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PATHOLOGY > Pancreatic histopath > Flashcards

Pancreatic histopath Flashcards

1
Q

summarise pancreatic microanatomy

A

main pancreatic duct goes into intralobular duct and intercalated duct

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2
Q

what is acute pancreatitis

A

acute inflammation of the pancreas

caused by aberrent release of pancreatic enzymes

Activation on enzymes secreted by pancreas is the main cause for the damage

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3
Q

incidence of acute pancreatitis

A

common

incidence is increasing

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4
Q

categories of causes for acute pancreatitis

A
  • duct obstruction
  • metabolic/toxic
  • poor blood supply
  • infection/inflammation
  • autoimmune
  • idiopathic
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5
Q

duct obstruction causes of acute pancreatitis

A

Enzymes cant go where meant to go - activated in wrong place

  1. gall stones - most comon
  2. trauma
  3. tumours
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6
Q

metabolic and toxic causes of acute pancreatitis

A

Alcohol - 1/3 cases of ac panc
* 5% of alcoholics will get ac panc

Thiazides

Hypercalcaemia

Hyperlipidaemia

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7
Q

poor blood supply causes of acute pancreatitis

A

shock - hypovolaemia
hypothermia

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8
Q

infection and inflammation causes of acute pancreatitis

A

is the cause and consequence

Virus - mumps = inflam of salivary glands too which secrete amylase

Coxacki

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9
Q

pathogenesis of obstruction -> pancreatitis

A

gallstone distal to where common bile duct and panc duct join
-> reflux of bile up panc duct
-> **damage to acini **
and release of proenzymes -> activated

alcohol -> spasm/oedema of sphincter of Oddi and formation of protein rich panc fluid
-> **obstruction **of panc duct

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10
Q

Pathogenesis of acute panc except from obstruction

A

direct acini injury

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11
Q

patterns of injury in acute pancreatitis

A

periductal:
* necrosis of acini cells near ducts - secondary to obstruction

perilobular
* necrosis at edges of the lobules
* usually from poor blood supply

panlobular
* develops from periductal and perilobular

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12
Q

how does injury propagate in acute pancreatitis

A

activated enzymes -> acinar necrosis -> enzyme release
+ve feedback
range from stromal oedema to haemorrhagic necrosis

eg lipases -> fat necrosis
1. (hydrolyse triglycerides)
2. (Ca ions bind to FFA
3. -> precipitated as soaps
4. seen as yellow-white foci)

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13
Q

complications of acute pancreatitis

A

pancreatic
* pseudocyst
* abscess

systemic
* shock
* hypoglycaemia - shock and a lot of insulin released
* hypocalcaemia - ca combine with fatty acid -> fat necrosis, ca taken out of blood and ppte

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14
Q

what is a pseudocyst

A

(cysts not lined by epithelium)

  • may communicate with ducts,
  • may burst,
  • have stasis -> abscess
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15
Q

acute pancreatitis and ca

A

Hyperca is the cause

Acute panc causes low ca

->

If acute panc and normal ca - could have been high and then fat necorsis normalises it

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16
Q

Px of acute pancreatitis

A

overall mortality of up to 50% for haemorrhagic pancreatitis

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17
Q

histo path of acute panc

A

White things - fat necrosis

Microscopic - blue - are ca combined with FFA -> fat necrosis

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18
Q

what is acute pancreatitis

A

relapsing or persistent

associated with acute in 1/2 case

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19
Q

epidemiology and px of chronic pancreatitis

A

uncommon

3% mortality per yr

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20
Q

causes of chronic pancreatitis

A

metabolic/toxic
* alcohol - 80%
* haemochromatosis

duct obstruction
* gallstones
* abnormal pancreatic duct anatomy
* CF (mucoviscoidosis)

tumours

idiopathic - autoimmune

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21
Q

haemochromatosis as a cause of chronic pancreatitis

A

iron overload - iron deposited in parenchymal cells of pancreas

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22
Q

duct obstruction as a cause of chronic pancreatitis

A
  • Gall stones
    • Abnormal pancreatic duct anatomy -> reflux of bile into pancreas
    • CF (mucoviscioidosis) - thick mucin deposited -> obstruction
  • Chronic disease -> chronic pancreatitis
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23
Q

pathogenesis of chronic pancreatitis

A

same as acute

Direct damage to acini eg by iron deposited in cells

Acute = neutrophils
Chronic = lymphocytes

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24
Q

pattern of damage in chronic pancreatitis

A

chronic inflammation with parenchymal fibrosis
associated with atrophy of the acini - loss of parenchyma
islets will be squeezed out too

haemochromatosis ‘‘bronze diabetes’’ - initially effect acini but will go on to effect islets

