Lecture 30: Neoplastic Lesions of the Pancreas and Gallbladder Flashcards
What is the 5 year survival rate of pancreatic cancer?
Less than 5%
What is the epidemiology of pancreatic adenocarcinoma?
- over 80% of pancreatic tumors
- mean age = 62
M:F = 1:1
What are the key characteristics of adenocarcinoma?
- Disorganized glands
- Presence of incomplete ductal lumina
- Cribriform glands
- Single cell infiltration
- Cells adjacent to large vessels
- Perineural infiltration (cells grow around the nerves)
- Nuclear size variation of 4:1 or more between ductal cells
- Mitoses
- Necrotic glandular debris
What is almost pathognomonic for adenocarcinoma?
Cells growing around the nerve (perineural infiltration)
Because of production of neuroregulin
What are the risk factors for adenocarcinoma?
- Cigarettes
- Chronic Pancreatitis
- Increased BMI
- Prolonged contact with Petroleum
- Diabetes
- Hereditary pancreatitis
- BRCA2 gene mutation
- Familial atypical multiple melanoma
- germline mutation in p16
- HNPCC
- Peutz-Jeghers Polyposis
What are the clinical findings of adenocarcinoma?
- Anorexia, nausea, vomiting, generalized malaise
- WEIGHT LOSS
- epigastric pain
- Obstructive jaundice
- Courvoisier’s sign (distended palpable non tender gall baldder)
- Trousseau’s syndrome (Superficial And deep vein thrombosis)
What is Courvoisier’s sign?
Distended palpable nontender gallbladder
A sign for pancreatic adenocarcinoma
What is Trousseau’s Syndrome?
Superficial (Sup.) And deep vein thrombosis
A sign for pancreatic adenocarcinoma
What is the treatment for pancreatic cancer?
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
What are the precursor lesions of pancreatic carcinoma?
Pancreatic intraepithelial neoplasia (PIN)
How does pancreatic cancer size correlate with prognosis?
Small (<3cm) is 33% of survival while bigger cancers will be 8% survival for a years
What are the types of Pancreatic cysts?
- No lining = Psudeocyst and pancreatitis associated
- True lining = mucinous, serous and others
- Degenerative/necrotic change in a neoplasm
What are the key characteristics of intraductal papillary mucinous neoplasm?
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
What is important about finding thick mucin in pancreas?
Could possible be from the intraductal papillary mucinous neoplasm (IPMN)
Which type of IPMN is more malignant?
Main Duct IPMN (ampulla of vater) is more frequent in carcinoma
Branch Duct IPMN is less frequent in invasion
What is the progression to carcinoma in IPMN? Significance?
Adenoma Dysplasia carcinoma (tubular or colloid)
Better survival than carcinomas
What are the key characteristics of Mucinous cystic neoplasms?
A predominately FEMALE disease rather than male F:M ratio = 20:1
Udually BODY/TAIL of the pancreas
Does not communicate with pancreatic duct
How do you detect IPMN?
CEA (carcinoembyronic antigen) antigen
If you see a cystic pancreatic neoplasm in a female it most likely?
A mucinous cystic neoplasms
What are the histological features of mucinous cystic neoplasm?
- epithelial lined cyst
- mucin secreting columnar cells or cuboidal cells
- squamoid cells, foveolar cells may be noted
- epithelium could be denuded
- ovarian stroma (stroma looks like from ovary?)
How does IPMN and MCN differ?
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
What are the key characteristics of SEROUS cystadenomas?
F:M 20:1 Just like mucinous cystadenomas Associated with von hipple landau disease Always BENIGN Cysts here have CLEAR CELLS
What is significant about SEROUS cystadenomas vs. mucinous cystadenomas?
SEROUS is LESS SERIOUS (usually always benign)
Mucinous = MORE serious lmaoo
What are the characteristics of Pancreatic NET?
They are broken down into
i. functional (produces hormones) ii. nonfunctional (doesn’t produce shitt)
