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GI > Neoplastic States of Pancreas/Gallbladder > Flashcards

Neoplastic States of Pancreas/Gallbladder Flashcards

1
Q

What are two vessels below neck of pancreas?

A

SMA and SMV

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2
Q

What are three important histological components of pancreas?

A

Acini
Islets
Ducts

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3
Q

What are two broad categories of pancreas lesions?

A

Cystic and Non-cystic

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4
Q

What are risk factors for pancreatic cancer?

A 
Age>60
Smoking
Obesity/diet
Alcohol abuse
Pancreatitis 
Diabetes
Genetic predisposition (fan history and syndromes like FAP, Lynch, MEN)
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5
Q

What are clinical features of pancreatic cancer?

A 
Pain 
Obstructive jaundice
Weight loss
Anorexia
Migratory thrombophlebitis

Often asymptomatic until invades adjacent structures

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6
Q

What is precursor of invasive ductal adenocarcinoma?

A

Pancreatic intraepithelial neoplasia (PanIN)

Increases in prevalence with age

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7
Q

Describe molecular progression of invasive ductal adenocarcinoma

A

Telomere shortening and KRAS mutation: PanIN1
Inactivation of CDKN2A: PanIN2
Inactivation of SMAD4: PanIN3
TP53: invasive ductal adenocarcinoma

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8
Q

What is surgical procedure for tumors at head/neck of pancreas?

A

Whipple procedure (aka pancreaticoduodenectomy)

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9
Q

Describe gross appearance of invasive ductal adenocarcinoma

A

Firm with poorly defined and infiltrative borders
Yellow-white in color
Hemorrhage/necrosis
Can appear cystic

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10
Q

Describe histological appearance of ductal invasive adenocarcinoma

A

Desmoplastic stroma with fibroblasts and inflammatory cells
Can have haphazard irregularly shaped glands
Can have perineurial, vessel or lymphatic invasion
Irregular nuclear contours, N/C up, atypia

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11
Q

What is the grading stages of adenocarcinoma?

A

Well differentiated==>poorly differentiated (how much of tumor is glandular)

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12
Q

At what stage are most pancreatic cancers diagnosed?

A

Late stage with distant metastases

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13
Q

What is 5 year survival for pancreatic ductal adenocarcinoma?

A

Real bad– 25% for local, 10% for regional 2% for distant

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14
Q

How are differentiation and grade determined?

A

Differentiation= how close do neoplastic cells resemble non-neoplastic counterparts

Grade: look at mitoses and Ki-67 to measure aggressiveness

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15
Q

Where does PanNET arise?

A

Usually a solitary, well-demarcated tumor that can occur anywhere along length of pancreas

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16
Q

Describe gross appearance of well-differentiated PanNET

A

Well circumscribed tumor that is tan-pink and lacks necrosis

17
Q

Describe histology of well-differentiated PanNET

A

Well circumscribed lesion with surrounding capsule
Cords with dense collagenized stroma
Cells have abundant cytoplasm and salt/pepper chromatin

18
Q

What are two categories of NETs

Which ones are more common?

A

Function (hormone producing) and non-functioning

NF>insulinomas>gastrinomas>glucagonomas

19
Q

What are three major genes/pathways of well-differentiated PanNETs?

A

MEN1
PTEN/TSC2==>Activation of mTOR signaling
DAXX/ATRX

20
Q

Describe poorly differentiated PanNET: Prevalence, age, clinical behavior

A

2% of PanNETs
Occurs in adults
Highly aggressive clinical behavior– local and widespread distant mets

21
Q

Describe gross appearance of poorly differentiated PanNET

A

Infiltrative, aggressive

22
Q

Describe histological appearance of poorly-differentiated PanNET

A

small round blue cells with scant cytoplasm and hyper chromatic nuclei
Necrosis
Aggressive/infiltrative, metastatic

23
Q

What is a pancreatic pseudocyst?

How common is it?
When do you see it?

A

Cystic lesion that LACK true epithelial lining
75% of pancreatic cysts
Arises after bout of acute pancreatitis or traumatic injury

24
Q

What is serous cystadenoma?
Prevalence
Sex, age

A

Benign neoplasm that usually occurs in tail of pancreas
25% cystic neoplasms of pancreas
More common in women; 6th-7th decade

25
Q

How does pancreatic serous cyst adenoma present?

A

Nonspecific symptoms such as abdominal pain

26
Q

What is most common genetic abnormality of serous cyst adenoma?

A

Inactivation of VHL tumor suppressor gene

27
Q

Describe gross appearance of serous cystadenoma

How is it normally treated?

A

Multi cystic with spongelike appearance

Cured by surgery

28
Q

Mucinous cystic neoplasm: What is it? Location, sex, presentation

A

Painless growing mass in tail of pancreas almost always in women.

It is filled with thick, tenacious mucin and is composed of columnar mutinous epithelium

29
Q

What are histological features of mucinous cystic neoplasm? (2)

A

Inner epithelial layer composed of tall mucin-secreting cells

Dense cellular ovarian-type stroma

30
Q

What are possible progression of mucinous cystic neoplasm? (2)

A

Dysplasia

Invasive carcinoma

31
Q

Describe the epidemiology of intraductal papillary mucinous neoplasm (IPMN)

A

Most frequent cystic mucinous tumor in pancreas
M>W; age=66yo
Predominantly head of pancreas

32
Q

What are general features of IPMN?

A

Grossly visible intraductal proliferation of neoplastic mucin-producing cells

Communicated with ductal system

33
Q

What are the distinctions between main duct vs. branch duct IOMN?

A

Main duct type: Diffusely or focally dilated, contains abundant mucus secretion

Branch duct: More indolent course

34
Q

Describe gross features of IPMN

A

Branch: Circumscribed cystic lesion or cluster of mildly dilated ducts

Main: Dilated duct

35
Q

Gallbladder adenocarcinoma Epidemiology: Prevalence, sex, geography, major risk factor

A

Most common malignancy of extra hepatic biliary tract
W>M
Chile/Bolivia/India
Gallstones is major risk factor

36
Q

What is typical prognosis for gallbladder adenocarcinoma?

A

usually diagnosed at advanced stage– 5 year survival

37
Q

Gross appearance of gallbladder adenocarcinoma

A

Large exophytic tumor

Calcification leading to porcelain gallbladder

GI (41 decks)

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