Pancreas

Question 1

Pancreatic cancer risk factor

Answer 1

Risk factor
o Cigarette smoking, alcohol
o Fat, meat
o Less intake of fruits and vegetables
o DM, chronic pancreatitis specially FCPD
o Lower socioeconomy
o DDT, naphthylamine, gasoline derivative- ie farmers and hydrocarbon
worker
o Partial gastrectomy ↑, tonsilectomy↓
o Family history- BRCA 2, HNPCC, MEN

Question 2

Paraneoplastic syndrome of pancreas

Answer 2

Paraneoplastic syndrome
- Migratory thrombophlebitis/trousseau syndrome
- Cushing syndrome
- Dermatomyositis, polymyostis
- Panniculitis-arthritis-eosinophilia (due to lipase)

Question 3

Type of pancreatic carcinoma

Answer 3

Carcinoma
- Exocrine pancreas origine
o Ductal adenocarcinoma (57% in head)
o Mucinous- (associated with migratory thrombophlebitis)
o Anaplastic (in body and tail commonly)
o Adenosquamous (pure epidermoid- hypercalcemia)
o Cystadenocarcinoma (indolent course, maybe localised for many year,
both cystic and solid component)
o oncocytic, clear cell giant cell, signet cell

Endocrine pancreas origin about 5%
o Neuroendocrine tumors
Sarcoma
Lymphoma
Secondary
- 4times more common than primary
- Breast, lung, melanoma, NHL

Question 4

Method of biopsy

Answer 4

EUS-guided needle biopsy is the preferred mode of obtaining tissue for diagnosis of pancreatic ductal adenocarcinoma (PDAC).
• Preferably, a latest generation (“core”) EUS needle should be used.
• Image-guided biopsy methods (CT, ultrasound) are preferred for liver lesions suspicious of metastasis.