreatic tumour?
Insulinomas
In which portion of the pancreas are neuroendocrine tumours most common?
Tail
What are the 2 types of gallstone?
Cholesterol
Pigment
What do pigment gallstones contain?
Calcium salts of unconjugated bilirubin
Which type of gallstones are radiolucent/radio opaque
Cholesterol: radiolucent
Pigment: radio-opaque
Recall 4 potential complications of gallstones
Bile duct obstruction
Cholecystitis
Gall bladder cancer
Pancreatitis
What is the most common cause of acute cholecystitis?
Gallstones (accounts for 90%)
What is a key histopathological finding in chronic cholecystitis?
Diverticula Rokitansky-Aschoff sinuses
What is the most common cause of gallbladder cancer?
Gallstones
What are the 3 patterns of injury that may be seen in acute pancreatitis?
Periductal (necrosis of acinar cells near ducts)
Perilobular (necrosis at the edges of lobules)
Panlobular (develops from either of the above)
What is IgG4 related disease?
A type of autoimmune disease that may affect the pancreas, surrounding structure or pretty much anywhere else in the body
What are the 4 different types of pancreatic tumour?
Carcinomas: 1. Ductal 2. Acinar Cystic neoplasms: 1. Serous cystadenomas 2. Mucinous cystic neoplasms
What is the typical microscopic appearance of ductal carcinoma of the pancreas?
Desmoplastic stroma
