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GI > Neoplasms of Pancreas and Gallbladder > Flashcards

Neoplasms of Pancreas and Gallbladder Flashcards

As with many pathology lectures... I'm not sure which of all the genes etc. listed are most important.

1
Q

> 80% of pancreatic tumors are what?

A

Adenocarcinoma

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2
Q

Where are most pancreatic adenocarcinomas?

A

75% are in the head of the pancreas.

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3
Q

Histological features of pancreatic adenocarcinoma?

A

Disorganized glands.
Perineural infiltration. <–
Nuclear atypia, mitosis, glandular debris etc.

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4
Q

Why must the Whipple procedure often be done?

A

Because these adenocarcinomas often invade the duodenum, gall bladder, and bile ducts… must link up remaining pancreas and bile ducts to jejunum, and stomach to jejunum.

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5
Q

5 risk factor for pancreatic adenocarcinoma?

A 
Cigarette smoking
Chronic pancreatitis
Increased BMI
Prolonged petroleum product exposure
Diabetes
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6
Q

What are a few genetic associations with pancreatic cancer?

A 
Family Hx
BRCA2
Familial Atypical Multiple Melanoma
p16 mutation
HNPCC
Peutz-Jeghers Polyposis
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7
Q

What happens when pancreatic adenocarcinoma occludes the pancreatic ducts?

A

Obstructive jaundice:

Build up of conjugated bilirubinemia.

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8
Q

What is Courvoisier’s sign?

A

Distended palpable non-tender gallbladder - indicative of a bile duct obstruction.

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9
Q

What is Trousseau’s Syndrome?

A

Superficial and deep vein thromboses…

can be a sign of many different cancers

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10
Q

What are the precursor lesions to pancreatic adenocarcinoma called?

A

Pancreatic Intraepitheilal Neoplasia - PanIN (like CIN, but in the pancreas)

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11
Q

What’s one of the first dysplastic changes that occurs in PanIN?

A

PanIN 1 has elongation of cells lining the ducts.

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12
Q

What PanIN stage has cells being shed into the duct lumen?

A

PanIN 3 / carcinoma in situ

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13
Q

What oncogene is expressed in most pancreatic adenocarcinomas starting early?

A

K-ras.

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14
Q

Do people have better prognoses for adenocarcinoma if the tumor removed is smaller?

A

Yes.

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15
Q

What’s currently the highest sensitivity imaging modality for pancreatic tumors?

A

Endoscopic ultrasound with fine needle aspiration.

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16
Q

What’s a pancreatic pseudocyst?

A

There “no lining” - associated with pancreatitis.

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17
Q

What are 2 types of mucinous pancreatic cysts that we care about?

A

Intraductal papillary mucinous neoplasms (IPMNs).

Mucinous cystic neoplasms.

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18
Q

What are 3 characteristics of intraductal papillary mucinous neoplasms (IPMNs)? (This is a softball)

A

They live in the pancreatic ducts.
They have a papillary configuration.
They produce thick mucin.

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19
Q

What are 2 types of IPMN? How do they differ in malignant potential?

A

Main duct IPMN.

Branch duct IPMN - very low malignant potential,

20
Q

Who gets IPMNs?

A

Usually males (ratio is 3:2 male:female… so it’s not really that more common)

21
Q

What do you see on ultrasound that makes you really think IPMN? On endoscopy?

A

US: Dilated pancreatic duct.
Endoscopy: Mucin oozing from ampulla.

22
Q

2 types of carcinoma that arise from IPMNs?

A

Tubular

Colloid - lots of mucin

23
Q

How does IPMN-derived carcinoma prognosis compare to adenocarcinoma?

A

Survival rates are much better.

24
Q

What would make you more worried about a branch duct IPMN?

A

A large cyst (>3cm).

25
Q

What’s a marker you can use to assess malignant potential of an IPMN?

A

CEA - elevated is bad.

26
Q

Who gets mucinous cystic neoplasms?

A

Women (20:1 female:male ratio).

Middle aged

27
Q

Do mucinous cystic neoplasms communicate with pancreatic ducts?

A

No. (In contrast with IPMNs, where you see dilated ducts, mucous oozing from ampulla.)

28
Q

Where in the pancreas are mucinous cystic neoplasms usually found?

A

In the body and tail. (>90%)

29
Q

Are mucinous cystic neoplasms frequently malignant?

A

Yes.

30
Q

What do serous cystadenomas have in common with mucinous cystic neoplasms?

A

They affect females in a 20:1 f:m ratio.
Usually in the body and tail of pancreas.
Don’t communicate with pancreatic duct.

31
Q

How do serous cystadenoma contrast with mucinous cystic neoplasms?

A

Serous cystadenomas are almost always benign.

and… they’re serous

32
Q

With what genetic syndrome are serous cystadenomas associated?

A

Van Hipple-Lindau disease

autosomal dominant… recall that pheos are also part of VHL

33
Q

What are the cells of serous cystadenoma rich in?

A

Glycogen.

34
Q

When we’re talking about pancreatic endocrine tumors, we’re talking about…

A

tumors of pancreatic islet cells

35
Q

Are most pancreatic NETs functional (hormone-producing) or not?

A

Most (60-70%) are functional.

36
Q

Most common pancreatic endocrine tumor?

A

Insulinoma… it does what you’d expect.

37
Q

Review: What syndrome do gastrinomas cause?

A

Zollinger-Ellison Syndrome

38
Q

If you see a pancreatic NET in young patient, what 2 syndromes should you think about?

A

MEN1 and VHL (Van Hipple Lindau)

39
Q

Which category of NET has a better prognosis? Which is very bad?

A 
Well-differentiated = better prognosis.
Poorly-differentiated = high grade = very aggressive.
40
Q

If you see something that looks like a pancreatic NET, what are 2 other things it could be?

A

Solid pseudopapillary tumor

Acinar cell carcinoma

41
Q

What are 2 pathways to gallbladder cancer?

A 
Gallstones -> chronic inflammation -> dysplasia.
Congenital abnormality (APBDJ) -> pancreatic juice reflux -> hyperplasia -> dysplasia.
42
Q

3 morphologies gallbladder cells can take on in pre-cancerous metaplasia?

A

Pseudo-pyloric (mucinous glands) - most common.
Gastric.
Intestinal (goblet cells, other) - most malignant potential?

43
Q

Are women more likely to get gallbladder cancer?

A

Yes.

44
Q

Are carcinomas of the gallbladder thought to be preceded by adenomas?

A

Perhaps sometimes, but it’s probably not the typical pathway.
(genetic changes aren’t the same. Often will find carcinomas adjacent to other kinds of dysplasia…)

45
Q

What the crap is APBDJ?

A

Anomalous pancreaticobiliary duct junction… leads to pancreatic reflux that leads to gallbladder cancer.

46
Q

What’s probably the most common reason for gallbladder cancer in the US?

A

Gallstones and chronic inflammation leading to dysplasia.

GI (45 decks)

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