Pancreatic Exocrine Neoplasia

Question 1

What type are most adult pancreatic tumors?

Answer 1

Infiltrating ductal carcinoma

Question 2

RFs for developing pancreatic cancer?

Answer 2

• Smoking
• BMI
• Diet
• Diabetes
• Chronic Pancreatitis

Question 3

What is the lesion preceding pancreatic cancer?

Answer 3

Pancreatic Intraductal Neoplasia (PanIN)

Question 4

What mutuation occurs in PanIN1?

Answer 4

Mutational activation of KRAS oncogene

Question 5

What gene is mutated in PanIN 2?

Answer 5

p16

Question 6

What genes can be mutated in PanIN3?

Answer 6

p53, BRCA2, DPC4/SMAD4

Question 7

Most common pancreatic anatomical location of ductal carcinoma?

Answer 7

Head

Question 8

Cause of persistent pain in pancreatic carcinoma?

Answer 8

Perineural invasion is characteristic

Question 9

Clinical Syx of Pancreatic carcinoma?

Answer 9

Anorexia, weight loss, epigastric pain radiating to the back

Question 10

Acute, painless gallbladder dilation accompanied by jaundice?

Answer 10

Courvoisier sign - caused by common bile duct obstruction by tumor

Question 11

What is Trousseau Syndrome?

Answer 11

Migratory thrombophelbitis that occurs with pancreatic cancer. (DVTs)

Question 12

What are the 3 likely causes leading to DVTs in pancreatic cancer?

Answer 12

1. Serine protease synthed and released by tumor cells directly activating plasma factor X
2. Tumor cells shed plasma membrane vesicles which have procoagulant activity
3. Necrotic tumor releases tisssue thromboplastins

Question 13

How is acinar carcinoma differentiated from ductal adenocarcinoma?

Answer 13

Acinar has less rapidly fata, lacks desmoplastic stroma of ductal and acinar carcinomas demonstrate production of exocrine enzymes

Question 14

What are the characteristics of pancreatoblastoma?

Answer 14

Occur in childhood, serum alpha-fetoprotein is elevated, can be associated with Beckwith-Wiedemann syndrome

Question 15

Characterisitcs of Serous Cystic Neoplasms?

Answer 15

Associated with VHL syndrome, typically associated w/ inactivation of VHL gene, nearly always benign

Question 16

Pancreatic tumor with tall mucin-secreting epithelium?

Answer 16

Intraductal papillary mucinous tumor

Question 17

Pancreatic tumor that almost exclusively occurs in middle-aged women

Answer 17

Mucinous Cystic Neoplasm

Question 18

TUmor that occurs typically in girls and young women and have mutations of the beta-catenin gene?

Answer 18

Solid pseudopapillary neoplasm