Pancreas and Peritoneal Cavity Pathology

Question 1

Define pancreatic agenesis

Answer 1

absence of the pancreas - oftentimes ssociated with other malformations that are incompatible with life

Question 2

Define pancreas divisum

Answer 2

failure of fusion of the fetal dorsal and ventral pancreatic ducts, so the bulk of the pancreas drains thoruhg the dorsal and then a small caliber mino papilla

THIS IS THE MOST COMMON PANCREATIC CONGENITAL ANOMALY

usually asymptomatic but can be associated with chronic pancreatitis

Question 3

Define annular pancreas

Answer 3

When a band-like ring of normal pancreatic tissue completely encircles the second portion of the duodenum.

Often associated with other congenital anomalies

may cause duodenal obstruction

Question 4

Define ectopic pancreas? Common sites?

Answer 4

when pancreatic tissue is found where it shouldn’t be

often in stomach, duodenum, jejunum, meckel’s diverticulum and ileum

typically an incidental finding in the submucosa

Question 5

Describe how fatty tissue and pancreatic parenchyma are injured in acute pancreatitis?

Answer 5

inappropriate release of activated pancreatic enzymes lead to autodigestion

the fat necrosis is from the lipolytic enzymes

Question 6

Contrast the gross and microscopic findings of acute hemorrhagic necrotizing pancreatitis with long-standing chronic pancreatitis.

Answer 6

severe cases of acute pancreatitis present with hemorrhagic necrosis of the pancreas

chronic pancreatitis won’t have hemorrhage, but rather fibrosis

Question 7

Describe how chronic pancreatitis can lead to pancreatic insufficiency.

Answer 7

you get destruction of the acinar cells, so you don’t get appropriate secretion of the digestive enzymes

leads to digestion and absoprtion issues

Question 8

Describe what fat necrosis looks like grossly

Answer 8

looks like a soft, chalky white area because calcium will deposit there

can sometimes be mistaken for tumors

Question 9

Describe the gross and microscopic finginds of typ I autoimmune pancreatitis

Answer 9

you get a lymphocytic sclerosis pancreatitis with increased igG4 production by plasma cells

may form a mass that mimics pancreatic cancer

Question 10

How is autoimmune pancreatitis treated?

Answer 10

generally responsive to steroid therapy

Question 11

Define IgG4-related disease

Answer 11

It’s a newly recognized fibroinflammatory condition characterized by tumefactive lesions, dense lymphoplasmatyci infiltrate risk in IgG4-positive plasma cells

you get storiform fibrosis, obliterative phlebitis and in some cases elevated serum IgG4

probably an autoimmune issue with antibodies directed against bacterial components that behave as autoantibodies

Question 12

List some examples of diseases now thought to be related to IgG4 disease?

Answer 12

it’s described in virtually every organ system

Mikulicz disease, Kuttner’s tumor, Riedel thyroiditis, multifocal fibrosclerosis, inflammatory pseudotumors, autoimmune pancreatitis, periarteritis, retroperitoneal fibrosis, idiopathic tubulointerstitial nephritis

Question 13

State the two most common cuases of pancreatic pseudocysts.

Answer 13

usually form as a result of acute pancreatitis or pancreatis trauma

Question 14

Describe the microscopic appearance of a pancreatic pseudocyst

Answer 14

they are localized collections of pancreatic fluid secretions without an epithelial lining - wall is just inflammatory fibrous tissue

Question 15

Describe the key clinical and pathologic features or serous (microcystic) cystadenoma

Answer 15

A benign cystic neoplasm composed og glycogen-rish cuboidal cells surrounding small cysts containing clear, thin sraw-colored fluid

typically in older adults presenting with abdominal pain

surgical resection is usually curative

Question 16

Describe the key clinical and pathologic features of mucinous cystadenoma

Answer 16

usually middle aged women

form large multiloculated cysts filled with mucin. arise in the tail or body and do not communicate with the pancreatic ducts

present as a painless slow-growing mass

treat with surgial resection

can be benign or malignant

Question 17

Describe the key clinical and pathologic features of intraductal pappillary mucinous neoplasm

Answer 17

It’s a papillary mucinous neoplasm arising in the pancreatic DUCTS

affects both men and women, usually older adults

usually the head of the pancreas

has an ovarian type stroma

can be benign or malignant

Question 18

Which can become malignant: serous cystadenoma, mucinous cystadenoma, or itnraductal pappillary mucinous neoplasm?

