Pancreas Flashcards
Benign mimics of malignancy
chronic pancreatitis
squamous metaplasia
Causes of pancreatitis
GET SMASHED
gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpion venom
hyperlipidaemia
ERCP
drugs
Autoimmune pancreatitis - types and features
Type 1 (IgG4 related):
Obliterate phlebitis
storiform sclerosis
duct centred lymphoplasmacytosis
>50 IgG4 plasma cell/HPF
>40 IgG4:IgG plasma cells
Type 2 (idiopathic duct centred pancreatitis)
Duct centred lymphoplasmacytosis
granulocytic epithelial lesions (intraepithelial neutrophilic microabscesses)
Cystic lesions
Pseudocyst
hydatid cyst
duct ectasia in chronic pancreatitis
LE cyst
dermoid cyst
serous cystadenoma
mucinous cystic neoplasm
intraductal papillary mucinous neoplasm
solid pseudopapillary neoplasm
cystic malignancy (incl mets)
Ductal adenoca vs chronic pancreatitis
CP:
lobular
Ducts open and with smooth contours
protein plugs
islets preserved
+/- pseudocysts
minimal atypia, no mitoses
Adenoca:
irregular +/- single cells
tufting, micropapillary, cribriform patterns
ruptured ducts
desmoplasia
extrapancreatic infiltration (diagnostic if in fat)
PNI and LVI
large cells (3x lymph), variation 4:1
Loss of SMAD4
Acinar cell ca vs PanNET vs SPN
ACC: palisaded stromal nuclei, red nucleoli, granular eosinophilic cytoplasm, trypsin/chymotrypsin+
NET: S&P chromatin, no nucleoli, trypsin-
SPN: young females, grooved uniform nuclei, PR and beta catenin+
Nesidiodysplasia (islet cell hyperplasia, esp post gastric bypass)
NET grading
G1: ki67<3% and mitoses <2/10hpf
G2: ki67 3-20% or mitoses 2-20/10hpf
G3 (NEC): ki67 >20% and mitoses >20/10hpf
(minimum 500 cells for ki67, 50hpf for mitoses)
Pancreatoblastoma (squamous corpuscles are pathognomonic)
Preinvasive ductal lesions
PanIN: 1a, 1b, 2, 3
intraductal papillary mucinous neoplasm
intraductal tubulopapillary neoplasm (IPMN with tubules and without mucin)
