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P & T I Block 3 > Pancreas/Biliary tree pathology > Flashcards

Pancreas/Biliary tree pathology Flashcards

1
Q

Review the normal anatomy of the pancreas

A

Remember that the pancreas is retroperitoneal, lies next to 2nd part of duodenum

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2
Q

Review the histology of the pancreas below

A

Exocrine: acinar cells (digestive enzymes)

Endocrine: Langerhans cells (insulin, glucagon)

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3
Q

Review the embryology of the pancreas below

A

Dorsal and ventral buds fuse (the mature pancreases itself mostly from dorsal)

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4
Q

The most common congenital pancreatic anomaly is ___, resulting from failure of fusion of dorsal and ventral buds @ 8 wks

A

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

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5
Q

___ results from abnormal rotation of the ventral pancreatic bud, creating a band around the 2nd part of the duodenum

A

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

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6
Q

___ is pancreatic tissue in areas other than the pancreas

A

Pancreatic tissue in areas other than the pancreas - ectopic pancreas

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7
Q

What are the mechanisms of acute pancreatitis? (3)

A

Duct obstruction, acinar cell injury, defective intracellular transport

**remember that acute pancreatitis >> autodigestion of pancreas by inappropriately activated enzymes**

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8
Q

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

A

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

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9
Q

What is the pathology below?

A

Acute pancreatitis

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10
Q

What is the pathology below?

A

Chronic pancreatitis

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11
Q

___ is pancreatitis that is a manifestation of IgG4 related systemic disease

T/F: This disorder is a precursor for pancreatic cancer

A

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*

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12
Q

What is the pathology below?

A

Type I autoimmune pancreatitis

**note the lymphocytic infiltrate**

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13
Q

___ is autoimmune pancreatitis that is confined to the pancreas and is characterized by neutrophilic microabscesses

A

Type 2 autoimmune pancreatitis is autoimmune pancreatitis that is confined to the pancreas and is characterized by neutrophilic microabscesses

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14
Q

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

A

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*

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15
Q

Pancreatic neoplasms can be divided into cystic and solid.

Name the cystic neoplasms (4)

Name the solid neoplasms (3)

A

Cystic neoplasms:

Serous cystadenoma

Mucinous cystic neoplasm

IPMN

Solid-Pseudopapillary neoplasm

Solid neoplasms:

Ductal adenocarcinoma

Neuroendocrine tumor

Acinar cell carcinoma

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16
Q

What is the pathology below?

A

Serous cystadenoma

17
Q

What is the pathology below?

A

Mucinous cystic neoplasm

18
Q

What is the pathology below?

A

Intraductal papillary mucinous neoplasm

19
Q

___ is a low-grade malignancy that occurs typically in young women and is characterized by pseudopapillae

A

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

20
Q

What is the pathology?

A

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*

21
Q

Fill in the table below

A

See below

(you need to master this table + the symptoms of each)

22
Q

Review the slide below on locations of pancreatic cancers

A
23
Q

___ 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

A

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)*

24
Q

What are the precursors to ductal adenocarcinoma? (3)

A

IPMNs

Mucinous cystic neoplasms

Pancreatic intraepithelial neoplasia (PanIN)

25
Q

Below are slides showing different grades of PanIN lesions. Name the grades

A

High grade: higher nucleus to cytoplasm ratio

More nuclear variation

Requires only a few more mutations to become invasive carcinoma

26
Q

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)

A

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

27
Q

What is the pathology below?

A

Ductal adenocarcinoma

28
Q

Name the congenital anomalies of the gallbladder (4)

A

Abscence

Duplication

Bilobed

Folded fundus

29
Q

___ 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

A

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)

30
Q

____ results from a fusiform dilation of the common bile duct, and can cause obstructive jaundice in children (mostly) and adults

A

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

31
Q

Review the following slide on gallstones

A
32
Q

Review the slide below on acute cholecystitis

A
33
Q

Review the slide below on chronic cholecystitis

A
34
Q

Review the slide below on gallbladder cancer

A

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)

35
Q

Review the slidebelow on cholangiocarcinoma

A

*increased risk in pts w/ ulcerative cholitis, PSC, parasitic infection, choledochal cyst*

36
Q

Review the slide below on cholaniocarcinoma microscopy

A

firm, sclerotic mass, mostly adenocarcinoma, similar to gallbladder adenocarcinoma

P & T I Block 3 (11 decks)

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