Pancreas histology

Question 1

acute pancreatitis causes

Answer 1

duct obstruction (gall stones 50%), metabolic (alcohol 33%), drugs, hypercalcaemia, hyperlipidaemia, poor blood supply, infection, autoimmune 15%

Question 2

Ductal carcinoma

Answer 2

arise from dysplastic ductal lesions: pancreatic intraductal neoplasia (PanIn), intraductal mucinous papilliary neoplasm (IMPN)

Question 3

DUCTAL CARCINOMA PATHOLOGY

Answer 3

macroscopic, gritty and grey, invade adjacent structure, tumours in head present earlier as it blocks ducts causes jaundice, adenomarcinomas on microscopic appearance, mucin secreting set in desmoplastic stroma (fibrous reaction to tumour)

Question 4

what is desmoplastic stroma

Answer 4

fibrous response to cancer

Question 5

ductal carcinoma sites

Answer 5

head 60%, body tail, diffuse

Question 6

cystic tumours

Answer 6

contain serous or mucin secreting epithelial (corresponding tumours arise in the ovary), usually benign

Question 7

pancreatic endocrine neoplasm marker

Answer 7

chromogranin

Question 8

pancreatic endocrine neoplasm is associated with what syndrome

Answer 8

MEN1

Question 9

what is the commonest secretory tumour

Answer 9

insulinomas

Question 10

gall stones risk factors

Answer 10

female, native americam, disorder of bile mtabolism, oral contraceptive, rapid weight loss

Question 11

gall stone types

Answer 11

cholesterol (more than 50%), may be signle mostly radiolucent,

pigment (contain calcium salts of unconjugated bilirubin,) multiple, mostly radioopaque,

Question 12

what is acute pancreatitis

Answer 12

Acute inflammation of the pancreas caused by aberrant release of
pancreatic enzymes

Question 13

how does duct obstruction cause pancreatitis

Answer 13

Gallstone stuck distal to where the common bile duct
and pancreatic ducts join leads to:
reflux of bile up the pancreatic duct followed by
damage to acini and release of proenzymes which
then become activate

Question 14

how does alcohol cause pancreatitis

Answer 14

Alcohol leads to spasm/oedema of Sphincter of Oddi
and the formation of a protein rich pancreatic fluid
which obstructs the pancreatic ducts

Question 15

acute pancreatitis pattern of injury

Answer 15

Periductal - necrosis of acinar cells near ducts (usually
secondary to obstruction)
Perilobular – necrosis at the edges of the lobules (usually due
to poor blood supply)
Panlobular – develops from 1. and 2

Question 16

acute pancreatitis prognosis/complications

Answer 16

ancreatic : pseudocyst, abscess
Systemic: shock, hypoglycaemia, hypocalcaemia
Overall mortality up to 50% for haemorrhagic
pancreatitis

Question 17

causes of chronic pancreatitis

Answer 17

Metabolic/toxic Alcohol (80%)
Haemochromatosis
Duct obstruction Gallstones
Abnormal pancreatic duct anatomy
Cystic fibrosis (“mucoviscoidosis”)
Tumours
Idiopathic Autoimmune

Question 18

chronic pancreatitis pathogenesis

Answer 18

• Pathogenesis of chronic pancreatitis
As for acute pancreatitis
• Pattern of injury
Chronic inflammation with parenchymal fibrosis and loss of
parenchyma
Duct strictures with calcified stones with secondary dilatations

Question 19

pancreatic pseudocyst

Answer 19

Associated with acute and/ or chronic pancreatitis
• Lined by fibrous tissue (no epithelial lining), contain
fluid rich in pancreatic enzymes or necrotic material
•Connect with pancreatic ducts
•May resolve, compress adjacent structures, become
infected or perforat

Question 20

what is autoimmune pancreatitis

Answer 20

Characterised by large numbers of IgG4 positive plasma
cells.
• May involve the pancreas, bile ducts and almost any other
part of the body.

Question 21

most common tumour of the pancreas

Answer 21

ductal (85%)

Question 22

pancreatic tumour types

Answer 22

Carcinomas
Ductal (85% of all neoplasms)
Acinar 
• Cystic neoplasms
Serous cystadenoma
Mucinous cystic neoplasm
• Pancreatic neuroendocrine tumours (

Question 23

ductal carcinoma complication

Answer 23

Due to spread
•Chronic pancreatitis
•Venous thrombosis (“migratory thrombophlebitis”)

Question 24

chronic cholecystitis

Answer 24

Chronic inflammation
• Fibrosis
•Diverticula – Rokitansky-Aschoff sinuses
• 90% contain gall stones