Lesson 3.2 - Panc Path Neoplasms

Question 1

neoplasms of panc (4)

Answer 1

• periampullary
• cystic
• pseudopapillary
• endocrine, lipoma, mets

Question 2

jaundice is the most important presentation for what type of neoplasm?

Answer 2

periampullary

Question 3

how are periampullary neoplasms managed

Answer 3

Whipples Procedure (pancreaticoduodenectomy)

Question 4

periampullary neoplasms include subcategories (4)

Answer 4

• ductal adenocarcinoma
• ampullary carcinoma
• duodenal carcinoma
• distal cholangiocarcinoma

Question 5

most common primary pancreatic neoplasm

Answer 5

pancreatic ductal adenocarcinoma

Question 6

ductal adenocarcinoma RF (8)

Answer 6

male 
older age
smoking, obesity, diabetes
chronic pancreatitis
cirrhosis
fam history

Question 7

classic S/S ductal adenocarcinoma (3)

Answer 7

jaundice
pain
weight loss

Question 8

urine dark, stools pale

Answer 8

ductal adenocarcinoma sign

Question 9

where do most periampullar adenocarcinomas originate in the panc

Answer 9

the head

Question 10

double duct sign associated with

Answer 10

ductal periampullar adenocarcinoma

Question 11

what can ductal periampullar adenocarcinoma lead to

Answer 11

if cancer originates in the head, can lead to Courvoisier GB

Question 12

what is Courvoisier GB

Answer 12

obstruction to CBD causing enlarged GB and jaundice

Question 13

what is the first thing we consider with treating periampullar cancer

Answer 13

if it can be resected (if over 2 cm or extension/vascular invasion, lymphadenopathy, then no resection)

Question 14

what is whipples procedure

Answer 14

removal of head, uncinate, GB, CBD,
distal stomach, duodenum, part of jejunem,

anastomosis of CHD, remaining panc, stomach –> jejunem is the result

Question 15

t/f cystic neoplasms can be benign or malignant

Answer 15

true

Question 16

the majority of cystic neoplasms are

Answer 16

pseudocysts

Question 17

ominous signs of cystic panc lesions (5)

Answer 17

symptomatic pts
growth
diameter >3cm
internal soft tissue
mural/septal thickening

Question 18

diseases assoc with cysts

Answer 18

polycystic kidney disease

von hippel-lindau disease

Question 19

what might suggest von hippel-lindau

Answer 19

multiple simple cysts

Question 20

what is von-hippel lindau

Answer 20

connective tissue disorder

Question 21

most common cystic neoplasms in order of prevalence

Answer 21

• serous cystic
• intraductal papillary muchinous
• mucinous cystic
• solid pseudopapillary

Question 22

t/f cystic neoplasms are usually benign or low grade malignancies

Answer 22

true

unless muchinous tumours - malignant

Question 23

microcystic adenoma is the same as

Answer 23

serous cystic neoplasm

Question 24

common location of serous cystic neoplasm

Answer 24

panc head

Question 25

serous cystic neoplasm sono app

Answer 25

myriad of tiny cysts too small for US | echogenic + posterior enhancement

Question 26

what neoplasm often presents as acute pancreatitis?

Answer 26

Intraductal papillary muchinous neoplasm

Question 27

where does Intraductal papillary muchinous neoplasm arise?

Answer 27

panc ducts

Question 28

hallmark sono app of intraductal papillary muchinous neoplasm

Answer 28

prominent ductal dilation

Question 29

what has the same appearance as sludge on US

Answer 29

mucin from IPMN

Question 30

what neoplasm is rare in men/more commonly in perimenopausal women

Answer 30

mucinous cystic neoplasm

Question 31

what neoplasm commonly occurs in panc body/tail

Answer 31

mucinous cystic neoplasm

Question 32

muchinous cystic neoplasm sono app (4)

Answer 32

unilocular/multilocular thick/thin wall septations internal debris

Question 33

what tumour seen in young females

Answer 33

solid-pseudopapillary tumour

Question 34

what neoplasm commonly occurs in panc tail

Answer 34

solid-pseudopapillary tumour

Question 35

sono app pseudopapillary tumours (4)

Answer 35

- round encapsulated masses - cystic, necrotic, soft tissue foci within - posterior enhancement - anechonic/hypo

Question 36

other panc masses

Answer 36

endocrine tumours metastases lipoma

Question 37

majority of panc endocrine tumours are what type of lesions

Answer 37

hyper-functioning

Question 38

when are non-hyperfunctioning lesions of panc endo tumours found

Answer 38

when they are larger and cause pain

Question 39

what is the most common pancreatic neoplasm

Answer 39

metastatic tumour

Question 40

primary sources of mets

Answer 40

``` renal cell carcinoma* breast* lung* colon melanoma stomach ```

Question 41

T/F US is unreliable in diagnosing fatty replacement

Answer 41

true, variable echogenicity

Question 42

what can fatty sparing cause

Answer 42

psuedomass in the uncinate process

Question 43

RF for severe fatty replacement (5)

Answer 43

cystic fibrosis, diabetes, obesity, NASH, old age