Pancreas/Biliary tree pathology Flashcards
Review the normal anatomy of the pancreas
Remember that the pancreas is retroperitoneal, lies next to 2nd part of duodenum
Review the histology of the pancreas below
Exocrine: acinar cells (digestive enzymes)
Endocrine: Langerhans cells (insulin, glucagon)
Review the embryology of the pancreas below
Dorsal and ventral buds fuse (the mature pancreases itself mostly from dorsal)
The most common congenital pancreatic anomaly is ___, resulting from failure of fusion of dorsal and ventral buds @ 8 wks
The most common congenital pancreatic anomaly is pancreas divisum resulting from failure of fusion of dorsal and ventral buds @ 8 wks
Pancreas drains thru minor papilla; some pts predisposed to pancreatitis due to stasis of fluid into the duodenum
___ results from abnormal rotation of the ventral pancreatic bud, creating a band around the 2nd part of the duodenum
Annular pancreas results from abnormal rotation of the ventral pancreatic bud, creating a band around the 2nd part of the duodenum
**
In the process of rotating, part of the pancreas encircles the duodenum >> band-like ring around duodenum
May cause duodenal narrowing, nausea, vomiting
___ is pancreatic tissue in areas other than the pancreas
Pancreatic tissue in areas other than the pancreas - ectopic pancreas
What are the mechanisms of acute pancreatitis? (3)
Duct obstruction, acinar cell injury, defective intracellular transport
**remember that acute pancreatitis >> autodigestion of pancreas by inappropriately activated enzymes**
One main difference between acute and chronic pancreatitis is that ___ is inflammation of pancreas that may be reversible if underlying cause removed, whereas ___ is irreversible inflammation of the pancreas w/ fibrosis
One main difference between acute and chronic pancreatitis is that acute pancreatitis is inflammation of pancreas that may be reversible if underlying cause removed, whereas chronic pancreatitis is irreversible inflammation of the pancreas w/ fibrosis
What is the pathology below?
Acute pancreatitis
What is the pathology below?
Chronic pancreatitis
___ is pancreatitis that is a manifestation of IgG4 related systemic disease
T/F: This disorder is a precursor for pancreatic cancer
Type I Autoimmune pancreatitis is pancreatitis that is a manifestation of IgG4 related systemic disease
Falsehood: This disorder mimics pancreatic cancer but responds to steroids
*Storiform fibrosis – fibrosis in all sorts of different directions*
What is the pathology below?
Type I autoimmune pancreatitis
**note the lymphocytic infiltrate**
___ is autoimmune pancreatitis that is confined to the pancreas and is characterized by neutrophilic microabscesses
Type 2 autoimmune pancreatitis is autoimmune pancreatitis that is confined to the pancreas and is characterized by neutrophilic microabscesses
2 categories of non-neoplastic cysts that occur in the pancreas are ___, which may occur in polycystic disease + are unilocular and thin walled, and ___, which isthe most common cause of cysts in the pancreas
2 categories of non-neoplastic cysts that occur in the pancreas are congenital cysts, which may occur in polycystic disease + are unilocular and thin walled, and pseudocyst, which is the most common cause of cysts in the pancreas
*see slide for more info*
Pancreatic neoplasms can be divided into cystic and solid.
Name the cystic neoplasms (4)
Name the solid neoplasms (3)
Cystic neoplasms:
Serous cystadenoma
Mucinous cystic neoplasm
IPMN
Solid-Pseudopapillary neoplasm
Solid neoplasms:
Ductal adenocarcinoma
Neuroendocrine tumor
Acinar cell carcinoma
What is the pathology below?
Serous cystadenoma
What is the pathology below?
Mucinous cystic neoplasm
What is the pathology below?
Intraductal papillary mucinous neoplasm
___ is a low-grade malignancy that occurs typically in young women and is characterized by pseudopapillae
Soild pseudopapillary neoplasm is a low-grade malignancy that occurs typically in young women and is characterized by pseudopapillae
(see slide)
Large, well circumscribed, solid + cystic, has fake papillary structures
Resection is curative
What is the pathology?
Soild pseudopapillary neoplasm
*note that this doesn’t have mucin so don’t confuse w/ IPMN, and also these are fake papillae, not real ones like the IPMNs*
Fill in the table below
See below
(you need to master this table + the symptoms of each)
Review the slide below on locations of pancreatic cancers
___ is the 4th leading cause of cancer death in the US and the major risk factor is smoking. Also characterized by jaundice and Trousseau syndrome
Ductal adenocarcinoma is the 4th leading cause of cancer death in the US and the major risk factor is smoking. Also characterized by jaundice and Trousseau syndrome
*migratory thrombophlebitis*
*precursor neoplasms: IPMNs and Mucinous cystic neoplasms (grossly visible) and Pancreatic intraepithelial neoplasia (microscopic)*
What are the precursors to ductal adenocarcinoma? (3)
IPMNs
Mucinous cystic neoplasms
Pancreatic intraepithelial neoplasia (PanIN)
Below are slides showing different grades of PanIN lesions. Name the grades
High grade: higher nucleus to cytoplasm ratio
More nuclear variation
Requires only a few more mutations to become invasive carcinoma
Both oncogenes and tumor suppressor gene mutations are involved in ductal carcinoma. The most commonly altered oncogene is ___, and the 3 most commonly altered tumor suppresor genes are ___ (3)
Both oncogenes and tumor suppressor gene mutations are involved in ductal carcinoma. The most commonly altered oncogene is KRAS and the 3 most commonly altered tumor suppresor genes are CDKN2A (p16), SMAD4, and p53
What is the pathology below?
Ductal adenocarcinoma
Name the congenital anomalies of the gallbladder (4)
Abscence
Duplication
Bilobed
Folded fundus
___ affects the extrahepatic bile ducts and occurs when there is complete or partial obstruction of the lumen of the biliary tree and is one of the most common causes of liver transplantation in children
Biliary atresia affects the extrahepatic bile ducts and occurs when there is complete or partial obstruction of the lumen of the biliary tree and is one of the most common causes of liver transplantation in children
**FA:
most common reason for pediatric liver transplantation
fibro-obliterative destruction of extrahepatic bile ducts
presents as newborn jaundice after 2 wks of life, darkening urine, acholic stools,hepatomegaly
(increased direct bili + GGT)
____ results from a fusiform dilation of the common bile duct, and can cause obstructive jaundice in children (mostly) and adults
Choledochal cysts results from a fusiform dilation of the common bile duct, and can cause obstructive jaundice in children (mostly) and adults
*Rx = excision w/ Roux-en-Y hepaticojejunostomy
Review the following slide on gallstones
Review the slide below on acute cholecystitis
Review the slide below on chronic cholecystitis
Review the slide below on gallbladder cancer
Not very common, more common in women and in Latin American countries
Poor prognosis because only detected when advanced
(review slide 45 for this lecture w/ microscopic eval; most gallbladder cancer - adenocarcinoma)
Review the slidebelow on cholangiocarcinoma
*increased risk in pts w/ ulcerative cholitis, PSC, parasitic infection, choledochal cyst*
Review the slide below on cholaniocarcinoma microscopy
firm, sclerotic mass, mostly adenocarcinoma, similar to gallbladder adenocarcinoma
