pancreas and biliary neoplasia

Question 1

most common exocrine pancreatic neoplasma

Answer 1

pancreatic ductal adenocarcinoma

Question 2

pancreatic ductal adenocarcinoma:

1. begins
2. survival rate
3. location
4. pain? jaundice?

Answer 2

1. begins in ductal epithelium with panln- pancreatic intraepithelial neoplasia
2. 5yr survival rate
3. head of pancreas
4. painless jaundice

Question 3

benign tumor of multiple small cysts 1-3mm in diameter giving “honeycombed” appearance

Answer 3

serous cystadenoma

Question 4

serous cystadenoma

1. previously known as
2. histo
3. malignant potential
4. resect

Answer 4

1. microcystic serous cystadenoma
2. cyst lined by single layer of cuboidal cells
3. no malignant potential
4. only resect if causing symptoms due to size

Question 5

cyst involves main pancreatic duct causing massive pancreatic duct dilation and irregularity

Answer 5

main duct intraductal papillary mucinous neoplasm

Question 6

cyst involves side branch of pancreatic ductal system

Answer 6

branch duct intraductal papillary mucinous neoplasm

Question 7

intraductal papillary mucinous neoplasm:

1. cyst communicates with
2. produces
3. location
4. histo
5. more aggressive?
6. mono or multi-focal
7. treatment

Answer 7

1. cyst communicates with pancreatic duct
2. mucin producing
3. head of pancreas
4. epithelial lining to the cyst with varying degrees of hyperplasia and dysplasia
5. main duct IPMN is more aggressive
6. multifocal
7. surgical resection for main duct IPMN and depends on size for branch duct IPMN

Question 8

large mucin filled cysts lined by columnar epithelium similar to mucinous cystadenomas in ovary

Answer 8

mucinous cystic neoplasm

Question 9

mucinous cystic neoplasm

1. location
2. involvement of ductal system
3. malignancy potential
4. stroma of cystic lesion is estrogen receptor
5. treatment

Answer 9

1. 95% in body and tail of pancreas
2. do not involve the ductal system
3. may progress to malignancy in 1/3
4. stroma of cystic lesion is estrogen receptor positive
5. treatment is surgical resection

Question 10

1-2% of all pancreatic tumors that is single discrete tumor of islet cells

Answer 10

neuroendocrine tumors of the pancreas

Question 11

most common neuroendocrine tumors of the pancreas

Answer 11

beta cell tumor- insulinoma syndrome

Question 12

endocrine neoplasia only real criteria of malignancy

Answer 12

• demonstration of metastases and invasion of surrounding organs and tissues
• no definitve cytologic features distinguish benign from malignant behavior

Question 13

gallbladder adenoma

1. detected
2. malignancy potential

Answer 13

1. detected incidentally through either cholecystectomies or ultrasound
2. pre-malignant lesion: risk for malignant transformation increases with size and villous pattern on histo

Question 14

gallbladder adenomyoma

1. what is it?
2. malignancy potential

Answer 14

1. benign, small, solitary mass in fundus of gallbladder

2. no risk of progression to malignancy

Question 15

interesting fact about gallbladder adenocarcinoma

Answer 15

gallbladder cancer occurs in <1% of patients with gallstones but 90% with cancer have cancer

Question 16

cholangiosarcoma

1. risk factor
2. type
3. locater
4. symptoms
5. histo

Answer 16

1. primary sclerosing cholangitis
2. adenocarcinoma
3. located perihilar at junction of left and right hepatic ducts— klatskin tumors
4. present with jaundice
5. microscopic features similar to pancreatic and gallbladder