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GI Week 3 > Lecture 30: Neoplastic Lesions of the Pancreas and Gallbladder > Flashcards

Lecture 30: Neoplastic Lesions of the Pancreas and Gallbladder Flashcards

1
Q

What is the 5 year survival rate of pancreatic cancer?

A

Less than 5%

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2
Q

What is the epidemiology of pancreatic adenocarcinoma?

A
  1. over 80% of pancreatic tumors
  2. mean age = 62
    M:F = 1:1
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3
Q

What are the key characteristics of adenocarcinoma?

A
  1. Disorganized glands
  2. Presence of incomplete ductal lumina
  3. Cribriform glands
  4. Single cell infiltration
  5. Cells adjacent to large vessels
  6. Perineural infiltration (cells grow around the nerves)
  7. Nuclear size variation of 4:1 or more between ductal cells
  8. Mitoses
  9. Necrotic glandular debris
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4
Q

What is almost pathognomonic for adenocarcinoma?

A

Cells growing around the nerve (perineural infiltration)

Because of production of neuroregulin

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5
Q

What are the risk factors for adenocarcinoma?

A
  1. Cigarettes
  2. Chronic Pancreatitis
  3. Increased BMI
  4. Prolonged contact with Petroleum
  5. Diabetes
  6. Hereditary pancreatitis
  7. BRCA2 gene mutation
  8. Familial atypical multiple melanoma
  9. germline mutation in p16
  10. HNPCC
  11. Peutz-Jeghers Polyposis
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6
Q

What are the clinical findings of adenocarcinoma?

A
  1. Anorexia, nausea, vomiting, generalized malaise
  2. WEIGHT LOSS
  3. epigastric pain
  4. Obstructive jaundice
  5. Courvoisier’s sign (distended palpable non tender gall baldder)
  6. Trousseau’s syndrome (Superficial And deep vein thrombosis)
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7
Q

What is Courvoisier’s sign?

A

Distended palpable nontender gallbladder

A sign for pancreatic adenocarcinoma

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8
Q

What is Trousseau’s Syndrome?

A

Superficial (Sup.) And deep vein thrombosis

A sign for pancreatic adenocarcinoma

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9
Q

What is the treatment for pancreatic cancer?

A 
1. if at head of the pancreas, they resect the part of the pancreas, bile duct, gall bladder, and small intestine
The reestablish flow by
	i. hepaticojujenostomy
	ii. pancreaticojejunostomy
	iii. Duodenojejunostomy
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10
Q

What are the precursor lesions of pancreatic carcinoma?

A

Pancreatic intraepithelial neoplasia (PIN)

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11
Q

How does pancreatic cancer size correlate with prognosis?

A

Small (<3cm) is 33% of survival while bigger cancers will be 8% survival for a years

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12
Q

What are the types of Pancreatic cysts?

A
  1. No lining = Psudeocyst and pancreatitis associated
  2. True lining = mucinous, serous and others
  3. Degenerative/necrotic change in a neoplasm
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13
Q

What are the key characteristics of intraductal papillary mucinous neoplasm?

A

Tumor confined to the pancreatic ducts
Papillary configuration is characteristic
Tumor cells produce thick mucin
Mucin is secreted into the duodenum
Usually in male, can have adjacent pancreeatitis, head of pancreas

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14
Q

What is important about finding thick mucin in pancreas?

A

Could possible be from the intraductal papillary mucinous neoplasm (IPMN)

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15
Q

Which type of IPMN is more malignant?

A

Main Duct IPMN (ampulla of vater) is more frequent in carcinoma
Branch Duct IPMN is less frequent in invasion

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16
Q

What is the progression to carcinoma in IPMN? Significance?

A

Adenoma  Dysplasia  carcinoma (tubular or colloid)

Better survival than carcinomas

17
Q

What are the key characteristics of Mucinous cystic neoplasms?

