Pancreas 2

Question 1

Cumulative risk of pancreatic cancer in chronic pancreatitis - After 10 years? After 20 years?

Answer 1

1.8%; 4%

Question 2

In order to diagnose autoimmune pancreatitis on histology, need?

Answer 2

EUS-core biopsy

Question 3

Classic imaging findings of autoimmune pancreatitis?

Answer 3

Sausage shaped pancreas with surrounding capsule-like rim hypoenhancement;

absence of pancreatic duct dilation

Question 4

An abrupt cut off of the pancreatic duct with upstream pancreatic atrophy is suggestive of?

Answer 4

malignancy

Question 5

IgG4 level that is consistent with autoimmune pancreatitis?

Answer 5

2x ULN

Question 6

In patients who have Autoimmune pancreatitis but have contraindications to steroids or have a high risk of relapse, consider starting

Answer 6

Rituximab

Question 7

Type 1 AIP versus Type 2 AIP — involves? IgG4 level? Which is associated with IBD? Relative relapse rate?

Answer 7

Systemic multifocal disease; pancreas specific disorder

Positive; -

Weak association; strong association

30-60%; under 10%

Question 8

Type 1 AIP versus Type 2 AIP — histology?

Answer 8

Lymphoplasmacytic sclerosing pancreatitis;

Periductal lymphoplasmacytic infiltrate and granulocyte epithelial lesions (GELs)

Question 9

Pancreatic cyst with CEA above 200 is most likely?

Answer 9

Mucinous

Question 10

Placing a drop of cystic fluid between the fingers and measuring the length of stretch before it breaks is called? Suggestive of?

Answer 10

String sign

String persists for over 1 cm or over one second, indicative of mucinous cyst

Question 11

Pancreatic cyst – high CEA, high fluid amylase? Mostly located?

Answer 11

IPMN

Head

Question 12

Pancreatic cysts – low CEA, low fluid amylase?

Age of onset

Answer 12

Simple cyst - any

Solid Pseudopapillary neoplasm - 20s

cystic pancreatic NET - 40s

serious cystadenoma - 60s

Question 13

Pancreatic cyst – low CEA, high fluid amylase?

Answer 13

Pseudocyst

Question 14

Pancreatic cyst – high CEA, low fluid amylase? Mostly located?

Answer 14

Mucinous cystic neoplasm

Body and tail

Question 15

Pancreatic cyst that are predominantly in men?

Answer 15

Pseudocyst and IPMN

Question 16

Pancreatic cyst that are found in women in their 40s?

Answer 16

Mucinous cystic neoplasm, cystic pancreatic neuroendocrine tumor

Question 17

IPMNs - high risk stigmata?

Next step?

Answer 17

Mural nodule 5+ mm, pancreatic duct dilation 1+ cm

Surgery

Question 18

IPMNs - Worrisome features? (But not “high risk stigmata”)

Next step?

Answer 18

Cyst >3cm
cyst growth >5mm/2 years (or >3mm/year)
Mural nodule <5 mm
Pancreatic duct 5-9mm
High CA 19-9
Abrupt narrowing of the pancreatic duct with upstream pancreatic atrophy

EUS/FNA

Question 19

Pancreatic cyst with “eggshell calcification”?

Management?

Answer 19

Mucinous cystic neoplasm (calcifications in the wall)

Surgery

Question 20

Pancreatic cyst with multiple microcysts and then septations giving it a “honeycomb appearance“?

Less commonly can also see this on imaging?

Management?

Answer 20

Serous cystadenoma

Sunburst appearance (central stellate scar with calcifications)

Surgery only if symptomatic (rare malignant transformation)

Question 21

Pancreatic cyst with a large solid tumor and well demarcated fibrous capsule Also with cystic component?

Immunostaining is positive for?

Management?

Answer 21

Solid Pseudopapillary neoplasm

Beta-catenin, CD10, vimentin

Surgery