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G.I & Nutrition > Neoplastic States of the Pancreas and Gallbladder > Flashcards

Neoplastic States of the Pancreas and Gallbladder Flashcards

1
Q

At what spinal level is the pancreas?

A

L1-2

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2
Q

> 80% of pancreatic tumors are of what kind?

A

adenocarcinoma

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3
Q

M or F: Adenocarcinoma

A

=

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4
Q

developed vs under-developed countries: adenocarcinoma

A

developed > underdeveloped

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5
Q

5 year survival of pancreatic adenocarcinoma

A

<5%

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6
Q

Where do most pancreatic adenocarcinomas arise?

A

head = 75% then body and tail

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7
Q

Histologic features of pancreatic adenocarcinoma

A

disorganized glands, incomplete ductal lumina, cribiform glands, single cell infiltrations, cells adjacent to large vessels, perineural infiltration, large nuclei, disorganized stroma

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8
Q

Risk factors for pancreatic adenocarcinoma

A

cigarettes, chronic pancreatitis, increased BMI, prolonged petroleum exposure, diabetes, family hx, brca2, family atypical multiple melanoma, germline mutation in p16, hnpcc, peutz-jeghers polyposis

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9
Q

Clinical findings with pancreatic adenocarcinoma

A

anorexia, nausea, vomiting, malaise, weight loss, epigastric pain, obstructive jaundice, courvoisier’s sign, trousseau’s syndrome

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10
Q

Trousseau’s syndrome

A

superficial and deep vein thrombosis

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11
Q

Courvoisier’s sign

A

distended, palpable, non tender gallbladder

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12
Q

What is the precursor lesion to pancreatic adenocarcinoma?

A

pancreatic intraepithelial neoplasia: normal –> PanIN1, 2 (nuclear changes), 3 –> invasive carcinoma

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13
Q

Important markers in pancreatic adenocarcinoma

A

kras, p16, mucin 1, DPC4/SMAD4, BRCA2, p53, mesothelin

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14
Q

Which marker is a positive prognostic indicator in pancreatic adenocarcinoma?

A

SMAD4/DPC4 –> more responsive to radiation

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15
Q

How does tumor size affect prognosis in pancreatic adenocarcinoma?

A

smaller is better

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16
Q

How does tumor differentiation affect prognosis in pancreatic adenocarcinoma?

A

well differentiated is better

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17
Q

How does tumor stage affect prognosis in pancreatic adenocarcinoma?

A

lower stage is better

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18
Q

Blocking what molecular target limits growth of early pancreatic adenocarcinomas?

A

EGFR

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19
Q

What do we call a pancreatic cyst with no lining?

A

pseudocyst: pancreatitis associated

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20
Q

hree pancreatic cysts with true linings

A

lining = neoplasm

  1. intraductal papillary mucinous neoplasm
  2. mucinous cystic neoplasm
  3. serous neoplasm
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21
Q

Where is IPMN located?

A

usually in head of pancreas: pancreatic ducts (intraductal)

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22
Q

Features IPMN

A

papillary formation, thick mucin production, intraductal

23
Q

Clinical finding that is diagnostic of IPMN?

A

thick mucus secretion in duodenum from ampulla

24
Q

2 subtypes of IPMN

A

depends on where it starts (main duct vs small duct) = main duct IPMN and branch duct IPMN

25
Q

M or F: IPMN

26
Q

Difference between main duct and branch duct IPMN

A

branch duct invades less often, branch duct is more frequently foveolar/gastric type and main duct is more frequently intestinal and malignant

27
Q

2 ways IPMN carcinoma appears on histology

A

tubular or colloid

28
Q

Is IPMN adenocarcinoma worse or better than NOS adenocarcinoma of pancreas?

A

much better survival

29
Q

CEA

A

carcinoma embryonic antigen –> marker for neoplastic mucinous cysts –> helps in distinguishing mucinous carcinomas

30
Q

F or M: mucinous cystic neoplasm

A

females (middle age)

31
Q

location of mucinous cystic neoplasms

A

body/tail of pancreas

32
Q

How do mucinous cystic neoplasms communicate with the pancreatic duct?

33
Q

Histologic features of MCN

A

epithelial lined cysts with columnar or cuboidal mucin secreting cells + ovarian stroma (spindle cells with bland nuclei, luteinization)

34
Q

Younger age group: IPMN or MCN

35
Q

Does mucous come out of the duodenal ampulla of vater in MCN?

36
Q

M or F: serous cystadenoma of pancreas

37
Q

location of serous cystadenoma of pancreas

38
Q

Does serous cystadenoma of pancreas communicate with the pancreatic duct?

39
Q

With what disease is serous cystadenoma of pancreas associated?

A

van hipple lindau

40
Q

What is the prognosis of serous cystadenoma of pancreas?

A

almost always benign

41
Q

Histologic features of serous cystadenoma of pancreas

A

glycogen rich clear cells, small to large cysts, central scar

42
Q

2 categories of pancreatic neuroendocrine tumors (NET)

A

functional (60%) or non functional (40%)

43
Q

What clinical feature is classically associated with glucagonomas?

A

necrolytic migratory erythema

44
Q

What markers are associated with pancreatic NETs?

A

MEN1 and VHL

45
Q

What is a high grade pancreatic NET?

A

behave like small cell lung cancer and have poor prognosis and rapid progression

46
Q

What tumor which looks like a pancreatic NET is associated with Wnt abnormalities?

A

solid psuedopapillary tumors (young, females, uncertain malignant potential)

47
Q

What tumor which looks like a pancreatic NET is associated with beta catenin/APC abnormalities?

A

acinar cell carcinoma (males, 50% survival @5 years, lipase secretion)

48
Q

Most common biliary tract cancer

A

gallbladder cancer

49
Q

prognosis of gallbladder cancer

A

poor: 5 year survival = 32%

50
Q

2 pathways to GBC

A
  1. genetic predisposition + F –> abnormal bile metabolism –> gallstones –> chronic inflammation –> dysplasia, etc.
  2. congenital abnormality –> APBDJ –> pancreatic reflux –> hyperplasia, dysplasia etc
51
Q

Goblet cell metaplasia is associated with kind of dysplasia of GB epithelium?

52
Q

How long does it take for GB dysplasia to become cancer?

53
Q

What mutation is associated with GB cancer?

54
Q

Are GB adenomas common?

G.I & Nutrition (43 decks)

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