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Flashcards in Cancer: Pancreas & GB Deck (40):
0

What is the most common pancreatic tumor?

Adenocarcinoma (80%).

1

Where does pancreatic adenocarcinoma rank as a cause of cancer death in the US?

4th.

2

Where are adenocarcinomas most commonly found in the pancreas?

The head (75%).

3

What are 10 histological features of pancreatic adenocarcinoma?

(1) disorganized glands
(2) presence of incomplete ductal lamina
(3) cribriform glands
(4) single cell infiltration
(5) cells adjacent to large vessels
(6) perineural infiltration
(7) nuclear size variation between ductal cells
(8) disorganized stroma
(9) mitoses
(10) necrotic debris

4

What procedure is performed in treatable patients with adenocarcinoma in the head of the pancreas?

Whipple.

5

What profile is at increased risk for pancreatic adenocarcinoma?

An aging, obese smoker with chronic pancreatitis, diabetes, and prolonged exposure to petroleum products.

6

What are conditions associated with pancreatic adenocarcinoma?

(1) hereditary pancreatitis
(2) BRCA2 mutation
(3) familial atypical multiple melanoma
(4) p16 germline mutation
(5) HNPCC
(6) Peutz-Jeghers polyposis

7

What is the clinical presentation of pancreatic adenocarcinoma?

(1) anorexia, nausea, vomiting, malaise
(2) weight loss
(3) epigastric pain
(4) obstructive jaundice
(5) Courvoisier's sign
(6) Trousseau's syndrome

8

J: This refers to a distended palpable non-tender gallbladder.

What is Courvoisier's sign?

9

J: This refers to superficial and deep vein thrombosis associated with pancreatic adenocarcinoma.

What is Trousseau's syndrome?

10

If pancreatic tumors are suspected, what tests can be performed?

(1) ERCP
(2) endoscopic ultrasound
(3) CT

11

What is the precursor lesion in pancreatic adenocarcinoma?

Pancreatic intraepithelial neoplasia.

12

J: This refers to a pancreatitis-associated cyst with no lining.

What is a pseudocyst?

13

What are the 2 most important types of pancreatic cysts?

(1) mucinous
(2) serous

14

What is IPMN?

Intraductal papillary mucinous neoplasm.

15

Where are IPMN most commonly found?

The head of the pancreas.

16

What are the major differences between IPMN of the branch duct and of the main duct?

BD: frequently gastric cell type with no invasion
MD: frequently intestinal cell type with malignant transformation

17

What is the characteristic finding of IPMN?

Thick mucin oozing into duodenum.

18

What is the principal worry with IPMN?

Progression to adenocarcinoma.

19

What gender is more likely to have a mucinous cystic neoplasm?

Female.

20

What gender is more likely to have an IPMN?

Male.

21

Where are mucinous cystic neoplasms most commonly found in the pancreas?

The body and tail.

22

What are the histological features of a mucinous cystic neoplasm?

(1) mucin-secreting columnar or cuboidal cells
(2) possible squamoid cells
(3) denuded epithelium
(4) ovarian stroma (may be luteinized)

23

What gender is more likely to have pancreatic serous cystadenoma?

Female.

24

Where in the pancreas are serous cystadenomas most common?

The body and tail.

25

What disease is associated with pancreatic serous cystadenoma?

Van Hipple Lindau disease.

26

How is pancreatic serous cystadenoma treated?

It typically isn't, as it is almost always benign.

27

What are histological features of pancreatic serous cystadenoma?

(1) glycogen-rich clear cells
(2) small to large cysts
(3) frequently a central scar

28

What are the common functional pancreatic NETs?

(1) insulinoma
(2) glucagonoma
(3) gastrinoma
(4) VIPoma
(5) somatostatinoma

29

What is the clinical presentation of a gastrinoma?

(1) recurrent peptic ulcers
(2) abdominal pain
(3) dyspepsia
(4) diarrhea

30

What is the clinical presentation of an insulinoma?

(1) headache
(2) irritability
(3) tachycardia
(4) dizziness, confusion
(5) hypoglycemia

31

What is the clinical presentation of glucagonoma?

(1) diabetes
(2) necrolytic migratory erythema
(3) lipolysis
(4) hypoaminoacidemia
(5) anemia
(6) diarrhea
(7) weight loss

32

What is the gross appearance of a pancreatic NET?

(1) well-demarcated
(2) solitary
(3) white, yellow
(4) soft, fleshy, or fibrotic
(5) possible hemorrhage or necrosis

33

What other type of cancer does a high grade neuroendocrine carcinoma behave like?

Small cell lunger carcinoma.

34

On histology, what other pancreatic tumors resemble NETs?

(1) solid pseudopapillary tumor
(2) acinar cell carcinoma

35

What is the most common biliary tract cancer?

Gallbladder cancer.

36

What gender is more likely to have gallbladder cancer?

Female.

37

What is the pathway to gallbladder cancer that begins with a genetic predisposition?

(1) abnormal bile metabolism
(2) gallstones
(3) chronic inflammation
(4) dysplasia / carcinoma in situ
(5) invasive carcinoma

38

What is the pathway to gallbladder cancer that begins with a congenital abnormality

(1) abnormal pancreaticobiliary junction
(2) reflux of pancreatic juice
(3) hyperplasia
(4) dysplasia / carcinoma in situ
(5) invasive carcinoma

39

What is the most common type of metaplasia in gallbladder cancer?

Pseudo-pyloric (also gastric and intestinal).