Neoplasms

Question 1

Pancreatic neoplasms

Answer 1

1. Epithelial tumours - b
   - Serous cystic neoplasms
   - Mucinous cystic neoplasms
   - Intraductal papillary mucinous neoplasm
2. Carcinoma - m
3. Endocrine neoplasms (islet cell tumours)
   - Insulinoma
   - Gastrinoma
   - Glucagonoma
   - Somatostatinoma
   - Vipoma
   - Carcinoid Tumour

Question 2

Pancreatic carcinoma subtypes

Answer 2

1. Adenocarcinoma
2. Squamous cell carcinoma
3. Cystadenocarcinoma
4. Acinar cell carcinoma
5. Undifferentiated carcinoma

Question 3

Sites of pancreatic carcinomas

Answer 3

• Head 60%
• Body 15%
• Tail 5%
• Entire gland 20%
• better prognosis if situated in head of pancreas, obstructs earlier, presents earlier

Question 4

Risk factors for pancreatic carcinomas

Answer 4

• cigarette smoking
• fat rich diet
• chronic pancreatitis
• diabetes mellitus
• strong family history

Question 5

Pathogenesis of pancreatic carcinomas

Answer 5

• Pancreatic intraepithelial neoplasms (PanINs)
• PanIN - invasive carcinoma sequence
• progressive mutations: telomere shortening, K-RAS mutations, inactivation of p16 tumour suppressor gene & other genes eg p53

Question 6

Complications of pancreatic carcinomas

Answer 6

• obstructive jaundice
• gastrointestinal bleeding
• migratory venous thrombosis

Question 7

Features of insulinomas

Answer 7

• β-cell tumour
• most common pancreatic neuroendocrine tumour
• manifests as Whipple’s triad
  1. hypoglycemic attacks
  2. CNS - confusion, stupor, LOC related to fasting/exercise
  3. prompt relief w glucose administration

Question 8

Features of gastrinomas

Answer 8

• arises within the gastrinoma triangle: duodenum, peripancreatic soft tissue, panceas
• Zollinger-Ellison syndrome
• clinically: gastric hypersecretion/acidity, intractable peptic ulceration, diarrhea

Question 9

Features of glucagonomas

Answer 9

• α-cell tumour
• mild DM
• migratory necrotising skin erythema
• anemia

Question 10

Features of somatostatinomas

Answer 10

• delta-cell tumour
• inhibitory effects
• suppressed insulin secretion - DM
• decreased gallbladder motility - Cholelithiasis
• decreased exocrine pancreas enzymatic secretions - Steatorrhea
• decreased parietal cell HCl secretion - hypochlorhydria

Question 11

Features of vipomas

Answer 11

• vasoactive intestinal peptide - WDHA syndrome
• watery diarrhea
• hypokalemia
• achlorhydria

Question 12

Features of carcinoid tumours

Answer 12

• produces serotonin (enterochromaffin cells)
• Carcinoid syndrome
• flushing
• diarrhea
• bronchospasm
• heart valve lesions