Essentials: Pancreas Pathology (Summary Slides)

Question 1

Pancreatitis (2 types)

Answer 1

Acute Pancreatitis
Chronic Pancreatitis

Question 2

Pancreatitis (definition + cause)

Answer 2

Inflammation of the pancreas caused by autodigestion of the pancreas by its own enzymes, due early enzyme activation

Question 3

Key difference between acute and chronic pancreatitis

Answer 3

Acute: REVERSIBLE
Chronic: IRREVERSIBLE

Question 4

Key features of acute pancreatitis (4)

Answer 4

• fat necrosis (saponification, calcium precipitation and hypocalcemia)
• parenchymal necrosis
• acute inflammation
• hemorrhage

Question 5

Key features of chronic pancreatitis (3)

Answer 5

• Calcification
• Gland dropout (atrophy)
• Fibrosis

Question 6

3 main causes of acute pancreatitis

Answer 6

• Alcohol (#1)
• Gallstones (#2)
• Drugs, vascular, infectious, genetic

Question 7

Genetic mutations that can cause acute pancreatitis (2)

Answer 7

Mutations in genes PRSS, SPINK1

Question 8

Complications of acute pancreatitis (6)

Answer 8

• DEATH (this is a medical emergency)
• Disseminated intravascular coagulopathy (DIC)
• Acute respiratory distress syndrome (ARDS)
• Hypocalcemia
• Peritonitis
• Pseudocyst

Question 9

4 main causes of chronic pancreatitis

Answer 9

• Alcohol (#1)
• Autoimmune (IgG4)
• Genetic

Question 10

3 genetic mutations that can cause chronic pancreatitis

Answer 10

Mutations in genes PRSS1, SPINK1
Cystic fibrosis

Question 11

4 complications of chronic pancreatitis

Answer 11

• Weight loss
• malabsorption
• diabetes mellitus
• pancreatic cancer

Question 12

Autoimmune pancreatitis responds well to…

Answer 12

steroids

Question 13

2 types of non-neoplastic pancreatic cysts (i.e. no new growth, no malignant potential)

Answer 13

Congenital cysts
Pseudocysts

Question 14

2 types of neoplastic pancreatic cysts without papillary structures

Answer 14

Serous cystadenoma
Mucinous cystic neoplasms

Question 15

2 types of neoplastic pancreatic cysts WITH papillary structures

Answer 15

Intraductal papillary mucinous neoplasm (IPMN)
Solid pseudopapillary neoplasms

Question 16

Congenital cystic lesions of the pancreas: important features

Answer 16

Benign
Developmental

Question 17

Congenital cysts are associated with 2 diseases…

Answer 17

Polycystic kidney disease
Von Hippel-Lindau syndrome

Question 18

Most common type of pancreatic cysts

Answer 18

Pseudocysts

Question 19

What are pseudocysts (pancreas)?

Answer 19

Collections of necrotic material rich in pancreatic enzymes. They are not true cysts because they have no epithelial lining.

Question 20

Why are pseudocysts not considered “real” cysts?

Answer 20

They do not have an epithelial lining

Question 21

Pseudocysts of the pancreas usually develop secondary to…

Answer 21

pancreatitis

Question 22

Serous cystadenoma (definition + key features)

Answer 22

Neoplastic cyst of the pancreas without papillary structures.
They have NO malignant potential (benign).

Question 23

Key histological feature of serous cystadenoma

Answer 23

Multilocular (having many small compartments)

Question 24

Serous cystadenomas usually affect…

Answer 24

females

Question 25

Serous cystadenomas may be associated with a syndrome called...

Answer 25

Von Hippel-Lindau syndrome

Question 26

Mucinous cystic neoplasms (definition + key features)

Answer 26

Neoplastic cysts of the pancreas without papillary structures. They DO have malignant potential!

Question 27

How do we manage mucinous cystic neoplasms?

Answer 27

Since they have malignant potential, they need to be resected.

Question 28

Mucinous cystic neoplasms usually affect...

Answer 28

females

Question 29

Key hisotlogical features of mucinous cystic neoplasms

Answer 29

They are made up of mucus-secreting cells and ovarian-like stroma

Question 29

Mucinous cystic neoplasms have NO connection to...

Answer 29

the duct system

Question 30

Intraductal papillary mucinous neoplasm (IPMN) (definition + key features)

Answer 30

Neoplastic cysts of the pancreas with papillary structures. They have malignant potential!!!

