Pancrease 1 Flashcards
congenital anamolies of pancreas
o Accessory (ectopic pancreas): pancreatic tissue outside it’s normal location (often in stomach, small intestine, meckel’s diverticulum)
o Annular pancreas: abnormal ring of pancreas that encircles the duodenum; assoc w/ down’s syndrome
o Pancreas divisum: failure of dorsal and ventral buds/ducts to fuse leading to retention of 2 separate duct systems; duct of santorinin provides main drainagel may cause acute pancreatitis
acute pancreatitis
common etiology
histo
Common etiologies: alcoholism, gallstones, mumps
Hist:
- Edema by microvascular leakage
- Fat necrosis by lipolytic enzymes (saponification)
- Acute inflammation (neutrophils)
- Proteolytic destruction of pancreatic parenchyma
- Destruction of blood vessels and subsequent interstitial hemorrhage
Pic shows Fat necrosis with dystrophic calcifcation
acute hemorrhagic pancreatitis
o Abrupt onset following heavy meal/alcohol
o Extensive tissue destruction w/ circulatory collapse and shock
o Elevated serum amylase and lipase
o 50% mortality
o may develop pseudocyst
What type of pancreatitis?
Chronic
oRecurrent, progressive pancreatic tissue destruction
o Alcohol abuse is major cause
o Chronic inflammation, fibrosis, calcification
o Pancreatic insufficiency w/ malabsorption and/or diabetes
o 3-4% mortality/year
autoimmune pancreatitis
o 40s-60s
o assoc. w/ autoimmune conditions (PSC, Sjogren)
o some w/ multifocal inflammatory fibrosclerosis (Reidel thyroiditis, orbital pseudotumor, mediastinal and retroperitoneal fibrosis)
o mimics pancreatic carcinoma both clinically (obstructive jaundice) and radiologically (mass-like lesion)—“sausage-like” appearance on imaging
o elevated serum IgG4
o respond well to steroids
o Histo:
• Dense “duct-centric” inflammation of predominantly lymphoplasmacytic cells and expansion of periductal fibrous tissue
• Periphlebitis and obliterative venulitis common
• Interstitial fibroblastic proliferaion w/ storiform architecture
• IgG4+ plasma cells
hereditary pancreatitis
o AD, mutations in PRSS1 and SPINK1 result in autoactivation of trysinogen
o Same features of chronic pancreatitis except earlier age onset, less pancreatic calicification, and DM
o 40% develop pancreatic ductal adenocarcinoma
pancreatic ductal adenocarcinoma
CT:
Most lethal solid tumor; Highest incidence after age 60
- o Risks: smoking, chemical exposure, high meat/fat diet, diabetes, chronic pancreatitis
- o KRAS activating mutations; Tumor suppressor mutations in p16, TP53, SMAD4
- o Precursor to cancer: pancreatic intraepithelial neoplasia
- o Sx:
- • Anorexia, wt loss
- • Abdominal/back pain
- • Jaundice
- • Migratory thrombophlebitis (troussea’s sign)—hypercoagulability and tendency to venous thrombosis
- o Derived from ductal cells; spreads by lymphatics and along nerves
- o 5 year survival=5% (only 20% are surgical candidates)
- o Gross: firm, gray poorly demarcated mass. Invasion of peripancreatic tissue and local structures common
- o Microscopic: >75% are well-moderately differentiated, prominent desmoplastic rxn, perineural invasion
pancreatoblastoma
o Children!
o Micro: acini and sqaumoid corpuscle
o 1/3 lymphn node/hepatic mets
pancreatic neuroendocrine neoplasms
o Derived from islet cells; non-functional or functional; M & F equally; ages 30-60; MEN1 syndrome
o Insulinoma (Beta-cell tumors): most common islet cell tumor
• Excess secretion of insulin→hypoglycemia, sweating, nervousness, hunger, confusion, lethargy
• Most are benign, solitary, small
• Uniform nests of cells, richly vascular, amyloid deposition
o Gastrinoma: G cell tumor secretes excess gastrin
• Zollinger-Ellison Syndrome (intractable gastric hypersecretion, peptic ulceration, and elevated blood gastrin levels)
serous cystadenoma
o Female predominance; pts with VHL at inc. risk
o Always benign, surgery is curative
o Composed of glycogen-rich cuboidal cells surrounding small (1 to 3 mm) cysts containing clear, thin, straw-colored fluid
mucinous cystic neoplasm
o Women
o Body or tail pancreas
o Painless, slow growing mass
o 1/3 assoc. w/ invasive carcinoma
o The cysts are lined by columnar mucinous epithelium, and a dense ovarian-type stroma
o Not involving the major pancreatic duct
intraductal papillary mucinous neoplasm
o Precursor to PDA
o Men
o Multifocal
o Can involve man pancreatic duct
o Lack ovarian type stroma
solid pseudopapillary neoplasm
o Low grade malignant neoplasm, 15% get mets
o Women in 20s
o Sx: intra-abdominal mass, palpable on exam
o Activating Mutation in beta-catenin
o cystic areas filled w/ hemorrhagic debris,
o Histo: cells as solid sheets, pseudopapillary,
cholelithiasis
o Gallstones in gallbladder or extrahepatic biliary tree
o Asymptomatic but may present w/ pain (biliary colic) if in cystic or common bile duct and fatty food intolerance
cholesterol stones
o Yellow-tan; cholesterol calcium salts, mucin; radiolucent
o Risks: women of reproductive age, inc. age, obesity, ethnicity, diet, metabolic abnormalities, drugs
o Contributing factors (4)
• Hypersaturaiton of bile w/ cholesterol
• Gallbladder hypomotility
• Crystal nucleation accelerated
• Hypersecretion of mucus in gallbladder traps crystals leading to aggregation
Normal Pancreas. Compare to what is shown on the back.
Pseudocyst
Pancreatic adenocarcinoma
