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HistoPath > Histopathology 9: Pancreatic pathology > Flashcards

Histopathology 9: Pancreatic pathology Flashcards

1
Q

Which 2 mediators control enzyme and alkali release from the pancreas ?

A

Secretin - released by S cells in the duodenum causes pancreatic HCO3- secretion

CCK- released by I cells in the duodenum causes pancreatic release of digestive enzymes

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2
Q

Which cells release glucagon and insulin?

A

Glucagon = alpha cells

Insulin = beta cells

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3
Q

Which cells release somatostatin ?

A

Delta cells

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4
Q

What type of hypersensitivity reaction is T1DM ?

A

Type 4 delayed T cell mediated

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5
Q

List the causes of Acute pancreatitis ?

A

I GET SMASHED

Idiopathic (15%)

Gall stones (50%)
Ethanol (35%)
Trauma

Steroids
Mumps
Auto-immune
Scorpion venom
Hyperlipidaemia
ERCP
Drugs- Thiazide diuretics, allopurinol

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6
Q

Which blood test is most sensitive for Acute pancreatitis ?

A

Serum Lipase

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7
Q

List 5 causes of chronic pancreatitis ?

A
  • Alcoholism (80%)
  • Cystic fibrosis - mucoviscoidosis (Mucus overproduction causing duct obstruction)
  • Haemochromatosis (‘Bronzed diabetes’)
  • Pancreatic duct obstruction - stones /cancer (less important)
  • Auto-immune
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8
Q

Describe the histology of chronic pancreatitis ?

A
  • Dilated ducts with strictures
  • Fibrosis and fat
  • Calcification (calcium stones form)
  • Loss of exocrine tissue (acini) which are replaced by fibrous tissue
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9
Q

A patient presents with significant weight loss, abdominal pain, multifocal fat necrosis and polyarthralgia.

Histopathology: Eosinophilic granular cytoplasm, immune reactivity for lipase

Most likely diagnosis ?

A

Acinar cell carcinoma

neoplasm that releases lots of lipase

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10
Q

A patient presents with epigastric pain that radiates to the back, he’s jaundiced and appears cachectic. An abdominal mass is felt on examination.

Most likely diagnosis ?

A

Ductal adenocarcinoma of the pancreas

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11
Q

Where in the pancreas do Ductal adenocarcinomas tend to occur ?

A

Head of the pancreas (60%)

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12
Q

what is courvoisiers law?

A

Presence of a palpable enlarged gallbladder, with painless jaundice means gallstones are unlikely, more likely cancer

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13
Q

What is the tumour marker for pancreatic/ductal cancer ?

A

CA19-9

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14
Q

Histopathology: Cells arranged in nests or trabecular with granular cytoplasm.

Hypoglycaemic attacks.

Most likely diagnosis ?

A

Islet cell tumour- Insulinoma

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15
Q

Which syndrome is associated with gastrinomas

A

Zollinger ellison syndrome

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16
Q

What are Rokitansky-Aschoff sinuses ?

A
  • Cholecystitis causes fibrosis which means the gallbladder is contracting against an obstruction
  • This pressure causes diverticula to form which are known as Rokitansky-Aschoff sinuses
  • So a result of chronic cholecystitis
17
Q

what are the 2 components of the exocrine parts of the pancreas

A

ductal
acinar - where enzymes are made

18
Q

describe how duct obstruction causes acute pancreatitis

A

gallstone distal to where common bile duct and pancreatic ducts join leads to reflux of bile up the pancreatic duct followed by damage to acini and release of proenzymes which become activated

NB alcohol also cause obstruction as it leads to spasm of Sphincter of Oddi

All other pancreatitis causes = direct injury to acinar cells (drugs, scorpioon venom etc)

19
Q

describe different patterns of injury in acute pancreatitis

A
  • periductal - necrosis of acinar cells near the ducts (usually secondary to obstruction)
  • perilobular - necrosis at the edges of the lobules (usually due to poor blood supply)
  • panlobular - develops from worsening of periductal or perilobular inflammation (VERY SEVERE)
20
Q

pathway of inflammation in acute pancreatitis

A

activated enzymes > acinar necrosis > bile and enzyme release (then get positive feedback loop)

21
Q

what are complications of acute pancreatitis

A
  • pancreatic pseudocysts formation
  • abscess
  • systemic - shock, hypoglycaemia, hypocalcemia
22
Q

list complications of chronic pancreatitis (4)

A
  • malabsorption
  • DM
  • pseudocysts (lined by fibrous tissue, contains fluid risk in pancreatic enzymes or necrotic material)
  • carcinoma of the pancreas
23
Q

describe features of AI pancreatitis

A
  • IgG4 related disease
  • large numbers of IgG4 positive plasma cells
  • responds well to steroids
24
Q

What happens to calcium levels in acute pancreatitis, and what is this called?

A
  • lipase release will hydrolyse fatty acids from triglycerides
  • Calcium ions bind to FFAs forming soaps (which are seen as yellow-white foci)- this is SAPONIFICATION
  • These complexes will deposit in tissues. This produces white flecks of FFA + calcium
  • This is why pancreatitic patients have low blood calcium as calcium has been sequestered in the process of fat necrosis
25
Q

Mortality in haemorrhagic/ necrotic pancreatitis

A

mortality up to 50%

26
Q

Why is AXR useful in chronic pancreatitis?

A

Get calcium deposits in pancreas (saponification), which shows up as stones

27
Q

Most common site for carcinoma in pancreas

A

Ductal (85%)

Other: acinar

28
Q

Features of ductal carcinoma

A
  • classic cancer: weight loss
  • Courvoisier’s law: palpable gallblader with PAINLESS jaundice
  • Can also get abdo pain, pruritis, diabetes mellitus
29
Q

RF for pancreatic carcinoma

A
  • Smoking
  • BMI and dietary factors
  • Chronic pancreatitis
  • Diabetes mellitus- carry increased risk (very low)
30
Q

Type of cancer in gallbladder cancers

What are 90% cases associated with?

A

adenocarcinomas

90% = gallstones

31
Q

What is chronic Cholecystitis and what are 90% of cases associated with?

A
  • Chronic inflammation with fibrosis, causing Gallbladder with thick wall
  • Get Rokitansky-Aschoff sinuses (basically diverticulae due to gallbladder contracting against an obstruction)
  • 90% = gallstones (also the case for acute cholecystitis)
32
Q

Most common type of secretory tumour

A

Insulinoma (secrete insulin from beta-cells)

Causes hypoglycaemia attacks

33
Q

5 F’s for gallstone causes

A

fair (Caucasians), fat (BMI ≥ 30), forty (+ years), female, fertile (≥ 1 children)

34
Q

2 types of gallstones

A
  • cholesterol (> 50%)
  • Pigment stones - contain calcium salts of unconjugated bilirubin
35
Q

What blood effect will ductal carcinoma of pancreas cause?

A

Venous Thrombosis - Tumours are often bulky and secrete mucin into the blood stream, activating the clotting cascade and producing thrombi in various places in the body

36
Q

Mutation in 95% cases of ductal carcinoma

A

K-RAS mutations

37
Q

2 pre-invasive stages of pancreatic cancer

A
  • Pancreatic Intraductal Neoplasia
  • Intraductal Mucinous Papillary Neoplasm
38
Q

Most common site in pncreas of Neuroendocrine tumours

A

Tail of pancreas

39
Q

Neuroendocrine marker in Pancreatic neuroendocrine Neoplasms

What syndrome may they be associated with?

A

chromogranin

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HistoPath (21 decks)

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