XVII - The Pancreas Flashcards
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
Acute pancreatitis (TOPNOTCH) Robbins Basic Pathology, 8th ed., pg. 677
Cardinal manifestation of acute pancreatitis
Abdominal pain(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 679
Necrosis of pancreatic tissue affecting acinar and ductal tissues as well as the islets of Langerhans; vascular damage causes hemorrhage into the parenchyma.
Acute necrotizing pancreatitis(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 678
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. SEE SLIDE 17.1.
Chronic pancreatitis(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 680
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
Mucinous cystic neoplasm of the pancreas(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 681
Similar to mucinous cystic neoplasms but appear more frequently in men
Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas(TOPNOTCH)Robbins Basic Pathology, 8th ed., pg. 682
Most common location of pancreatic cancer.
Head of pancreas. Usually causes jaundice due to common bile duct impingement (leading to earlier diagnosis relative to cancer in the body and tail) (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 654
Most common symptom of pancreatic carcinoma located at the tail and body of the gland?
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
Moderately to poorly differentiated adenocarcinoma forming abortive tubular structures or cell clusters and exhibiting an aggressive, deeply infiltrative growth pattern. SLIDE 17.2.
Pancreatic carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 684
Type of pancreatic carcinoma showing prominent acinar cell differentiation with zymogen granules and exocrine enzyme production
Acinar cell carcinomas(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 684
Type of pancreatic carcinoma with focal squamous differentiation in addition to glandular differentiation.
Adenosquamous carcinomas(TOPNOTCH)Robbins Basic Pathology, 8th ed., p. 684
What is the most common clinically significant congenital anomaly of the pancreas?
Pancreas Divisum. SEE SLIDE 17.3. (TOPNOTCH)
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
Annular Pancreas. SEE SLIDE 17.4. (TOPNOTCH)
The most common cause of acute pancreatitis is?
Excessive alcohol intake(TOPNOTCH)
5 morphological alterations in Acute pancreatitis
- 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)
The most common cause of chronic pancreatitis is?
Long term alcohol abuse(TOPNOTCH)
What is the most constant morphological feature of Chronic Pancreatitis?
Acinar Loss(TOPNOTCH)
60% of cancers of the pancreas arise in what area?
Head > Body > Tail(TOPNOTCH)
What is the most frequently altered oncogene in pancreatic cancer?
K-RAS (TOPNOTCH)
What is the most frequently inactivated tumor suppressor gene in pancreatic cancer?
p16(TOPNOTCH)
What is the strongest environmental risk factor for developing Pancreatic Cancer?
Smoking(TOPNOTCH)
What are the two characteristic features of Pancreatic Cancer?
Highly invasive and it elicits an intense non neoplastic host reaction called a desmoplastic response(TOPNOTCH)
Where do Pancreatic cancers usually metastasize?
Lungs and bones(TOPNOTCH)
What is the first symptom of pancreatic cancer?
Pain(TOPNOTCH)
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
Pseudocyts. SEE SLIDE 17.5. (TOPNOTCH)
These kinds of cyst account for 75% of cysts seen in the pancreas
Pseudocyts(TOPNOTCH)
Morphology: Pancreas shows region of fat necrosis and focal pancreatic parenchymal necrosis
Acute pancreatitis(TOPNOTCH)
What is the most important triggering event in acute pancreatitis?
Activation of trypsinogen and subsequent autodigestion of the pancreatic substances(TOPNOTCH)
2 most common causes of acute pancreatitis
Biliary tract disease and alcoholism. (TOPNOTCH) Robbins Pathologic Basis of Disease, 9th ed., p. 884
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:
Acute pancreatitis (TOPNOTCH)
Morphology: mild inflammation, interstitial edema, and focal fat necrosis in the pancreas and peripancreatic fat.
Acute interstitial pancreatitis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 887
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.
Acute necrotizing pancreatitis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 887
Morphology: Extensive parenchymal necrosis accompanied by dramatic hemorrhage within the substance of the gland.
Hemorrhagic pancreatitis (TOPNOTCH)
Clinical features include intermittent or persistent abdominal pain, intestinal malabsorption, and diabetes. It is characterized by irreversible injury of the pancreas.
Chronic pancreatitis. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 889
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?
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
Migratory thrombophlebitis occuring in pancreatic cancer due to elaboration of PAF and procoagulants from the carcinoma or its necrotic products.
Trosseau sign(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 894
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.
Pancreatic cancer(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 895
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.
Pancreatic pseudocysts. SEE SLIDE 17.5. (TOPNOTCH)Robbins Basic Pathology, 9th ed., pg. 890
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
is a common sequela of acute pancreatitis (pancreatic pseudocyst) is (TOPNOTCH) Robbins Basic Pathology, 8th ed., p 680.
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
all of the above is (TOPNOTCH) Robbins Basic Pathology, 8th ed., 683
Distint form of pancreatitis characterized by either one of two patterns: 1) lymphoplasmacytic cell infiltration, positive for IgG4, with sweling fibrosis (lymphoplasmacytic sclerosing); 2) mixed infiltrate obliterating the ductal epithelium (idopathic duct centric)
Autoimmune pancreatitis (TOPNOTCH) Robbins Basic Pathology, 9th ed., 650
Two features that are highly characteristic of pancreatic cancer
1) Highly invasive and 2) Elicits an intense desmoplastic response (proliferation of fibroblasts, ECM, and lymphocytes) (TOPNOTCH) Robbins Basic Pathology, 9th ed., 654
Most common type of pancreatic cancer
Adenocarcinoma (TOPNOTCH) Robbins Basic Pathology, 9th ed., 654
