Pancreas Ch. 12 Hagen

Question 1

Involves the exocrine portion of the gland–Fatal tumor

Accounts for greater than 90% of all malignant pancreatic tumors

Answer 1

Pancreatic Adenocarcinoma

Question 2

Causes areas of diffuse inflammatory edema of soft tissue

Answer 2

Phlegmonous Pancreatitis

Question 3

Cystic Pancreatic Neoplasms (4 subtypes with varying malignant potential)

Answer 3

Serous cystic tumors
Mucinous cystic neoplasms
Intraductal papillary mucinous neoplasms
Solid pseudopapillary neoplasms

Question 4

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

Answer 4

Pancreatic Abscess

Question 5

Cystic Lesions of the Pancreas

Answer 5

Autosomal dominant polycystic disease

Von Hippel-Lindau syndrome

Cystic Fibrosis

Cystic Pancreatic Neoplasms

Question 6

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

Answer 6

Pancreatic Adenocarcinoma

Question 7

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

Answer 7

Gastrinoma (G-Cell)

Question 8

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.

Answer 8

Lymphoma

Question 9

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

Answer 9

Intraductal Papillary Mucinous Tumor

Question 10

Primary tumors that can metastasize to the pancreas are:

Answer 10

Melanomas
Breast
Gastrointestinal
Lung tumors

Question 11

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

Answer 11

Islet-Cell tumors

Question 12

2nd most common functioning islet cell tumor

Answer 12

Gastrinoma

Question 13

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

Answer 13

Hemorrhagic Pancreatitis

Question 14

Most common primary neoplasm of the pancreas

Answer 14

Pancreatic Adenocarcinoma

Question 15

Low incidence, but serious complication—related to tissue necrosis
Majority of patients develop an abscess secondary to pancreatitis that develops from postoperative procedures

Answer 15

Pancreatic Abscess

Question 16

Ultrasound Findings
Phlegmonous tissue appears hypoechoic with good through-transmission
Usually involves the lesser sac, left anterior pararenal space, and transverse mesocolon

Answer 16

Phlegmonous Pancreatitis

Question 17

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.

Answer 17

Microcystic Adenoma

Question 18

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

Answer 18

Insulinoma (B-Cell)

Question 19

2 types of Cystic Pancreatic Neoplasms

Answer 19

Microcystic (serous adenoma)
Macrocystic (mucinous adenoma)

Cystic neoplasms of the pancreas account for 10-15% of all pancreatic cyst

Question 20

May proceed to necrosis

Extension outside the gland occurs in 18-20% of patients

Answer 20

Phlegmonous Pancreatitis

Question 21

Rapid progression of acute with rupture of vessels resulting in hemorrhage

Answer 21

Hemorrhagic Pancreatitis

Question 22

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

Answer 22

Hemorrhagic Pancreatitis

Question 23

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

Answer 23

Endocrine Pancreatic Neoplasms

Question 24

Ultrasound Findings
Mixed pattern
Increased overall echogenicity with hypoechoic (from inflammation) and hyperechoic foci
Decreased size
Irregular borders
Possibly dilated duct

Answer 24

Chronic Pancreatitis

Question 25

Results from recurrent attacks of acute and causes continuing destruction of pancreas
Generally associated with chronic alcoholism or biliary disease

Answer 25

Chronic Pancreatitis

Question 26

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

Answer 26

Microcystic Adenoma

Question 27

an inflammatory process that spreads along fascial pathways

Answer 27

Phlegmonous Pancreatitis

Question 28

33% of all islet-cell neoplasms

Tendency to present as large tumors in the head of the pancreas with a high incidence of malignancy

Answer 28

Nonfunctioning Islet-Cell Tumors

Question 29

Most common parapancreatic neoplasm

Answer 29

Lymphoma

Question 30

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

Answer 30

Pancreatic Adenocarcinoma

Question 31

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

Answer 31

Pseudocyst

Question 32

Poor prognosis– survival time of 2-3 months and 1 year survival rate of 8%

Answer 32

Pancreatic Adenocarcinoma

Question 33

Fourth most common cause of cancer related mortality after lung, breast, and colon cancer

Answer 33

Pancreatic Adenocarcinoma

Question 34

Most common functioning islet cell tumor

Answer 34

Insulinoma