Pancreas Ch. 12 Hagen Flashcards
Involves the exocrine portion of the gland–Fatal tumor
Accounts for greater than 90% of all malignant pancreatic tumors
Pancreatic Adenocarcinoma
Causes areas of diffuse inflammatory edema of soft tissue
Phlegmonous Pancreatitis
Cystic Pancreatic Neoplasms (4 subtypes with varying malignant potential)
Serous cystic tumors
Mucinous cystic neoplasms
Intraductal papillary mucinous neoplasms
Solid pseudopapillary neoplasms
Ultrasound Findings
Poorly defined hypoechoic mass
Smooth or irregular walls
Few internal echoes seen, may be echo-free
Air bubbles may be seen within, with shadowing posterior
When it forms secondary to chronic pancreatitis and develops calcification within its walls typically doesn’t resolve on its own
Pancreatic Abscess
Cystic Lesions of the Pancreas
Autosomal dominant polycystic disease
Von Hippel-Lindau syndrome
Cystic Fibrosis
Cystic Pancreatic Neoplasms
Clinical Symptoms
Depends on the location
Tumors in the head present symptoms early, causing obstruction of the CBD with jaundice and hydrops of the GB (Courvoisier’s sign)
Palpable, nontender GB with jaundice seen in 25% of patients with pancreatic ca
Tumors in the body and tail—less specific symptoms
Most commonly- weight loss, pain, jaundice, and vomiting (as GI tract has been invaded by tumor)
Tumors in the body and tail more frequently larger
Most common location is the head followed by body, then tail
Pancreatic Adenocarcinoma
Produces Zollinger-Ellison syndrome
Caused by non-insulin secreting pancreatic tumors that secrete excessive amounts of gastrin
Stimulates the stomach to produce great amounts of hydrochloric acid and pepsin
Gastrinoma (G-Cell)
Arise from lymphoid tissue
May be difficult to separate from primary lesion
Multiple nodes are seen along the pancreas, duodenum, porta hepatis, and superior mesenteric vessels.
Lymphoma
Form of mucinous cystic neoplasm
Originates from main pancreatic duct or its branches
Slow growing occurs in patients in their 60’s & 70’s
Benign to malignant
Clinical symptoms- abdomen pain, elevated amylase, so pancreatitis is a differential
Intraductal Papillary Mucinous Tumor
Primary tumors that can metastasize to the pancreas are:
Melanomas
Breast
Gastrointestinal
Lung tumors
Ultrasound Findings-
Typically small
Best seen when in the head
May be multiple and usually occur in the body and tail—greater concentration of Langerhans islets in that area
Islet-Cell tumors
2nd most common functioning islet cell tumor
Gastrinoma
Ultrasound Findings Depends on the age of the hemorrhage May be homogeneous and echogenic with fresh blood Areas of fat necrosis seen At 1 week may appear cystic
Hemorrhagic Pancreatitis
Most common primary neoplasm of the pancreas
Pancreatic Adenocarcinoma
Low incidence, but serious complication—related to tissue necrosis
Majority of patients develop an abscess secondary to pancreatitis that develops from postoperative procedures
Pancreatic Abscess
Ultrasound Findings
Phlegmonous tissue appears hypoechoic with good through-transmission
Usually involves the lesser sac, left anterior pararenal space, and transverse mesocolon
Phlegmonous Pancreatitis
Rare, benign disease is found more often in older women.
Tumor is well circumscribed and usually consists of a large mass with multiple tiny cysts.
Microcystic Adenoma
Hypoglycemic symptoms with immediate relief after IV glucose
Clinical Symptoms
Palpitations, headache, confusion, pallor, sweating, slurred speech and coma
Usually benign
Most- small, well encapsulated, and hypervascular
Insulinoma (B-Cell)
2 types of Cystic Pancreatic Neoplasms
Microcystic (serous adenoma)
Macrocystic (mucinous adenoma)
Cystic neoplasms of the pancreas account for 10-15% of all pancreatic cyst
May proceed to necrosis
Extension outside the gland occurs in 18-20% of patients
Phlegmonous Pancreatitis
Rapid progression of acute with rupture of vessels resulting in hemorrhage
Hemorrhagic Pancreatitis
Diffuse enzyme destruction of pancreas
Cause focal areas of fat necrosis
In nearly half of these patients, this occurs after a large binge or excessively large meal
Hemorrhagic Pancreatitis
Rise from the islet cells of the pancreas
Several types of islet cell tumors; may be functional or nonfunctional
Benign or malignant
Growth rate is slow
Usually do not spread beyond regional lymph nodes and liver
Endocrine Pancreatic Neoplasms
Ultrasound Findings Mixed pattern Increased overall echogenicity with hypoechoic (from inflammation) and hyperechoic foci Decreased size Irregular borders Possibly dilated duct
Chronic Pancreatitis
Results from recurrent attacks of acute and causes continuing destruction of pancreas
Generally associated with chronic alcoholism or biliary disease
Chronic Pancreatitis
Ultrasound Findings Well-defined Thin or thick walled Usually larger than 2 cm 4 types Hypoechoic Echogenic with debris Cyst with solid mural vegetations Completely filled or solid looking cyst
Microcystic Adenoma
an inflammatory process that spreads along fascial pathways
Phlegmonous Pancreatitis
33% of all islet-cell neoplasms
Tendency to present as large tumors in the head of the pancreas with a high incidence of malignancy
Nonfunctioning Islet-Cell Tumors
Most common parapancreatic neoplasm
Lymphoma
Ultrasound Findings
Poorly defined mass in the region of the pancreas
Hypoechoic or isoechoic
Rarely, necrosis will be seen as a cystic area within the mass
May have secondary enlargement of the duct from edema or tumor in the panc. head
If tumor is within the head look for biliary dilation
Sonographer should look for mets in the liver, para-aortic nodes, displacement of vessels
Pancreatic Adenocarcinoma
Ultrasound Findings
Usually well-defined mass—echo-free
Debris may be seen within- infection and hemorrhage
Borders are echogenic
Calcifications may develop within the wall
Pseudocyst
Poor prognosis– survival time of 2-3 months and 1 year survival rate of 8%
Pancreatic Adenocarcinoma
Fourth most common cause of cancer related mortality after lung, breast, and colon cancer
Pancreatic Adenocarcinoma
Most common functioning islet cell tumor
Insulinoma
