Pancreas and Peritoneal Cavity Pathology Flashcards
Define pancreatic agenesis
absence of the pancreas - oftentimes ssociated with other malformations that are incompatible with life
Define pancreas divisum
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
Define annular pancreas
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
Define ectopic pancreas? Common sites?
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
Describe how fatty tissue and pancreatic parenchyma are injured in acute pancreatitis?
inappropriate release of activated pancreatic enzymes lead to autodigestion
the fat necrosis is from the lipolytic enzymes
Contrast the gross and microscopic findings of acute hemorrhagic necrotizing pancreatitis with long-standing chronic pancreatitis.
severe cases of acute pancreatitis present with hemorrhagic necrosis of the pancreas
chronic pancreatitis won’t have hemorrhage, but rather fibrosis
Describe how chronic pancreatitis can lead to pancreatic insufficiency.
you get destruction of the acinar cells, so you don’t get appropriate secretion of the digestive enzymes
leads to digestion and absoprtion issues
Describe what fat necrosis looks like grossly
looks like a soft, chalky white area because calcium will deposit there
can sometimes be mistaken for tumors
Describe the gross and microscopic finginds of typ I autoimmune pancreatitis
you get a lymphocytic sclerosis pancreatitis with increased igG4 production by plasma cells
may form a mass that mimics pancreatic cancer
How is autoimmune pancreatitis treated?
generally responsive to steroid therapy
Define IgG4-related disease
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
List some examples of diseases now thought to be related to IgG4 disease?
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
State the two most common cuases of pancreatic pseudocysts.
usually form as a result of acute pancreatitis or pancreatis trauma
Describe the microscopic appearance of a pancreatic pseudocyst
they are localized collections of pancreatic fluid secretions without an epithelial lining - wall is just inflammatory fibrous tissue
Describe the key clinical and pathologic features or serous (microcystic) cystadenoma
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
Describe the key clinical and pathologic features of mucinous cystadenoma
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
Describe the key clinical and pathologic features of intraductal pappillary mucinous neoplasm
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
Which can become malignant: serous cystadenoma, mucinous cystadenoma, or itnraductal pappillary mucinous neoplasm?
serous cystadenoma is benign
mucinous cystadenoma or intraductal papillary mucinous neoplasms can be malignant
Where does pancreatic cancer rank in the list of causes of cancer deaths?
4th leading cause of cancer death
Describe how pancreatic carcinoma is diagnosed
imaging studdies that demonstrate mass lesions, followed by tissue biopsy from ultrasound guided biopsy technique
Describe the whipple procedure for treatment of pancreatic cancer
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
State which type of patients may develop pancreatoblastoma
a very rare pancreatic carcinoma usually in children in the first decade of life
has acinar and squamoid differentiation
State which type of patients may develop pancreatic solid-pseudopappillary tumor
found in young women!
tumor is large, well-circumscribed with solid and sometimes cystic areas - can see foci of hemorrhage and necrosis
Contrast the gross appearance and clinical course of panceatic neuroendocrine tumors with that of typical pancreatic adenocarcinoma
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
