Pathology of the Pancreas Flashcards
What gene is most commonly mutated in pancreatic carcinoma?
KRAS gene
What sign is highly associated with pancreatic carcinoma?
Trousseau sign - migratory thrombophlebitis (presence of blood clots in superficial veins that migrate)
True/False. Pancreatic neoplasms of the body and tail are more likely to cause block obstruction and thus early symptoms, such as jaundice.
False - neoplasms in the head of the pancreas are more likely to cause obstruction. This may lead to earlier presentation of symptoms
Where is pancreatic carcinoma most likely to metastasize?
Liver, lungs, bones
This pancreatic neoplasm is uncommon, but is more likely to present in young women. It has both cystic and solid components.
Solid-pseudopapillary neoplasm
Locally aggressive. Complete resection is curative, but difficult to accomplish
What are the leading causes of acute pancreatitis?
Alcohol, gallstones, biliary obstruction
This cystic pancreatic neoplasm is most common in perimenopausal women and is filled with a thick, mucin substance.
Mucinous adenoma
What syndrome, caused by a massive release of lipase, is highly associated with acinar cell carcinoma?
Lipase hypersecretion syndrome - fat necrosis, blood eosinophilia, thrombotic endocarditis
This is a key feature of pancreatitis caused by lipase release.
Fat necrosis
What is a common complication of chronic pancreatitis that is not often seen in acute pancreatitis?
Pseudocytys - lack a cystic membrane
Acute necrotizing pancreatitis is the most severe form on acute pancreatitis. What symptoms are seen with this condition?
Fat necrosis, destruction of the Islets of Langerhans and Acinar cells, hemorrhage
Mutations of this gene cause decreased bicarbonate secretion by the pancreas and contribute to chronic pancreatitis.
CFTR (cystic fibrosis transmembrane conductance regulator)
True/False. Alcohol use increases pancreatic secretions.
True - alcohol increases the tone of the sphincter of oddi
Pancreatic carcinoma is highly invasive and undergoes desmoplastic reaction (fibrosis). Where is it usually located?
Head of the pancreas
These are benign complications of chronic pancreatitis that contain blood, necrotic debris, and pancreatic enzymes.
Pseudocysts - lack epithelial cystic lining
What is a common neoplastic precursor to pancreatic carcinoma?
Pancreatic intraepithelial neoplasms (PaIN)
Serum levels of these antigens may be elevated in cases of pancreatic carcinoma.
CEA & CA19-9
How does chronic pancreatitis differ from acute pancreatitis with regard to gross morphology and histology?
Chronic pancreatitis - fibrosis, duct distortion, oxidative stress of acinar cells, alterations of pancreatic enzymes, eventual degradation of Islets of Langerhans
Acute pancreatitis causes radiating pain, nausea, vomiting, and elevated amylase and lipase levels. What symptoms are present in chronic pancreatitis?
Possible fever, mildly elevated amylase (increases more slowly than acute), pancreatic calcifications on imaging
What are the three primary mechanisms that cause pancreatitis?
Duct obstruction, acinar cell injury, defective transport of enzymes to lysosomes
This cystic pancreatic neoplasm is most common in elderly women and has a honeycomb appearance.
Serous cystadenoma
Where does mucinous adenoma commonly arise?
In the body or tail of the pancreas - most common in perimenopausal women
What are general risk factors for pancreatic carcinoma?
Males, elderly, African American, cigarette smoking, fatty diets, diabetes, chronic pancreatitis, chronic alcohol use
This neoplasm is most common among men and occurs in the head of the pancreas.
Intraductal papillary carcinoma
Mutations in two genes that regulate trypsin are implicated in hereditary pancreatitis. What are they and what are their functions?
Cationic trypsinogen gene (PRSS1) - inactivation of trypsin by trypsin
Serine Protease Inhibitor Kazal Type 1 (SPINK1) - pancreatic inhibition of trypsin
Activation of the clotting and complement systems in acute pancreatitis contributes to ischemia. How are these pathways activated?
Trypsin activates prekallikrein to its activated form. This initiatives the kinin system and activation of Factor XII.
What is another term for pancreatic carcinoma?
Infiltrating ductal adenocarcinoma
This virus used to be commonly associated with acute pancreatitis. Incidence, however, has decreased due to vaccination.
Mumps