Question 31

How do we manage intraductal papillary mucinous neoplasms?

Answer 31

Since they have malignant potential, they need to be resected.

Question 32

Intraductal papillary mucinous neoplasms (IPMN) usually affect...

Answer 32

males

Question 33

Key histological feature of intraductal papillary mucinous neoplasms (IPMN)

Answer 33

Made of mucous cells

Question 34

What type of pancreatic cyst has NO connection to ducts? What type of cyst is intimately connected with ducts?

Answer 34

No connection to duct system: Mucinous cystic neoplasms Connection to duct system: Intraductal papillary mucinous neoplasm (IPMN)

Question 35

Solid pseudopapillary neoplasm (definition + key features)

Answer 35

RARE neoplastic cyst of the pancreas with papillary structures. It has malignant potential (locally agressive).

Question 36

How do we manage solid pseudopapillary neoplasms?

Answer 36

Since they have malignant potential (locally aggressive), they must be resected.

Question 37

solid pseudopapillary neoplasms usually affect...

Answer 37

young females

Question 38

Name 4 types of pancreatic cancer

Answer 38

1. Ductal adenocarcinoma 2. Neuroendocrine tumours 3. Acinar carcinoma 4. Pancreatoblastoma

Question 39

Most (90%) of pancreatic cancers are...

Answer 39

ductal adenocarcinomas

Question 40

Ductal adenocarcinomas are a cancer of... a) exocrine pancreas b) endocrine pancreas

Answer 40

a) exocrine pancreas

Question 41

Ductal adenocarcinoma usually affects...

Answer 41

males

Question 42

Key histological features of ductal adenocarcinomas (3)

Answer 42

* Haphazard glands * Desmoplastic stroma (fibrosis) * Perineural invasion (common)

Question 43

Ductal adenocarcinoma is characterized by elevated serum markers...

Answer 43

CEA ad CA19.9

Question 44

Precursor of ductal adenocarcinoma

Answer 44

Pancreatic intraepithelial neoplasia (PanIN)

Question 45

Gene mutations that cause ductal adenocarcinomas (4)

Answer 45

Mutations in genes KRAS, TP53, SMAD4, BRCA2

Question 46

Ductal adenocarcinoma risk factors (8)

Answer 46

* Chronic pancreatitis * Smoking * Hereditary pancreatitis (PRSS1, SPINK1) * BRAC1 and BRCA2 genes * Lynch syndrome (mismatch repair proteins are dysfunctional) * FAP syndrome (APC gene) * Peutz-Jeghers syndrome * Familial melanoma syndrome

Question 47

Which part of the pancreas does ductal adenocarcinoma usually present in?

Answer 47

Head of pancreas

Question 48

Presentation of ductal adenocarcinoma at the head of pancreas vs body/tail

Answer 48

Head: Presents with jaundice & pruritus (itching) Body/Tail: Pain, weight loss

Question 49

Ductal adenocarcinomas are a cancer of... a) exocrine pancreas b) endocrine pancreas

Answer 49

b) endocrine pancreas

Question 50

What cells of the pancreas are affected by neuroendocrine tumours?

Answer 50

Islet cells

Question 51

Functional vs non-functional neuroendocrine pancreatic tumours

Answer 51

Functional: Mostly benign Non-functional: Mostly malignant

Question 52

What 3 criteria do neuroendocrine (non-functional) tumours have to meet to be considered malignant?

Answer 52

* Vascular invasion * Local invasion * Metastasis (lymph nodes, liver, distant)

Question 53

4 types functional neuroendocrine pancreatic tumours

Answer 53

* insulinoma * gastrinoma * glucagonoma * somatostatinoma

Question 54

Most FUNCTIONAL neuroendocrine tumours of the pancreas are...

Answer 54

insulinomas

Question 55

Insulinomas cause...

Answer 55

hypoglycemia

Question 56

Neuroendocrine tumours of the pancreas are associated with a genetic disorder called...

Answer 56

MEN1 syndrome

Question 57

Name 2 rare pancreatic cancer subtypes

Answer 57

Acinar carcinoma Pancreatoblastoma (pediatric tumour)

Question 58

Name a a rare pancreatic cancer/tumour affecting children

Answer 58

Pancreatoblastoma (pediatric)