pancreatic endocrine neoplasms

Question 1

a pancreatic neuroendocrine tumor is a _ differentiated tumor of _ malignant potential

it is dervied from _ _ _

it can be functional or non functional

risk of malignancy depend on _ and _

grade is based on _ index and can be shown with a _ stain

Answer 1

well

low

pancreatic islet cells

stage (invasion) and grade

mitotic

Ki67

Question 2

insulinomas are functionally active and a tumor of _ cells it is characterized by whipples triad, what is this

pancreatic neuroendocrine tumor

Answer 2

b cells

whipples triad: hypoglycemic symptoms (CNS dysfuctnion, confusion, visual changes, stupor)

low plasma glucose and relief with raising plasma glucose levels

Question 3

insulinoma are almost always _ and are what color?

histologic feature

there is inappropiate high _ and concentration during spotneous hypoglycemia (fasting) can confirm diagnosis

Answer 3

benign

pale-brown-red

amyloid (from amylin)

insulin

Question 4

what is factitious hypoglycemia

Answer 4

hypoglycemia due to inappropriate insulin use (administration of too much of a drug that causes beta cells to release insulin termed an insulin secretogougue)

Question 5

c peptide is normally created by the body when _ is released

it will be low if _ insulin is being used

Answer 5

insulin

outside

Question 6

labs for factiticous hypoglycemia

should be included in the workup of insulinoma

Answer 6

high insulin

low c peptide

Question 7

a gastrinoma is a neuroendocrine tumor that secretes _ found in the _ triangle

Answer 7

gastrin

gastrin triangle

Question 8

increased gastrin in a gastrinoma causes increased _ release from the pariteal cells and causes gastric/duodenal _

Answer 8

HCL

ulcers

Question 9

duodenal ulcers and findings of a gastrinoma with peptic ulcer disease is termed

Answer 9

zollinger ellison syndrome

Question 10

peptic ulcer disease symptoms

Answer 10

epigastric pain/discomfort

Question 11

duodenal ulcer symptoms

Answer 11

symptoms after serverl hours after eating ; at night without food

Question 12

more than half of the gatrinomas are _ and are associated with _ syndrome

you should suspect gatrinomas is there are multiple or if they are _ located

Answer 12

malignant

MEN1 syndrome

abnormally (jejunal)

Question 13

how do you diagnose zollinger ellision syndrome due to gastrinoma

Answer 13

high fastinc gatrin and gastric pH lower than 2

Question 14

a cell tumors produce _ and is associated with the 4 _

Answer 14

glucagonoma

D’s

dermatitis (necrolytic migratory erythema)
diabetes
depression
DVT ( coagulation factors)

increased glucagon

Question 15

delta cell tumors are called _ with markedley high levels of _

Answer 15

somatostainomas

somatostatin

Question 16

what does somatostatin do?

Answer 16

it suppresses insulin giving you diabetes

it suppresses cholecytokinin giving you cholethiasis

and it suppresses pancreatic enzymes giving you steatohrea

Question 17

symptoms of somatostaninoma

delta cell tumor

Answer 17

diabetes, cholethliasis, steatorrhea

Question 18

VIPomas are derived from _ _ cells and produced increased _

Answer 18

non beta

VIP (vasoactive intesintal peptide levels)

Question 19

effect of a vipoma

Answer 19

cholera like secretory diarrhea with hypokalemia (secretion of electrolytes)

decreased acid in the stomach