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.
> 80% of pancreatic tumors are what?
Adenocarcinoma
Where are most pancreatic adenocarcinomas?
75% are in the head of the pancreas.
Histological features of pancreatic adenocarcinoma?
Disorganized glands.
Perineural infiltration. <–
Nuclear atypia, mitosis, glandular debris etc.
Why must the Whipple procedure often be done?
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.
5 risk factor for pancreatic adenocarcinoma?
Cigarette smoking Chronic pancreatitis Increased BMI Prolonged petroleum product exposure Diabetes
What are a few genetic associations with pancreatic cancer?
Family Hx BRCA2 Familial Atypical Multiple Melanoma p16 mutation HNPCC Peutz-Jeghers Polyposis
What happens when pancreatic adenocarcinoma occludes the pancreatic ducts?
Obstructive jaundice:
Build up of conjugated bilirubinemia.
What is Courvoisier’s sign?
Distended palpable non-tender gallbladder - indicative of a bile duct obstruction.
What is Trousseau’s Syndrome?
Superficial and deep vein thromboses…
can be a sign of many different cancers
What are the precursor lesions to pancreatic adenocarcinoma called?
Pancreatic Intraepitheilal Neoplasia - PanIN (like CIN, but in the pancreas)
What’s one of the first dysplastic changes that occurs in PanIN?
PanIN 1 has elongation of cells lining the ducts.
What PanIN stage has cells being shed into the duct lumen?
PanIN 3 / carcinoma in situ
What oncogene is expressed in most pancreatic adenocarcinomas starting early?
K-ras.
Do people have better prognoses for adenocarcinoma if the tumor removed is smaller?
Yes.
What’s currently the highest sensitivity imaging modality for pancreatic tumors?
Endoscopic ultrasound with fine needle aspiration.
What’s a pancreatic pseudocyst?
There “no lining” - associated with pancreatitis.
What are 2 types of mucinous pancreatic cysts that we care about?
Intraductal papillary mucinous neoplasms (IPMNs).
Mucinous cystic neoplasms.
What are 3 characteristics of intraductal papillary mucinous neoplasms (IPMNs)? (This is a softball)
They live in the pancreatic ducts.
They have a papillary configuration.
They produce thick mucin.
What are 2 types of IPMN? How do they differ in malignant potential?
Main duct IPMN.
Branch duct IPMN - very low malignant potential,
Who gets IPMNs?
Usually males (ratio is 3:2 male:female… so it’s not really that more common)
What do you see on ultrasound that makes you really think IPMN? On endoscopy?
US: Dilated pancreatic duct.
Endoscopy: Mucin oozing from ampulla.
2 types of carcinoma that arise from IPMNs?
Tubular
Colloid - lots of mucin
How does IPMN-derived carcinoma prognosis compare to adenocarcinoma?
Survival rates are much better.
What would make you more worried about a branch duct IPMN?
A large cyst (>3cm).
What’s a marker you can use to assess malignant potential of an IPMN?
CEA - elevated is bad.
Who gets mucinous cystic neoplasms?
Women (20:1 female:male ratio).
Middle aged
Do mucinous cystic neoplasms communicate with pancreatic ducts?
No. (In contrast with IPMNs, where you see dilated ducts, mucous oozing from ampulla.)
Where in the pancreas are mucinous cystic neoplasms usually found?
In the body and tail. (>90%)
Are mucinous cystic neoplasms frequently malignant?
Yes.
What do serous cystadenomas have in common with mucinous cystic neoplasms?
They affect females in a 20:1 f:m ratio.
Usually in the body and tail of pancreas.
Don’t communicate with pancreatic duct.
How do serous cystadenoma contrast with mucinous cystic neoplasms?
Serous cystadenomas are almost always benign.
and… they’re serous
With what genetic syndrome are serous cystadenomas associated?
Van Hipple-Lindau disease
autosomal dominant… recall that pheos are also part of VHL
What are the cells of serous cystadenoma rich in?
Glycogen.
When we’re talking about pancreatic endocrine tumors, we’re talking about…
tumors of pancreatic islet cells
Are most pancreatic NETs functional (hormone-producing) or not?
Most (60-70%) are functional.
Most common pancreatic endocrine tumor?
Insulinoma… it does what you’d expect.
Review: What syndrome do gastrinomas cause?
Zollinger-Ellison Syndrome
If you see a pancreatic NET in young patient, what 2 syndromes should you think about?
MEN1 and VHL (Van Hipple Lindau)
Which category of NET has a better prognosis? Which is very bad?
Well-differentiated = better prognosis. Poorly-differentiated = high grade = very aggressive.
If you see something that looks like a pancreatic NET, what are 2 other things it could be?
Solid pseudopapillary tumor
Acinar cell carcinoma
What are 2 pathways to gallbladder cancer?
Gallstones -> chronic inflammation -> dysplasia. Congenital abnormality (APBDJ) -> pancreatic juice reflux -> hyperplasia -> dysplasia.
3 morphologies gallbladder cells can take on in pre-cancerous metaplasia?
Pseudo-pyloric (mucinous glands) - most common.
Gastric.
Intestinal (goblet cells, other) - most malignant potential?
Are women more likely to get gallbladder cancer?
Yes.
Are carcinomas of the gallbladder thought to be preceded by adenomas?
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…)
What the crap is APBDJ?
Anomalous pancreaticobiliary duct junction… leads to pancreatic reflux that leads to gallbladder cancer.
What’s probably the most common reason for gallbladder cancer in the US?
Gallstones and chronic inflammation leading to dysplasia.
