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LECOM S3 PBL > pathology 19 (883-895) pancreas > Flashcards

pathology 19 (883-895) pancreas Flashcards

1
Q

what does the pancreas normally arise from embryologically

A

from the fusion of dorsal and ventral outpouchings of the foregut

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2
Q

what is the most common congenital anomaly of the pancreas

A

pancreas divisum

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3
Q

where does the main pancreatic duct typically join the common bile duct

A

just proximal to the papilla of vater

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4
Q

what is pancreas divisum cased by

A

failure of fusion of the fetal duct systems of the dorsal and ventral pancreatic primordia

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5
Q

what are the favored sites for ectopic pancreas

A

stomach and duodenum

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6
Q

what are most proenzymes from the pancreas activated by

A

trypsin

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7
Q

what is trypsin activated by

A

duodenal enteropeptidase (enterokinase)

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8
Q

what is acute pancreatitis characterized by

A

reversible pancreatic parenchymal injury associated with inflammation

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9
Q

what does acute pancreatitis result from

A

inappropriate release and activation of pancreatic enzymes, which destroy pancreatic tissue and elicit an acute inflammatory reaction

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10
Q

what are the 3 major initiating events for how inappropriate activation of pancreatic enzymes occurs in sporadic forms of acute pancreatitis

A

pancreatic duct obstruction, primary acinar cell injury, defective intracellular transport of proenzymes within acinar cells

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11
Q

what is pancreatic duct obstruction most commonly caused by

A

gallstones and biliary sludge

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12
Q

what is the most common shared feature of most hereditary forms of pancreatitis

A

defect that increase or sustains the activity of trypsin

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13
Q

what are the basic morphological alterations with acute pancreatitis

A

microvascular leak and edema, fat necrosis, acute inflammation, destruction of pancreatic parenchyma, destruction of blood vessels and interstitial hemorrhage

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14
Q

in the more severe case of acute necrotizing pancreatitis, where is necrosis occuring

A

acing and ductal tissues as well as islets of langerhans

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15
Q

describe the macroscopic substance correlated with acute necrotizing pancreatitis

A

red-back from hemorrhage and contains interspersed foci of yellow-white, chalky fat necrosis

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16
Q

what is the cardinal clinical manifestation of acute pancreatitis

A

abdominal pain

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17
Q

where is the pain typically referred with acute pancreatitis

A

upper back and occasionally left shoulder

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18
Q

what lab finding is very common with acute pancreatitis

A

marked elevation of serum amylase

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19
Q

define chronic pancreatitis

A

prolonged inflammation of the pancreas associated with irreversible destruction of exocrine parenchyma, fibrosis, and in late stages, destruction of endocrine parenchyma

20
Q

what is the most common cause of chronic pancreatitis

A

long-term alcohol use

21
Q

what is autoimmune pancreatitis associated with

A

presence of IgG-4 secreting plasma cells in the pancreas

22
Q

what is chronic pancreatitis morphologically characterized by

A

fibrosis, atrophy and dropout of acini, and variable dilation of pancreatic ducts

23
Q

what is autoimmune pancreatitis characterized by

A

duct-centric mixed inflammatory cell infiltrate, venalities, and increased numbers of IgG4-secreting plasma cells

24
Q

describe congenital pancreatic cysts

A

unilocular, thin-walled cysts- believed to result from anomalous development of the pancreatic ducts

25
Q

what is the term for localized collections of necrotic and hemorrhagic material that are rich in pancreatic enzymes and lack an epithelial lining

A

pseudocysts

26
Q

where are pseudocysts most commonly located

A

in the lesser mental sac or in the retroperitoneum between the stomach and transverse colon or between the stomach and liver

27
Q

where do serous cystic neoplasms usually occur

A

in the tail of the pancreas

28
Q

what type of cells are serous cystic neoplasms lined by and what kind of fluid is inside

A

glycogen-rich cuboidal cells filled with clear, thin, straw-colored fluid

29
Q

do mutinous cystic neoplasms arise more in women or men

A

95% of the time in women

30
Q

what is the major difference between serous cystic neoplasms and mutinous cystic neoplasms

A

mutinous can be precursors to invasive carcinomas

31
Q

where do mutinous cystic neoplasms usually occur

A

in the tail of the pancreas

32
Q

describe the fluid in mutinous cystic neoplasms

A

thick, tenacious mucin and lined by a columnar mucin-producing epithelium

33
Q

what do intraductal papillary mutinous neoplasms (IPMNs) usually effect and where

A

larger ducts of the pancreas at the head of the pancreas

34
Q

are IPMNs more common in women or men

A

men

35
Q

who is solid-pseudopapillary neoplasms most commonly seen in

A

young women

36
Q

what are solid-pseudopapillary neoplasms filled with

A

hemorrhagic debris

37
Q

what are invasive pancreatic cancers typically arising from

A

pancreatic intraepithelial neoplasia

38
Q

what is the most frequently altered oncogene in pancreatic cancer

A

KRAS

39
Q

what does KRAS do

A

small, GTP-binding protein that normally participates in signaling events downstream of growth factor receptors with intrinsic tyrosine kinase activity

40
Q

what is the most common inactivated tumor suppressor gene in pancreatic cancers

A

CDKN2A

41
Q

what is the strongest environmental influence for developing pancreatic cancer

A

cigarette smoking

42
Q

what is the most common location for cancers of the pancreas

A

in the head

43
Q

what are the 2 common features of pancreatic cancer

A

it is highly invasive and it elicits an intense host reaction in the form of dense fibrosis

44
Q

T/F: carcinomas of the body and tail of the pancreas do not impinge on the biliary tree

A

TRUE

45
Q

what is usually the first symptoms of carcinomas of the pancreas

A

pain

46
Q

what is the distinct microscopic appearance of pancreatoblastomas

A

squamous islands admixed with acing cells

LECOM S3 PBL (10 decks)

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