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

Answer 1

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

Question 2

Cardinal manifestation of acute pancreatitis

Answer 2

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

Question 3

Necrosis of pancreatic tissue affecting acinar and ductal tissues as well as the islets of Langerhans; vascular damage causes hemorrhage into the parenchyma.

Answer 3

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

Question 4

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 4

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

Question 5

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 5

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

Question 6

Similar to mucinous cystic neoplasms but appear more frequently in men

Answer 6

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

Question 7

Most common location of pancreatic cancer.

Answer 7

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

Question 8

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

Answer 8

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., p. 684

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

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

Answer 11

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

Question 12

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

Answer 12

Pancreas Divisum(TOPNOTCH)

Question 13

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 13

Annular Pancreas(TOPNOTCH)

Question 14

The most common cause of acute pancreatitis is?

Answer 14

Excessive alcohol intake(TOPNOTCH)

Question 15

5 morphological alterations in Acute pancreatitis

Answer 15

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 16

The most common cause of chronic pancreatitis is?

Answer 16

Long term alcohol abuse(TOPNOTCH)

Question 17

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 17

Chronic Pancreatitis(TOPNOTCH)

Question 18

What is the most constant morphological feature of Chronic Pancreatitis?

Answer 18

Acinar Loss(TOPNOTCH)

Question 19

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

Answer 19

Head > Body > Tail(TOPNOTCH)

Question 20

What is the most frequently altered oncogene in pancreatic cancer?

Answer 20

K-RAS (TOPNOTCH)

Question 21

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

Answer 21

p16(TOPNOTCH)

Question 22

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

Answer 22

Smoking(TOPNOTCH)

Question 23

What are the two characteristic features of Pancreatic Cancer?

Answer 23

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

Question 24

Where do Pancreatic cancers usually metastasize?

Answer 24

Lungs and bones(TOPNOTCH)

Question 25

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

Answer 25

Acinar cell carcinoma(TOPNOTCH)

Question 26

What is the first symptom of pancreatic cancer?

Answer 26

Pain(TOPNOTCH)

Question 27

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 w

Answer 27

Pseudocyts(TOPNOTCH)

Question 28

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

Answer 28

Pseudocyts(TOPNOTCH)

Question 29

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

Answer 29

Acute pancreatitis(TOPNOTCH)

Question 30

What is the most important triggering event in acute pancreatitis?

Answer 30

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

Question 31

2 most common causes of acute pancreatitis

Answer 31

Biliary tract disease and alcoholism. (TOPNOTCH) Robbins Pathologic Basis of Disease, 9th ed., p. 884

Question 32

A 32 y/o male presented with abdominal pain, nausea, and vomiting. Pain was described as constant and intense with radiation to the upper back. Lab result showed elevated plasma amylase. The clinical impression is:

Answer 32

Acute pancreatitis (TOPNOTCH)

Question 33

Morphology: mild inflammation, interstitial edema, and focal fat necrosis in the pancreas and peripancreatic fat.

Answer 33

Acute interstitial pancreatitis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 887

Question 34

Morphology: pancreatic substance is red-black form hemorrhage and contains interspersed foci of yellow-white, chalky fat necrosis. Peritoneal cavity contains serous, turbid, brown-tinged fluid containing globules of fat.

Answer 34

Acute necrotizing pancreatitis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 887

Question 35

Morphology: Extensive parenchymal necrosis accompanied by dramatic hemorrhage within the substance of the gland.

Answer 35

Hemorrhagic pancreatitis (TOPNOTCH)

Question 36

Clinical features include intermittent or persistent abdominal pain, intestinal malabsorption, and diabetes. It is characterized by irreversible injury of the pancreas.

Answer 36

Chronic pancreatitis. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 889

Question 37

A 53 y/o male, smoker, presented with abdominal pain, weight loss, and jaundice since 1 month. The abdominal CT revealed a mass on the pancreas. What part of the pancreas is most likely affected?

Answer 37

Head of the pancreas. Obstructive jaundice is associated with most cases of carcinoma of the head of the pancreas. (TOPNOTCH) Robbins Basic Pathology, 9th ed. P. 894

Question 38

Migratory thrombophlebitis occuring in pancreatic cancer due to elaboration of PAF and procoagulants from the carcinoma or its necrotic products.

Answer 38

Trosseau sign(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 894

Question 39

Most patients with this disease present with abdominal pain and weight loss, sometimes accompanied by jaundice and DVT, and succumb to the disease within 1 to 2 years.

Answer 39

Pancreatic cancer(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 895

Question 40

Poorly defined cyst with a necrotic brown-black wall, lacks epithelial lining. It is usually solity and may be situated within the pancreas or in the lesser omental sac or in the retroperitoneum. Formed when areas of intrapancreatic or peripancreatic hemorrhagic fat necrosis are walled off by fibrous tissue and granulation tissue.

Answer 40

Pancreatic pseudocysts(TOPNOTCH)Robbins Basic Pathology, 9th ed., pg. 890

Question 41

A 44 year old alcoholic woman has been having intermittent postprandial epigastric pain of 5 years. An imaging study done showed a solitary 3 cm cyst at the anterior portion of his pancreatic head. Fearing the worst, she opts to undergo a Whipple procedure, and the definitive specimen showed a cyst with a smooth internal surface and surrounding fibrosis. Microscopic examination showed a cyst wall lined by fibrin, granulation tissue, and chronic inflammation. There is no epithelial lining observed. The cyst (A) is a common sequela of acute pancreatitis (B) is hormonally responsive to estrogen (C) is a precursor to pancreatic adenocarcinoma (D) is known to harbor K-RAS mutations

Answer 41

is a common sequela of acute pancreatitis (pancreatic pseudocyst) is (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 680.

Question 42

Which of the following is associated with an increased risk of pancreatic carcinoma? (A) smoking (B) chronic pancreatitis (C) diabetes mellitus (D) all of the above

Answer 42

all of the above is (TOPNOTCH) Robbins Basic Pathology, 8th ed., 683