Pancreas

Question 1

Pancreatic mucinous neoplasm

Answer 1

Tail or body
Large , > 10cm, multiloculated
Mostly females, 50 yrs

Invasive carcinoma in 10-15%
No communication with pancreatic ductal system

D/D: IPMN which transform to colloid carcinoma
Both entities can have molecular change in RNF43 (not seen PDAC)

Question 2

Solid pseudo papillary neoplasm features

Answer 2

Solid pseudo papillary neoplasm
Low malignant potential
Young women , 28 yrs av
Nuclear B-catenin, Alpha1 antitrypsin, alpha 1 chymotrypsin, CD117, PR , CD56, CD10.

Question 3

Pancreatic cyst marker levels

Answer 3

Serous cystadenoma - low, non elevated CEA and low amylase levels

Mucinous cystic neoplasm - elevated CEA and low amylase

IPMN - elevated CEA and amylase

Pancreatic pseudocyst - low CEA and high amylase

Question 4

Genetic abnormalities seen in Pan-IN are :

Answer 4

Activation of K- RAS oncogene 
Lack of MUC2 expression
Positive MUC1 expression 
Inactivation of p16 and p53 
Loss of DPC4 expression

Question 5

Serous cystadenoma associated with

Answer 5

vHL syndrome

PAS+, cytokeratin+, alpha-inhibit+ and MUC6

Question 6

What predicts behavior of IPMN?

Answer 6

Presence of MUC2 predicts more indolent behavior in IPMN.