Pancreas

Question 1

How do you follow up based on pathology result after pancreatectomy for IPMN

Answer 1

Invasive - Manage like pancreatic adenocarcinoma: staging, adjuvant chemotherapy

+ margin w high grade dysplasia - re-resect margin

+ margin w low grade dysplasia - Image 6 months

• margin, benign - Image 2 & 5 years

Question 2

What IPMNs should be resected?

Answer 2

Main duct IPMNs
Branch duct IPMNs if:
>3 cm, enhancing mural nodule >5 mm, main duct dilation >1 cm, obstructive jaundice

Question 3

What’s symptom/signs of glucagonoma? What’s diagnostic lab test?

Answer 3

Necrolytic migratory erythema, stomatitis, diabetes, weight loss, glossitis, DVT
Serum glucagon>1000

Question 4

What’s symptom/signs of Insulinoma? What’s diagnostic lab test?

Answer 4

Whipple triad (fasting hypoglycemia, symptoms of hypoglycemia, relief of symptoms with glucose)
Fasting insulin:glucose > 0.4 mmol/L with elevated C-peptide

Question 5

What’s symptom/signs of gastrinoma? What’s diagnostic lab test?

Answer 5

Refractory PUD, diarrhea (most common NET in MEN1)
Serum gastrin >1000 OR secretin stimulation test (gastrin level increases with secretin)

Question 6

What’s symptom/signs of VIPoma? What’s diagnostic lab test?

Answer 6

watery diarrhea, hypokalemia, achlorhydria
Elevated VIP level, exclude other causes of diarrhea

Question 7

What’s symptom/signs of Somatostatinoma? What’s diagnostic lab test?

Answer 7

Diabetes, gallstones, steatorrhea
Elevated fasting somatostatin levels

Question 8

Where is glucagonoma most commonly located? Insulinoma? Somatostatinoma? VIPoma? gastrinoma?

Answer 8

Glucagonoma: Body/tail
VIPoma: Body/tail
Insulinoma: Even distribution
Somatostatinoma: Head (inhibition comes from brain)
Gastrinoma: Gastrinoma triangle (confluence of cystic and common bile ducts, junction of the second and third portions of the duodenum, and junction of the neck and body of the pancreas)