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YR5 Histopathology > Pancreas and Gallbladder Pathology > Flashcards

Pancreas and Gallbladder Pathology Flashcards

1
Q

What is this?

A

Exocrine component of pancreas
Acini + canaliculi

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2
Q

What is this?

A

Endocrine component of pancreas
Islets of Langerhans

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3
Q

What is acute pancreatitis?

A

Acute inflammation of pancreas caused by aberrant release of pancreatic enzymes

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4
Q

What are 6 general categories of causes of acute pancreatitis?

A

Duct obstruction

Metabolic/ toxic

Poor blood supply

Infection/ Inflammation

Autoimmune

Idiopathic (15%)

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5
Q

What are 3 examples of duct obstruction which may lead to acute pancreatitis?

A

GALLSTONES (50% of all causes)

Trauma

Tumours

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6
Q

What are 4 examples of metabolic/toxic which may cause acute pancreatitis?

A

Alcohol (33%) - 5% of alcoholics develop acute pancreatitis

Drugs (e.g. thiazides)

Hypercalcaemia

Hyperlipidaemia

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7
Q

What are 2 examples of poor blood supply which may cause acute pancreatitis?

A

Shock

Hypothermia

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8
Q

What is an example of infection/ inflammation that may cause acute pancreatitis?

A

Viruses (e.g. mumps)

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9
Q

Describe the broad pathogenesis of acute and chronic pancreatitis

A

Duct obstruction
Direct acinar injury

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10
Q

How can duct obstruction lead to acute pancreatitis?

A

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

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

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11
Q

What are patterns of injury for acute pancreatitis?

A

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 periductal + perilobular.

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12
Q

What is the pathophysiology of acute pancreatitis?

A
  1. Activated enzymes
  2. Acinar necrosis
  3. Further Enzyme release etc.

Ranges from stromal oedema, to haemorrhagic necrosis.

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13
Q

Give an example of an enzyme released in acute pancreatitis and describe how it causes damage

A

Lipases lead to fat necrosis:
Lipases hydrolyse TGs to fatty acids
Ca ions bind to free fatty acids forming soaps which precipitate as yellow-white foci

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14
Q

What are 2 pancreatitic complications of acute pancreatitis?

A

Pseudocyst: not lined by epithelium.

Abscess: stasis of necrotic material- infected

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15
Q

What are 3 systemic complications of acute pancreatitis?

A

Shock

Hypoglycaemia: insulin released by damaged organ + part due to shock

Hypocalcaemia: Ca + FFA precipitate forming fat necrosis

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16
Q

How could calcium levels fluctuate in acute pancreatitis?

A

If Hypercalcaemia is cause
could become normocalcaemic as Ca precipitates out with FFAs as fat necrosis

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17
Q

What is the prognosis of acute pancreatitis?

A

Overall mortality up to 50% for haemorrhagic pancreatitis

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18
Q

What is this? Describe the feature seen

A

Acute pancreatitis
Fat necrosis: yellow/ white nodules

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19
Q

What is this? Describe the feature seen

A

Acute pancreatitis
Blue areas: fat necrosis

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20
Q

What is chronic pancreatitis?

A

Relapsing or persistent, a/w acute pancreatitis in half of cases.

Relatively uncommon.

Mortality 3% per year.

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21
Q

What are causes of chronic pancreatitis?

A

Metabolic/toxic:
* ALCOHOL (80%)
* Haemochromatosis

Duct obstruction:
* Gallstones
* Abnormal pancreatic duct anatomy
* CF (“mucoviscoidosis”)

Tumours

Idiopathic: Autoimmune

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22
Q

Which immune cells dominate in acute and chronic pancreatitis?

A

Acute: Neutrophils
Chronic: Lymphocytes

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23
Q

What is the pattern of injury of chronic pancreatitis?

A

Chronic inflammation with parenchymal fibrosis + loss of parenchyma.

Duct strictures with calcified stones with secondary dilatations.

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24
Q

How is the endocrine function affected in chronic pancreatitis?

A

Islets relatively preserved + doesn’t matter ducts are obstructed
Ultimately islets squeezed out by fibrosis, leads to DM

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25
Q

Why is haemochromatosis also known as bronzed diabetes?

A

Bronze: pigmentation in skin
Diabetes: chronic pancreatitis from iron deposits initially affecting acini, going on to affect islets

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26
Q

What are 4 complications associated with chronic pancreatitis?

A

Malabsorption

Diabetes mellitus

Pseudocyts

Carcinoma of the pancreas

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27
Q

What is this? Describe what can be seen

A

Chronic pancreatitis
Pancreatic calcifications

28
Q

What is this? What can be seen?

A

Chronic pancreatitis
Scarring- pale tissue
Cysts forming

29
Q

What is this? What can be seen?

A

Chronic pancreatitis
Islets surrounded by fibrosis, acini have atrophied

30
Q

What is a pancreatic pseudocyst?

A

Lined by fibrous tissue (NOT epithelial lining)

Contain fluid rich in pancreatic enzymes +/- necrotic material.

A/w acute + chronic pancreatitis.

Connect with pancreatic ducts.

May resolve, compress adjacent structures, become infected or perforate.

31
Q

What is this?

A

Pancreatic pseudocyst

32
Q

What is this? Describe the histology

A

Pancreatic pseudocyst
Lumen on LHS
Fibrous tissue on RHS
NO epithelial lining

33
Q

What is autoimmune pancreatitis also known as?

A

IgG4 related disease

34
Q

What is the pathophysiology of autoimmune pancreatitis?

