Pancreas II: Cystic Fibrosis, Cystic Disorders, Pancreatic CA

Question 1

What changes do you expect to see in the pancreas of someone with early cystic fibrosis?

Answer 1

Early:
• Severly Distented and inspissated (thick, dry, hard) DARK PINK SECRETIONS (this is just tenacious mucus)

Question 2

What changes are seen in this late state biopsy of a CF pancreas?

Answer 2

Ducts that are PURPLE (b/c they are full on inspissated secretions)
• ATROPHIC ACINI - white arrows
• DYING ISLETS - black arrows

Question 3

This is a late stage CF pancreas with FIbroadipose replacement of exocrine portion of the gland.

Question 4

What is this?
• what would you expect to see on histology?
• What condition is this associated with?

Answer 4

Pancreatic pseudocysts are associated with acute pancreatitis

Question 5

Describe the key features of the pancreatic tissue shown here.

Answer 5

This is pancreatic adenocarcinoma - but hard to tell from fibrosis without zooming in and seeing cellular atypia

Key features:
• Desmoplastic Response (fibrosis surrouding cancerous glands)

Question 6

What is shown in this biopsy from the pancreas?
• what features would you expect to see if you zoomed out?

Answer 6

This is pancreatic adenocarcinoma displaying anaplastic cells with poorly formed glands

Zoomed out:
• you would see back to back glands

Question 7

What pancreatic abnormalities are seen here?

Answer 7

Radiolucent area in the pancreas is likely cancer

Question 8

What kinds of pancreatic cyst is this tissue most representative of?
• Key features?

Answer 8

lined by glycogen-rich cuboidal cells, and ​

contain clear, thin, straw-colored fluid​

Question 9

Shown here is a Mucinous Cyst from the pancreas.
• what key histological features would you look for?

Answer 9

columnar mucin-producing epithelium associated with a dense stroma similar to ovarian stroma ​

Thick tenacious mucin​

Question 10

What genes are often mutated in Mucinous Cysts?
• what mutations does this have in common with intraductal papillary mucinous neoplasms?

Answer 10

Mucinous Cysts often have mutations in KRAS and p53

IPMNs have KRAS, p53 mutations as well as GNAS mutations occasionally

Question 11

What Key features are seen in this tissue?
• what is it?

Answer 11

Still has a somewhat mucinous epithelial lining as a Mucin Cyst but there are 2 key differences:

1. No ovarian stroma behind epithelial lining
2. Often involves the pancreatic duct

Question 12

This tissue was taken from the pancreas, what is it?
• key features?

Answer 12

This is a Solid Papillary Neoplasm
• Solid and Cystic components filled with hemorrhagic debris
• Solid sheets become dishesive