Histopathology 9: Pancreatic pathology

Question 1

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

Answer 1

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

Question 2

Which cells release glucagon ?

Answer 2

Alpha cells

Question 3

Which cells release somatostatin ?

Answer 3

Delta cells

Question 4

What type of hypersensitivity reaction is T1DM ?

Answer 4

Type 4 delayed T cell mediated

Question 5

List the causes of Acute pancreatitis ?

Answer 5

I GET SMASHED

Idiopathic 
Gall stones
Ethanol
Trauma 
Steroids
Mumps 
Auto-immune 
Scorpion venom
Hyperlipidaemia 
ERCP
Drugs- Thiazide diuretics

Question 6

Which blood test is most sensitive for Acute pancreatitis ?

Answer 6

Serum Lipase

Question 7

List 4 causes of chronic pancreatitis ?

Answer 7

Cystic fibrosis
Alcoholism
Pancreatic duct obstruction - stones /cancer
Auto-immune

Question 8

Describe the histology of chronic pancreatitis ?

Answer 8

• Dilated ducts
• Fibrosis
• calcification
• loss of exocrine tissue

Question 9

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 ?

Answer 9

Acinar cell carcinoma

neoplasm that releases lots of lipase

Question 10

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 ?

Answer 10

Ductal adenocarcinoma of the pancreas

Question 11

Where in the pancreas do Ductal adenocarcinomas tend to occur ?

Answer 11

Head of the pancreas

Question 12

What is trousseau’s sign ?

Answer 12

Presence of a palpable enlarged gallbladder, with painless jaundice means gallstones are unlikely.

Question 13

What is the tumour marker for pancreatic cancer ?

Answer 13

CA19.9

Question 14

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

Hypoglycaemic attacks.

Most likely diagnosis ?

Answer 14

Islet cell tumour- Insulinoma

Question 15

List 3 types of neuroendocrine islet cell tumours ?

Answer 15

• Insulinoma
• Gastrinoma
• VIPoma

Question 16

Which syndrome is associated with gastrinomas

Answer 16

Zollinger ellison syndrome

Question 17

What are Rokitansky-Aschoff sinuses ?

Answer 17

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.