Lesson 3.2 - Panc Path Neoplasms Flashcards
neoplasms of panc (4)
- periampullary
- cystic
- pseudopapillary
- endocrine, lipoma, mets
jaundice is the most important presentation for what type of neoplasm?
periampullary
how are periampullary neoplasms managed
Whipples Procedure (pancreaticoduodenectomy)
periampullary neoplasms include subcategories (4)
- ductal adenocarcinoma
- ampullary carcinoma
- duodenal carcinoma
- distal cholangiocarcinoma
most common primary pancreatic neoplasm
pancreatic ductal adenocarcinoma
ductal adenocarcinoma RF (8)
male older age smoking, obesity, diabetes chronic pancreatitis cirrhosis fam history
classic S/S ductal adenocarcinoma (3)
jaundice
pain
weight loss
urine dark, stools pale
ductal adenocarcinoma sign
where do most periampullar adenocarcinomas originate in the panc
the head
double duct sign associated with
ductal periampullar adenocarcinoma
what can ductal periampullar adenocarcinoma lead to
if cancer originates in the head, can lead to Courvoisier GB
what is Courvoisier GB
obstruction to CBD causing enlarged GB and jaundice
what is the first thing we consider with treating periampullar cancer
if it can be resected (if over 2 cm or extension/vascular invasion, lymphadenopathy, then no resection)
what is whipples procedure
removal of head, uncinate, GB, CBD,
distal stomach, duodenum, part of jejunem,
anastomosis of CHD, remaining panc, stomach –> jejunem is the result
t/f cystic neoplasms can be benign or malignant
true
the majority of cystic neoplasms are
pseudocysts
ominous signs of cystic panc lesions (5)
symptomatic pts growth diameter >3cm internal soft tissue mural/septal thickening
diseases assoc with cysts
polycystic kidney disease
von hippel-lindau disease
what might suggest von hippel-lindau
multiple simple cysts
what is von-hippel lindau
connective tissue disorder
most common cystic neoplasms in order of prevalence
- serous cystic
- intraductal papillary muchinous
- mucinous cystic
- solid pseudopapillary
t/f cystic neoplasms are usually benign or low grade malignancies
true
unless muchinous tumours - malignant
microcystic adenoma is the same as
serous cystic neoplasm
common location of serous cystic neoplasm
panc head
serous cystic neoplasm sono app
myriad of tiny cysts too small for US
echogenic + posterior enhancement
what neoplasm often presents as acute pancreatitis?
Intraductal papillary muchinous neoplasm
where does Intraductal papillary muchinous neoplasm arise?
panc ducts
hallmark sono app of intraductal papillary muchinous neoplasm
prominent ductal dilation
what has the same appearance as sludge on US
mucin from IPMN
what neoplasm is rare in men/more commonly in perimenopausal women
mucinous cystic neoplasm
what neoplasm commonly occurs in panc body/tail
mucinous cystic neoplasm
muchinous cystic neoplasm sono app (4)
unilocular/multilocular
thick/thin wall
septations
internal debris
what tumour seen in young females
solid-pseudopapillary tumour
what neoplasm commonly occurs in panc tail
solid-pseudopapillary tumour
sono app pseudopapillary tumours (4)
- round encapsulated masses
- cystic, necrotic, soft tissue foci within
- posterior enhancement
- anechonic/hypo
other panc masses
endocrine tumours
metastases
lipoma
majority of panc endocrine tumours are what type of lesions
hyper-functioning
when are non-hyperfunctioning lesions of panc endo tumours found
when they are larger and cause pain
what is the most common pancreatic neoplasm
metastatic tumour
primary sources of mets
renal cell carcinoma* breast* lung* colon melanoma stomach
T/F US is unreliable in diagnosing fatty replacement
true, variable echogenicity
what can fatty sparing cause
psuedomass in the uncinate process
RF for severe fatty replacement (5)
cystic fibrosis, diabetes, obesity, NASH, old age
