XVII - The Pancreas

Question 1

This disease is characterized by the following morphological changes: (1) microvascular leakage causing edema, (2) necrosis of fat by lipases, (3) an acute inflammatory reaction, (4) proteolytic destruction of parenchyma, (5) destruction of blood vessels with hemorrhage

Answer 1

Acute pancreatitis (TOPNOTCH) Robbins Basic Pathology, 8th ed., pg. 677

Question 2

Extensive pancreatic parenchymal necrosis accompanied by diffuse hemorrhage.

Answer 2

Hemorrhagic pancreatitis(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 678

Question 3

Cardinal manifestation of acute pancreatitis.

Answer 3

Abdominal pain(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 679

Question 4

Necrosis of pancreatic tissue affecting acinar and ductal tissues as well as the islets of Langerhans; vascular damage causes hemorrhage into the parenchyma.Macroscopically, the pancreas exhibits red-black hemorrhage interspersed with foci of yellow-white, chalky fat necrosis.

Answer 4

Acute necrotizing pancreatitis(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 678

Question 5

Solitary, 2-30 cm lesions of the pancreas, formed by walling-off of areas with hemorrhagic fat necrosis.Composed of necrotic debris encased by fibrous walls of granulation tissue, and lacks epithelial lining.

Answer 5

Pancreatic pseudocysts(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 679

Question 6

Characterized by parenchymal fibrosis, reduced number and size of acini, and variable dilation of the pancreatic ducts. With relative sparing of Islets of Langerhans. Ductal concretions are present.

Answer 6

Chronic pancreatitis(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 680

Question 7

Presents as painless, slow-growing cystic masses filled with thick, tenacious mucin, lined with columnar mucinous epithelium, associated with densely cellular stroma. Almost always arise in women.

Answer 7

Mucinous cystic neoplasm of the pancreas(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 681

Question 8

Similar to mucinous cystic neoplasms but appear more frequently in men.

Answer 8

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 682

Question 9

Most common location of pancreatic cancer.

Answer 9

Head of pancreas(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 684

Question 10

Most common symptom of pancreatic carcinoma located at the tail and body of the gland?

Answer 10

None/AsymptomaticSince it does not impinge on the biliary tract, it may be quite large and widely disseminated by the time they are discovered.(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 684

Question 11

Moderately to poorly differentiated adenocarcinoma forming abortive tubular structures or cell clusters and exhibiting an aggressive, deeply infiltrative growth pattern.

Answer 11

Pancreatic carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 684

Question 12

Type of pancreatic carcinoma showing prominent acinar cell differentiation with zymogen granules and exocrine enzyme production.

Answer 12

Acinar cell carcinomas(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 684

Question 13

Type of pancreatic carcinoma with focal squamous differentiation in addition to glandular differentiation.

Answer 13

Adenosquamous carcinomas(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 684

Question 14

What is the most common clinically significant congenital anomaly of the pancreas?

Answer 14

Pancreas Divisum(TOPNOTCH)

Question 15

This congenital abnormality develops embryologically when one portion of the ventral pancreatic primordium becomes fixed, while the other portion of this primordium is drawn around the duodenum

Answer 15

Annular Pancreas(TOPNOTCH)

Question 16

What is the cardinal manifestation of acute pancreatitis?

Answer 16

Abdominal Pain(TOPNOTCH)

Question 17

The most common cause of acute pancreatitis is?

Answer 17

Excessive alcohol intake(TOPNOTCH)

Question 18

What are the 5 basic morphological alterations seen in Acute Pancreatitis?

Answer 18

1. Edema caused by microvascular leakage2. Necrosis of fat caused by lipolytic enzymes3. Acute inflammatory reaction4. Destruction of pancreatic parenchyma by proteolytiz enzymes5. Destruction of blood vessels with subsequent interstitial hemorrage(TOPNOTCH)

Question 19

What is the most common cause of Chronic Pancreatitis?

Answer 19

Long term alcohol abuse(TOPNOTCH)

Question 20

This condition is characterized by parenchymal fibrosis, reduced number and size of acini with relative sparing of the islets of Langerhans, and variable dilation of the pancreatic ducts.

Answer 20

Chronic Pancreatitis(TOPNOTCH)

Question 21

What is the most constant morphological feature of Chronic Pancreatitis?

Answer 21

Acinar Loss(TOPNOTCH)

Question 22

60% of cancers of the pancreas arise in what area?

Answer 22

Head > Body > Tail(TOPNOTCH)

Question 23

What is the most frequently altered oncogene in pancreatic cancer?

Answer 23

K-RAS (TOPNOTCH)

Question 24

What is the most frequently inactivated tumor suppressor gene in pancreatic cancer?

Answer 24

p16(TOPNOTCH)

Question 25

What is the strongest environmental risk factor for developing Pancreatic Cancer?

Answer 25

Smoking(TOPNOTCH)

Question 26

What are the two characteristic features of Pancreatic Cancer?

Answer 26

Highly invasive and it elicits an intense non neoplastic host reaction called a desmoplastic response(TOPNOTCH)

Question 27

Where do Pancreatic cancers usually metastasize?

Answer 27

Lungs and bones(TOPNOTCH)

Question 28

This variant of Pancreatic cancer is characterized by formation of zymogen granules and the production of exocrine enzymes including trypsin and lipase`

Answer 28

Acinar cell carcinoma(TOPNOTCH)

Question 29

What is the first symptom of pancreatic cancer?

Answer 29

Pain(TOPNOTCH)

Question 30

These structures are formed by the walling off of areas of peripancreatic hemorrhagic fat necrosis with fibrous tissue and are usually composed of central necrotic hemorrhagic material rich in pancreatic enzymes surrounded by non epithelial lined fbrous walls of granulation tissue

Answer 30

Pseudocyts(TOPNOTCH)

Question 31

These kinds of cyst account for 75% of cysts seen in the pancreas

Answer 31

pseudocyts(TOPNOTCH)

Question 32

Gross morphology: extensive parenchymal necrosis accompanied by diffuse hemorrhage within the substance of the gland

Answer 32

Hemorrhagic pancreatitis(TOPNOTCH)

Question 33

Morphology: Pancreas shows region of fat necrosis and focal pancreatic parenchymal necrosis

Answer 33

Acute pancreatitis(TOPNOTCH)

Question 34

What is the most important triggering event in acute pancreatitis?

Answer 34

Activation of trypsinogen and subsequent autodigestion of the pancreatic substances(TOPNOTCH)