SM_159b: Pathology of Pancreatic Disorders Flashcards
Pancreas regions are the ____, ____, ____, and ____
Pancreas regions are the head, neck, body, and tail
Uncinate process of the pancreas hooks around the ____ and ____
Uncinate process of the head of the pancreas hooks around the superior mesenteric artery and superior mesenteric vein
Superior mesenteric artery and vein run behind the ____ of the pancreas
Superior mesenteric artery and vein run behind the body of the pancreas
Exocrine component of the pancreas is ____ and ____
Exocrine component of the pancreas is acini and ducts
(acini make up most of pancreas)
Endocrine component of the pancreas is the ____
Endocrine component of the pancreas is the islets of Langerhans
Acini of pancreas ____
Acini of pancreas produce, store, and secrete digestive enzymes (amylase, lipase, trypsin, etc)
Ducts of pancreas ____ and ____
Ducts of pancreas carry the enzymes to duodenum and secrete mucin for lubrication, activation, and protection
Describe the exocrine pancreas
Exocrine pancreas
- Majority of pancreatic enzymes are synthesized by inactive proenzymes and sequestered in membrane-bound zymogen granules
- Activation of pro-enzymes requires conversion of trypsinogen to trypsin by duodenal enteropeptidase
- Trypsin inhibitors are also secreted by acinar and ductal cells
- Trypsin cleaves and inactivates itself: negative feedback mechanism that normally limits local levels of activated trypsin
Endocrine pancreas produces the hormones ____, ____, ____, and ____
Endocrine pancreas produces the hormones insulin, glucagon, somatostatin, and pancreatic polypeptide
Acute pancreatitis is ____
Acute pancreatitis is reversible inflammatory disorder that varies in severity from focal edema and fat necrosis to widespread hemorrhagic necrosis
Pancreatitis pathogenesis is ____
Pancreatitis pathogenesis is autodigestion of the pancreas by inappropriately activated pancreatic enzymes
- Premature activation of trypsin within the substance of pancreas can unleash other proenzymes -> acute pancreatitis
____ and ____ commonly cause acute pancreatitis
Cholelithiasis and alcohol commonly cause acute pancreatitis
Describe clinical features of acute pancreatitis
Acute pancreatitis clinical features
- Adults primarily
- Alcoholics (more commonly men) and gallstones (more commonly women)
- Laboratory tests: elevated amylase and lipase
Acute pancreatitis commonly presents with ____, ____, and ____
Acute pancreatitis commonly presents with acute upper abdominal pain, nausea, and vomiting
Describe pathology of acute pancreatitis
Acute pancreatitis pathology
- Gross findings depend on severity of disease
- Usually, the gland is swollen and edematous
- Fat necrosis appears as whitish yellow plaques
- Hemorrhagic pancreatitis: pancreas is dark brown
This is ____ in ____
This is fat necrosis in acute pancreatitis
Severe necrotizing pancreatitis is associated with significant mortality and high complication rates including ____ and ____
Severe necrotizing pancreatitis is associated with significant mortality and high complication rates including pancreatic abscess and pseudocyst
- Mild cases usually recover within 5-7 days
- Treatment: supportive care, infection prevention
Pseudocyst is ____
Pseudocyst is a cyst with a collection of fluid and cell debris
- Most common type of cystic lesion in the pancreas
Pancreatic pseudocyst cyst wall consists of ____
Pancreatic pseudocyst cyst wall consists of fibrous tissue but no epithelial lining
Chronic pancreatitis is characterized by ___
Chronic pancreatitis is characterized by long-standing inflammation that leads to irreversible destruction of the exocrine pancreas followed by loss of iselts of Langerhans
Chronic pancreatitis most commonly results from ____
Chronic pancreatitis most commonly results from long-term alcohol abuse
Chronic pancreatitis involves ____, ____, ____, ____, ____, and ____
Chronic pancreatitis involves abdominal pain, steatorrhea, diabetes mellitus, weight loss, nausea, and vomiting
Describe pathology of chronic pancreatitis on gross examination
Chronic pancreatitis on gross examination
- Pancreas is shrunken and hard
- Cut surface is fibrotic and whitish
- Ducts dilated and may contain calculi
Chronic pancreatitis on microscopic examination involves ____, ____, and ____
Chronic pancreatitis on microscopic examination involves fibrosis, chronic inflammation, and loss of exocrine (acini) and endocrine tissue