A

Characterised by large no. of IgG4 +ve plasma cells.

May involve pancreas, bile ducts + almost any other part of the body.

35
Q

What is this?

A

AI pancreatitis
Blue: Pancreatic duct
White: Sheath of inflammation

36
Q

What is this? Describe what can be seen

A

AI pancreatitis
Pancreatic duct surrounded by dense plasma cell infiltrate
Background parenchyma replaced by fibrosis
Absence of acini

37
Q

What types of tumours can occur in the pancreas?

A

Carcinomas:
* Ductal (85% of all neoplasms)
* Acinar

Cystic neoplasms:
* Serous cystadenoma
* Mucinous cystic neoplasm

Pancreatic neuroendocrine tumours (Islet cell tumours)

38
Q

What is the most common neoplasm of the pancreas? What principle is this consistent with?

A

Ductal carcinomas (85% of all neoplasms)
Same case in any other organ in body with ductal + acinar/ lobular components e.g. Breast

39
Q

What is the epidemiology and prognosis of ductal carcinoma of the pancreas?

A

5% of cancer deaths

Increasingly common with age, 2M: 1F

5y survival: 5%

40
Q

What are 4 risk factors for pancreatic carcinomas?

A

SMOKING

BMI + dietary factors

Chronic pancreatitis

Diabetes

41
Q

What do ductal carcinomas of the pancreas commonly arise from?

A

Arise from dysplastic ductal lesions:

  • Pancreatic Intraductal Neoplasia (PanIN)
  • Intraducal Mucinous Papillary Neoplasm
42
Q

What is the most common mutation associated with ductal carcinoma?

A

K-Ras mutations in 95%

43
Q

What is the macroscopic appearance of ductal carcinoma?

A

Gritty + grey

Invades adjacent structures

Tumours in the head present earlier

44
Q

What is the microscopic appearance of ductal carcinomas?

A

Adenocarcinomas: Mucin secreting glands set in desmoplastic stroma.

45
Q

What is this?

A

Ductal carcinoma

46
Q

What is this? What can be seen?

A

Ductal carcinoma
Perineural invasion (characteristic of Pancreatic Ca)
Glands containing mucin

47
Q

What are common sites of ductal carcinomas?

A

Head (60%)

Body

Tail

Diffuse

48
Q

Where do ductal carcinomas commonly spread?

A

Direct: Bile ducts, duodenum

Lymphatic: LNs

Blood: Liver

Serosa: Peritoneum

49
Q

What are complications associated with ductal carcinoma?

A

Due to spread

Chronic pancreatitis

Venous thrombosis (“migratory thrombophlebitis”)- mucin acts like TF, activates coagulation

50
Q

What are cystic tumours?

A

Contain serous or mucin secreting epithelium (cf. ovarian tumours)

Usually benign

51
Q

What is this?

A

Cystic tumour

52
Q

What are typical behaviours of pancreatic endocrine neoplasms?

A

Usually non-secretory

Contain neuroendocrine markers e.g. chromogranin

Behaviour difficult to predict

53
Q

What can pancreatic endocrine neoplasms be associated with?

A

Multiple Endocrine Neoplasia (MEN) 1 syndrome

54
Q

What is the commonest type of secretory neuroendocrine tumour in the pancreas?

A

Insulinoma (derived from beta cells)

55
Q

What is this?

A

Insulinoma

56
Q

What is this?

A

Insulinoma

57
Q

What are 3 common pathologies associated with the gall bladder?

A

Gall stones

Inflammation

Cancer

58
Q

What are 5 risk factors for gall stones (cholelithiasis)?

A

Age + sex: Increasing age, F>M

Ethnic + geographic: e.g. Native Americans

Hereditary: e.g. disorders of bile metabolism

Drugs: e.g. oral contraceptive

Acquired disorders: e.g. rapid weight loss (secrete fats via biliary system)

59
Q

What are the two types of gall stones?

A

Cholesterol (> 50% cholesterol): May be single, mostly radiolucent.

Pigment (contain calcium salts of unconjugated BR): Multiple, mostly radio-opaque.

60
Q

What are 4 complciations associated with gall stones?

A

Bile duct obstruction

Acute + chronic cholecystitis

Gall bladder cancer

Pancreatitis

61
Q

What is acute cholecystitis?

A

Acute inflammation of gall bladder

90% a/w gall stones

Acalculus cholecystitis rare

62
Q

What is chronic cholecystitis?

A

Chronic inflammation (lymphocytes seen)

Fibrosis

Diverticula: Rokitansky-Aschoff sinuses

90% contain gall stones

63
Q

What is this?

A

Rokitansky-Aschoff sinsus
Blue: Lumen
Orange: Epithelium lining lumen
Green: Outpocketing

64
Q

What is gall bladder cancer?

A

Adenocarcinomas

90% a/w gall stones

65
Q

What is the commonest type of pancreatic neoplasm?
A. Neuroendocrine
B. Ductal adenocarcinoma
C. Serous cyst adenoma

A

B. Ductal adenocarcinoma

66
Q

The following are all complications of gall stones except…
A. Acute cholecystitis
B. Gall bladder cancer
C. Haemolytic anaemia
D. Obstructive jaundice

A

C. Haemolytic anaemia

67
Q

What is this?

A

Gallbladder with chronic cholecystitis
Thickness of wall of gallbladder due to fibrosis
Diverticuli: mucosa pushed out into the wall due to raised intraluminal pressure (Rokitansky Ashcoff sinuses)

YR5 Histopathology (27 decks)

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