Pancreas pathology

Question 1

Pancreas anatomy

Answer 1

Exocrine component - acini (release inactive zymogens protease / lipase / amylase) - into ducts
Endocrine component - Islet of Langerhans (alpha cells glucagon, beta cells insulin, delta cells somatostatin) - into blood
Pancreatic duct epithelial cells - secrete alkaline bicarbonate ions into ducts

Key products: Zymogens + bicarbonate + hormones

Basically split into ductal / acinar / Islet cells

Question 2

Sudden onset upper abdo pain radiating to back
Nausea, vomiting, hypotension
Raised serum amylase
Swollen + soft with yellow-white flecks of fat necrosis
Calcium deposits bind free fatty acids
Periductal / perilobular / panlobular inflammatory patterns

Answer 2

Acute pancreatitis

Question 3

Three patterns of inflammation in acute pancreatitis

Answer 3

Periductal (necrosis of acinar cells at centre near duct - occurs in obstruction)
Perilobular (necrosis of acinar cells at periphery furthest from blood supply)
Panlobular (whole lobule affected)

Question 4

Cystic fluid-filled mass on pancreas lined by fibrous tissue (NOT EPITHELIUM)
Filled with inflammatory exudate
Complication of acute and chronic pancreatitis OR post-surgical

Answer 4

Pancreatic pseudocyst

Question 5

Cystic fluid-filled mass on pancreas lined by EPITHELIUM

Answer 5

Pancreatic cystadenoma

Question 6

Acute pancreatitis causes

Answer 6

Acute inflammation due to aberrant release of pancreatic enzymes
GETSMASHED - Gallstones / ethanol in majority
- Either direct acinar injury (rest of causes) OR duct obstruction = bile reflux (alcohol SoO spasm, gallstones)

Question 7

Acute pancreatitis + scarring + more extensive disease

Answer 7

Chronic pancreatitis

Question 8

IgG4 positive plasma cells

Answer 8

AI pancreatitis

Question 9

3 types of pancreatic tumour

Answer 9

Carcinomas (85% ductal)
Cystadenomas
Neuroendocrine (Islet cells)

Question 10

Acinar-ductal metaplasia pathway
Mostly derive from ducts
Intermediate dysplasia step - PanIN, IMP (K-ras mutations)
Macroscopic: Head of pancreas, gritty + grey
Microsopic: Secrete mucus + form glands, peri-neural invasion (wraps around nerves)
Late diagnosis, poor prognosis
Painless jaundice + weight loss
Dilated intrahepatic bile ducts

Answer 10

Pancreatic carcinoma

adenocarcinomas

Question 11

PanIN and IMP

K-ras mutation

Answer 11

Pancreatic dysplasias - intermediate step prior to pancreatic carcinoma (like adenoma in adenocarcinoma pathway!)
K-Ras mutations in 95%

Question 12

Tumour in head vs. tail of pancreas

Answer 12

Head = Carcinoma
Tail = Neuroendocrine tumour

Question 13

Pseudocyst vs. cystadenoma

Answer 13

Pseudocyst no epithelium, cystadenoma epithelium

Question 14

Mucinous or serous
Benign
Lined by epithelium

Answer 14

Cystadenoma

Question 15

Chromogranin stain positive
MEN1
Insulinoma = hypoglycaemia
Tail of pancreas
Rosette cells

Answer 15

Pancreatic NE tumours