Describe complications of chronic pancreatitis
Chronic pancreatitis complications
- Maldigestion of carbohydrates, fats, and proteins because of atrophy of acinar tissue
- Diabetes because of loss of endocrine tissue
- Pseudocyst
- Obstruction of common bile duct
- Slight increase in pancreatic cancer
____ is the fourth leading cause of cancer-related death
Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related death
Pancreatic ductal carcinoma most commonly occurs between age ____ and most cases are ____ at presentation
Pancreatic ductal carcinoma most commonly occurs between age 60-80 and most cases are unresectable at presentation
Pancreatic ductal adenocarcinoma often presents with nonspecific symptoms including ____, ____, and ____ that delay diagnosis
Pancreatic ductal adenocarcinoma often presents with nonspecific symptoms including painless jaundice, abdominal pain, and weight loss that delay diagnosis
Pancreatic ductal adenocarcinoma is associated with ____, ____, ____, and ____
Pancreatic ductal adenocarcinoma is associated with
- Trosseau syndrome / migratory thrombophlebitis
- Diabetes mellitus
- Sister Mary Joseph sign (palpable periumbilical nodules)
- Courvoisier sign (distended palpable gallbladder)
Pancreatic ductal adenocarcinoma is a ____
Pancreatic ductal adenocarcinoma is a solid infiltrative mass
- Larger neoplasms can have necrosis and secondary cystic changes
Pancreatic ductal adenocarcinoma histology is characterized by ____, ____, ____, and ____
Pancreatic ductal adenocarcinoma histology is characterized by lack of lobularity, haphazardness of ductal elements, perineural invasion, and ducts in vascular spaces (carcinoma)
Commonly mutated genes in pancreatic ductal adenocarcinoma are ____, ____, ____, and ____
Commonly mutated genes in pancreatic ductal adenocarcinoma are
- KRAS (oncogene): growth factor signal transducer
- p16/CDKN2A (tumor suppressor gene): negative cell cycle regulator
- TP53 (tumor suppressor gene): response to DNA damage
- SMAD4: TGF-beta pathway
Describe the pancreatic intraepithelial neoplasm (PanIN) tumor progression model
Pancreatic intraepithelial neoplasm (PanIN) tumor progression model
- K-ras mutation and telmore shortening to PanIN 1 (low grade dysplasia)
- p16 inactivation to PanIN 2
- p53, DPC4, and BRCA2 mutations to PanIN 3 (high grade dysplasia)
- Invasive carcinoma
Intraductal papillary mucinous neoplasm is ____, occurs more frequently in ____, and involves the ____ of the pancreas
Intraductal papillary mucinous neoplasm is a precursor lesion of pancreatic ductal adenocarcinoma, occurs more frequently in men, and involves the head of the pancreas
Mucinous cystic neoplasm is ____, occurs in ____, occurs in the ____ of the pancreas, and is a ____
Mucinous cystic neoplasm is a precursor lesion of pancreatic ductal adenocarcinoma, occurs in peri-menopausal women, occurs in the tail of the pancreas, and is a thick walled multilobular cyst
- Cysts lined by tall columnar mucin-producing epithelium
- Ovarian-type stroma
Well-differentiated neuroendocrine cocurs in patients ____, has etiology of ____ or ____, and can be ____ or ____
Well-differentiated neuroendocrine cocurs in patients 30-60 years old, has etiology of sporadic or syndromic diseases, and is functional or nonfunctional
- Syndromic diseases: MEN1, von Hippel-Lindau syndrome, tuberous sclerosis
- Functional: insulinoma, glucagonoma, somatostatinoma
Well-differentiated neuroendocrine tumor conventional architectural features include ____, ____, ____, and ____
Well-differentiated neuroendocrine tumor conventional architectural features include trabeculae, fibrosis, nests, and pseudorosettes
Well-differentiated neuroendocrine tumor conventional cytomorphologic is ____
Well-differentiated neuroendocrine tumor conventional cytomorphologic is monotonous cells with round nuclei displaying salt and pepper chromatin and inconspicuous nucleoli
Well-differentiated neuroendocrine tumor prognosis is ____
Well-differentiated neuroendocrine tumor prognosis is variable
- Features associated with adverse outcome include: high mitosis / high proliferation index, vascular invasion, tumor necrosis
Describe common disease of the pancreas
Common disease of the pancreas
- Non-neoplastic: acute pancreatitis, chronic pancreatitis
- Neoplastic: exocrine (pancreatic ductal adenocarcinoma), endocrine (well-differentiated neuroendocrine tumor)
