Pathology of the Pancreas

Question 1

What gene is most commonly mutated in pancreatic carcinoma?

Answer 1

KRAS gene

Question 2

What sign is highly associated with pancreatic carcinoma?

Answer 2

Trousseau sign - migratory thrombophlebitis (presence of blood clots in superficial veins that migrate)

Question 3

True/False. Pancreatic neoplasms of the body and tail are more likely to cause block obstruction and thus early symptoms, such as jaundice.

Answer 3

False - neoplasms in the head of the pancreas are more likely to cause obstruction. This may lead to earlier presentation of symptoms

Question 4

Where is pancreatic carcinoma most likely to metastasize?

Answer 4

Liver, lungs, bones

Question 5

This pancreatic neoplasm is uncommon, but is more likely to present in young women. It has both cystic and solid components.

Answer 5

Solid-pseudopapillary neoplasm

Locally aggressive. Complete resection is curative, but difficult to accomplish

Question 6

What are the leading causes of acute pancreatitis?

Answer 6

Alcohol, gallstones, biliary obstruction

Question 7

This cystic pancreatic neoplasm is most common in perimenopausal women and is filled with a thick, mucin substance.

Answer 7

Mucinous adenoma

Question 8

What syndrome, caused by a massive release of lipase, is highly associated with acinar cell carcinoma?

Answer 8

Lipase hypersecretion syndrome - fat necrosis, blood eosinophilia, thrombotic endocarditis

Question 9

This is a key feature of pancreatitis caused by lipase release.

Answer 9

Fat necrosis

Question 10

What is a common complication of chronic pancreatitis that is not often seen in acute pancreatitis?

Answer 10

Pseudocytys - lack a cystic membrane

Question 11

Acute necrotizing pancreatitis is the most severe form on acute pancreatitis. What symptoms are seen with this condition?

Answer 11

Fat necrosis, destruction of the Islets of Langerhans and Acinar cells, hemorrhage

Question 12

Mutations of this gene cause decreased bicarbonate secretion by the pancreas and contribute to chronic pancreatitis.

Answer 12

CFTR (cystic fibrosis transmembrane conductance regulator)

Question 13

True/False. Alcohol use increases pancreatic secretions.

Answer 13

True - alcohol increases the tone of the sphincter of oddi

Question 14

Pancreatic carcinoma is highly invasive and undergoes desmoplastic reaction (fibrosis). Where is it usually located?

Answer 14

Head of the pancreas

Question 15

These are benign complications of chronic pancreatitis that contain blood, necrotic debris, and pancreatic enzymes.

Answer 15

Pseudocysts - lack epithelial cystic lining

Question 16

What is a common neoplastic precursor to pancreatic carcinoma?

Answer 16

Pancreatic intraepithelial neoplasms (PaIN)

Question 17

Serum levels of these antigens may be elevated in cases of pancreatic carcinoma.

Answer 17

CEA & CA19-9

Question 18

How does chronic pancreatitis differ from acute pancreatitis with regard to gross morphology and histology?

Answer 18

Chronic pancreatitis - fibrosis, duct distortion, oxidative stress of acinar cells, alterations of pancreatic enzymes, eventual degradation of Islets of Langerhans

Question 19

Acute pancreatitis causes radiating pain, nausea, vomiting, and elevated amylase and lipase levels. What symptoms are present in chronic pancreatitis?

Answer 19

Possible fever, mildly elevated amylase (increases more slowly than acute), pancreatic calcifications on imaging

Question 20

What are the three primary mechanisms that cause pancreatitis?

Answer 20

Duct obstruction, acinar cell injury, defective transport of enzymes to lysosomes

Question 21

This cystic pancreatic neoplasm is most common in elderly women and has a honeycomb appearance.

Answer 21

Serous cystadenoma

Question 22

Where does mucinous adenoma commonly arise?

Answer 22

In the body or tail of the pancreas - most common in perimenopausal women

Question 23

What are general risk factors for pancreatic carcinoma?

Answer 23

Males, elderly, African American, cigarette smoking, fatty diets, diabetes, chronic pancreatitis, chronic alcohol use

Question 24

This neoplasm is most common among men and occurs in the head of the pancreas.

Answer 24

Intraductal papillary carcinoma

Question 25

Mutations in two genes that regulate trypsin are implicated in hereditary pancreatitis. What are they and what are their functions?

Answer 25

Cationic trypsinogen gene (PRSS1) - inactivation of trypsin by trypsin

Serine Protease Inhibitor Kazal Type 1 (SPINK1) - pancreatic inhibition of trypsin

Question 26

Activation of the clotting and complement systems in acute pancreatitis contributes to ischemia. How are these pathways activated?

Answer 26

Trypsin activates prekallikrein to its activated form. This initiatives the kinin system and activation of Factor XII.

Question 27

What is another term for pancreatic carcinoma?

Answer 27

Infiltrating ductal adenocarcinoma

Question 28

This virus used to be commonly associated with acute pancreatitis. Incidence, however, has decreased due to vaccination.

Answer 28

Mumps