Answer 18

serous cystadenoma is benign

mucinous cystadenoma or intraductal papillary mucinous neoplasms can be malignant

Question 19

Where does pancreatic cancer rank in the list of causes of cancer deaths?

Answer 19

4th leading cause of cancer death

Question 20

Describe how pancreatic carcinoma is diagnosed

Answer 20

imaging studdies that demonstrate mass lesions, followed by tissue biopsy from ultrasound guided biopsy technique

Question 21

Describe the whipple procedure for treatment of pancreatic cancer

Answer 21

You remove the head of the pancreas, duodenum, antrum of the stomach and gallbladder with common bile duct.

then you attach the hepatic duct to the jejunum, remainder of the pancreas to the jejunum and the stomach to the ileum

Question 22

State which type of patients may develop pancreatoblastoma

Answer 22

a very rare pancreatic carcinoma usually in children in the first decade of life
has acinar and squamoid differentiation

Question 23

State which type of patients may develop pancreatic solid-pseudopappillary tumor

Answer 23

found in young women!

tumor is large, well-circumscribed with solid and sometimes cystic areas - can see foci of hemorrhage and necrosis

Question 24

Contrast the gross appearance and clinical course of panceatic neuroendocrine tumors with that of typical pancreatic adenocarcinoma

Answer 24

typical pancreatic adenocarcinoma generally has a poor prognosis and it’s diffuse tumor with glandular differentiation

neuroendocrine tumors are of neuroendocrine differentiation and it’s hard to predict prognosis for them. all are potentially malignant. typically has a prolonged clinical course in comparison to pancreatic carcinoma

Question 25

What types of hormones can functioning pancreatic neuroendocrine tumors produce?

Answer 25

insulin, gastrin, glucagon, somatostatin, vasoactive intestinal peptide, ACTH

carcinoid syndrome is very rare with this

Question 26

Define peritonitis

Answer 26

inflammation of the thin, mesothelial covered layer of tissue that lines the abdominal cavity and covers most of the abdominal organs

Question 27

List some common causes of peritonitis

Answer 27

bacterial peritonitis secondary to perforaction of a viscus (appendicitis, PUD, cholecystitis, diverticulitis), ischemia, acute salpingitis, and peritoneal dialysis

also bile peritonitis with leakage of bile

acute hemorrhagic necrotizing pancreatitis can cause it

foreign material

endometriosis or localized hemorrhage of some other cause

Question 28

Define ascites

Answer 28

accumulation of excess fluid in the peritoneal cavity

Question 29

List some of the most common causes of ascites. By a large margin, which is the most common?

Answer 29

portal hypertension associated with cirrhosis is far and away the most common

cancer
heart failure
tuberculosis
dialysis
pancreatic disease
nephrotic syndrome

Question 30

Describe the most significant complication of ascites

Answer 30

spontaneous bacterial peritonitis - a bacterial infection developing in abscence of known contaminatine source

Question 31

Describe the rational for the use of lab tests of ascitic fluid. What can you do?

Answer 31

helpsdetermine the cause and whether the fluid is infected or not

typically co cell-count with differential, culture o f the fluid with gram stain, albumin, total protein and fluid cytology if malignancy is suspected.

Question 32

Why would you also obtain a serum albumin in addition to an albumin on ascitis fluid?

Answer 32

Allows you to get a serum ascites albumin gradient

you just do serum albumin concentration - ascitic fluic albumin concentration

Question 33

A SAAG less than 1.1 is considered due to what? How about over 1.1?

Answer 33

having a SAAG over 1.1 means there is still way more albumin in the serum that in the ascites, which suggests a transudative process with cirrhosis, hepatic metastases, budd chiari, or cardiac disease

if you have something less than 1.1, that means there’s quite a bit of albumin in the ascites and probably an exudative process from a malignancy, TB, pancreatitis, or nephrotic syndrome

Question 34

Which two metastatic tumors are the most common cause of malignant ascites?

Answer 34

most malignant peritoneal tumors are metastatic tumors - most commonly from ovarian or pancreatic carcinoma

Question 35

Define idiopathic retroperitoneal fibrosis

Answer 35

it’s a dense fibrosing process that can reuls in renal failure due to ureteral obstruction

an IgG4 disease…