A

A predominately FEMALE disease rather than male F:M ratio = 20:1
Udually BODY/TAIL of the pancreas
Does not communicate with pancreatic duct

18
Q

How do you detect IPMN?

A

CEA (carcinoembyronic antigen) antigen

19
Q

If you see a cystic pancreatic neoplasm in a female it most likely?

A

A mucinous cystic neoplasms

20
Q

What are the histological features of mucinous cystic neoplasm?

A
  1. epithelial lined cyst
    • mucin secreting columnar cells or cuboidal cells
    • squamoid cells, foveolar cells may be noted
    • epithelium could be denuded
  2. ovarian stroma (stroma looks like from ovary?)
21
Q

How does IPMN and MCN differ?

A

Former is a male disease, latter is female
Former onset = 60 while latter onset = 40
Former begins in the head of the pancreas, latter begins in body/tail
Former = multigrowth while latter is not multifocal
Former has mucin while latter does not
Latter does NOT communicate with pancreatic duct

22
Q

What are the key characteristics of SEROUS cystadenomas?

A 
F:M 20:1
Just like mucinous cystadenomas
Associated with von hipple landau disease
Always BENIGN
Cysts here have CLEAR CELLS
23
Q

What is significant about SEROUS cystadenomas vs. mucinous cystadenomas?

A

SEROUS is LESS SERIOUS (usually always benign)

Mucinous = MORE serious lmaoo

24
Q

What are the characteristics of Pancreatic NET?

A

They are broken down into

i. functional (produces hormones)
ii. nonfunctional (doesn’t produce shitt)
25
Q

What are the signs of gastrinoma?

A

Recurrent peptic ulcers
Ab pain
ZES

26
Q

What are the signs of insulinoma?

A 
Headache
Irritability
Trachycardia
Lightheadedness
Low blood sugar (hypoglycemia)
27
Q

What are the signs of glucoganoma?

A 
Diabetes
Increased blood sugar
NECROLYTIC MIGRATORY ERYTHEMA
Hypoaminoacidemia
Anemia, diarrhea, weight loss
28
Q

What are the histological features of NET?

A

Salt and pepper chromatin

29
Q

What are the features of pancreatic NET?

A
  1. well demarcated

2. solitary

30
Q

What are the two types of NET?

A
  1. well differentiated = better prognosis = limited necrosis

2. High grade neuroendocrine carcinoma (like small cell tumor) = less differentiated = poor prognosis

31
Q

What does PNET look similar to?

A
  1. Solid Pseudopapillary tumor

2. Acinar Cell Carcinoma

32
Q

What are the key characteristics of gallbladder cancer?

A

5000 cases/year in the US (so rare)

Difficult to treat and diagnose

33
Q

What are the two pathways to gall bladder cancer?

A
  1. Genetic disposition + gender leads to abnormal bile metabolism which leads to dysplasia carcinoma in situ
  2. Congenital abnormality leads to hyperplasia due to reflux, then dysplasian carcinoma in situ
34
Q

What are the unique predisposing factors to gallbladder cancer?

A
  1. genetic predisposition
  2. geographic
  3. female gender
  4. chronic inflammation
  5. Congenital developmental abnormalities
35
Q

What is significant about intestinal metaplasia in the gallbladder?

A

Associated with dysplasia and therefore carcinoma

36
Q

How do you know there is metaplasia in gallbladder?

A

Seeing goblet cells there

37
Q

What are the characteristics of adenomas of the gallbladder?

A
  1. usually solitary
  2. have gallstones in <50% of cases
    Very rare
38
Q

What are the pre-malignant lesions of the gallbladder?

A

i. gallstones and chronic inflammation
- metaplasia = dysplasia  carcinoma
ii. Anomalous PancreaticoBiliary Ductal Junction (APBDJ)
- hyperplasia  dysplasia  carcinoma
- rare in the Us
iii. Adenoma (rare)

GI Week 3 (11 decks)

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