duct strictures with calcified stones and secondary dilations

25
chronic pancreatitis complications
malabsorption - acini gone and ducts obstructed DM - in late stage pseudocysts ?carcinoma of pancreas - unclear whether associated - But tumour cause of acute and chronic panc - unclear which comes 1st
26
- Calcification of pancreas - Chronic calcifying pancreatitis
27
- Scarring pale tissue - Cysts - Chronic panc
28
- Fibrosis - Islets left behind Acini have gone - might start to look like a neuroendocrine tumour
29
summarise pancreatic pseudocyst
associated with **acute and chronic** pancreatitis lined by **fibrous tissue (no epithelial tissue)** contain fluid rick **pancreatic enzymes or necrotic material** connect with pancreatic ducts may resolve may **compress** structures befome **infected** **perf** -> necrotic material and pancreatic enzymes -> peritonitic reaction
30
- Fibrous tissue - Pseudocyst
31
- Fibrous tissue - Pseudocyst
32
no epithelial lining
33
What is autoimmune hepatitis
IgG4 related characterised by large numbers of IgG4 positive plasma cells can involve any part of pancreas, bile ducts, and any other part of the body
34
Top L - May look like ca On immunohistochem - IgG4 positive plasma cells Ddx for panc cancer
35
Mx of autoimmune hepatitis
responds well to steroids
36
what are the types of pancreatic cancer
carcinomas * **ductal - 85% of all neoplasms** * acinar cystic * serous cystadenoma * mucinous cystic neoplasm pancreatic neuroendocrine tumours (islet cell tumours)
37
Summarise ductal cell carcinomas
5% all cancer deaths more common with age >men 5ur survival - 5%
38
rf for ductal carcinoma - pancreas
Smoking BMI Chronic pancreatitis Diabetes
39
**pathogenesis** of pancreatic ductal carcinomas
arise from dysplastic ductal lesions * **pancreatic intraductal neoplasma (PanIN)** * I**ntraductal Mucinous Papillary neoplasm** **K-Ras** mutation in 95%
40
microscopic appearance of ductal pancreatic carcinoma
gritty and grey invades adjecent structures tumour in head present earlier - because duct obstruction *(when in back of panc - present when they met to liver*
41
macroscopic appearance of ductal carcinomas
adenocarcinomas = mucin secreting glands set in desmoplastic stroma
42
sites of ductal ca
**head - 60%** body tail diffuse
43
- Glands - Mucin Perineural invasion - the bit in the middle is nerve
44
spread of ductal ca
direct - bile ducts, duodenum lymphatic - lymph nodes (coeliac) blood - liver (via oancreatic and portal vein) serosa - peritoneum **perineural very common**
45
complications of ductal carcinoma
due to spread chronic pancreatitis venous thrombosis - migratory thrombophlebitis * a lot of mucin produced by ca * -> secrete into blood stream * -> act like tissue factor * -> activate thrombosis all over the body
46
summarise cystic pancreatic tumours
contain serous or mucin secreting epithelium *like ovarian* usually benign *(cystadenocarcinomas are malignant)*
47
summarise cystic pancreatic tumours
contain serous or mucin secreting epithelium *like ovarian* usually benign *(cystadenocarcinomas are malignant)*
48
summarise pancreatic endocrine neoplasms
usually **non-secretory** contain neuroendocrine markers - **chromogranin** - can measure in blood behaviour difficult to predict - low grade can met associated with **MEN 1**
49
summarise insulinomas
derived from beta cells commonest type of secretory tumour
50
Characteristic Stain for - **chromogranin!**
51
RF for gallstones
More common with age 20% adults in west have more common in native americans >female hereditory - disorder of bile metabolism drugs - COCP acquired - rapid wht loss - lose fat - secrete via bilairy system -> stones
52
Types of gallstones
Cholesterol - Most contain >50% cholesterol - May be **single** - **Radiolucent - don’t see them on plain AXR** Pigment - Associated with BR - Contain ca salts - **Combined to conjugated BR - Because contain ca - radioopaqye Small and multiple**
53
complications of gallstones
- Bile duct obstruction - Acute and chronic cholecystitis - Gall bladder ca - Pancreatitis - due to obstruction
54
summarise acute cholecystitis
90% **associated with gall stones** acute inflammation - Neutrophils Can be salmoneela/typhoid - much rarer
55
summarise chronic cholecystitis
**Fibrosis** chronic inflammation -> Lymphocytes **Diverticular** - obstruction by stone - gall bladder try to push through - raised pressure - diveritucular - **rokitansky-Aschoff sinuses** 90% contain **gall stones**
56
- Thickness of wall because of fibrosis Round - is diverticular
57
- Lumen - Outpocketing of diverticular Can get obstruction?
58
summarise gall bladder cancer
adenoca 90% associated with **gall stones**

PATHOLOGY (94 decks)

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