Neoplastic States of the Pancreas and Gallbladder

Question 1

At what spinal level is the pancreas?

Answer 1

L1-2

Question 2

> 80% of pancreatic tumors are of what kind?

Answer 2

adenocarcinoma

Question 3

M or F: Adenocarcinoma

Answer 3

=

Question 4

developed vs under-developed countries: adenocarcinoma

Answer 4

developed > underdeveloped

Question 5

5 year survival of pancreatic adenocarcinoma

Answer 5

<5%

Question 6

Where do most pancreatic adenocarcinomas arise?

Answer 6

head = 75% then body and tail

Question 7

Histologic features of pancreatic adenocarcinoma

Answer 7

disorganized glands, incomplete ductal lumina, cribiform glands, single cell infiltrations, cells adjacent to large vessels, perineural infiltration, large nuclei, disorganized stroma

Question 8

Risk factors for pancreatic adenocarcinoma

Answer 8

cigarettes, chronic pancreatitis, increased BMI, prolonged petroleum exposure, diabetes, family hx, brca2, family atypical multiple melanoma, germline mutation in p16, hnpcc, peutz-jeghers polyposis

Question 9

Clinical findings with pancreatic adenocarcinoma

Answer 9

anorexia, nausea, vomiting, malaise, weight loss, epigastric pain, obstructive jaundice, courvoisier’s sign, trousseau’s syndrome

Question 10

Trousseau’s syndrome

Answer 10

superficial and deep vein thrombosis

Question 11

Courvoisier’s sign

Answer 11

distended, palpable, non tender gallbladder

Question 12

What is the precursor lesion to pancreatic adenocarcinoma?

Answer 12

pancreatic intraepithelial neoplasia: normal –> PanIN1, 2 (nuclear changes), 3 –> invasive carcinoma

Question 13

Important markers in pancreatic adenocarcinoma

Answer 13

kras, p16, mucin 1, DPC4/SMAD4, BRCA2, p53, mesothelin

Question 14

Which marker is a positive prognostic indicator in pancreatic adenocarcinoma?

Answer 14

SMAD4/DPC4 –> more responsive to radiation

Question 15

How does tumor size affect prognosis in pancreatic adenocarcinoma?

Answer 15

smaller is better

Question 16

How does tumor differentiation affect prognosis in pancreatic adenocarcinoma?

Answer 16

well differentiated is better

Question 17

How does tumor stage affect prognosis in pancreatic adenocarcinoma?

Answer 17

lower stage is better

Question 18

Blocking what molecular target limits growth of early pancreatic adenocarcinomas?

Answer 18

EGFR

Question 19

What do we call a pancreatic cyst with no lining?

Answer 19

pseudocyst: pancreatitis associated

Question 20

hree pancreatic cysts with true linings

Answer 20

lining = neoplasm

1. intraductal papillary mucinous neoplasm
2. mucinous cystic neoplasm
3. serous neoplasm

Question 21

Where is IPMN located?

Answer 21

usually in head of pancreas: pancreatic ducts (intraductal)

Question 22

Features IPMN

Answer 22

papillary formation, thick mucin production, intraductal

Question 23

Clinical finding that is diagnostic of IPMN?

Answer 23

thick mucus secretion in duodenum from ampulla

Question 24

2 subtypes of IPMN

Answer 24

depends on where it starts (main duct vs small duct) = main duct IPMN and branch duct IPMN

Question 25

M or F: IPMN

Answer 25

male

Question 26

Difference between main duct and branch duct IPMN

Answer 26

branch duct invades less often, branch duct is more frequently foveolar/gastric type and main duct is more frequently intestinal and malignant

Question 27

2 ways IPMN carcinoma appears on histology

Answer 27

tubular or colloid

Question 28

Is IPMN adenocarcinoma worse or better than NOS adenocarcinoma of pancreas?

Answer 28

much better survival

Question 29

CEA

Answer 29

carcinoma embryonic antigen --> marker for neoplastic mucinous cysts --> helps in distinguishing mucinous carcinomas

Question 30

F or M: mucinous cystic neoplasm

Answer 30

females (middle age)

Question 31

location of mucinous cystic neoplasms

Answer 31

body/tail of pancreas

Question 32

How do mucinous cystic neoplasms communicate with the pancreatic duct?

Answer 32

they dont

Question 33

Histologic features of MCN

Answer 33

epithelial lined cysts with columnar or cuboidal mucin secreting cells + ovarian stroma (spindle cells with bland nuclei, luteinization)

Question 34

Younger age group: IPMN or MCN

Answer 34

MCN

Question 35

Does mucous come out of the duodenal ampulla of vater in MCN?

Answer 35

no

Question 36

M or F: serous cystadenoma of pancreas

Answer 36

F

Question 37

location of serous cystadenoma of pancreas

Answer 37

body/tail

Question 38

Does serous cystadenoma of pancreas communicate with the pancreatic duct?

Answer 38

no

Question 39

With what disease is serous cystadenoma of pancreas associated?

Answer 39

van hipple lindau

Question 40

What is the prognosis of serous cystadenoma of pancreas?

Answer 40

almost always benign

Question 41

Histologic features of serous cystadenoma of pancreas

Answer 41

glycogen rich clear cells, small to large cysts, central scar

Question 42

2 categories of pancreatic neuroendocrine tumors (NET)

Answer 42

functional (60%) or non functional (40%)

Question 43

What clinical feature is classically associated with glucagonomas?

Answer 43

necrolytic migratory erythema

Question 44

What markers are associated with pancreatic NETs?

Answer 44

MEN1 and VHL

Question 45

What is a high grade pancreatic NET?

Answer 45

behave like small cell lung cancer and have poor prognosis and rapid progression

Question 46

What tumor which looks like a pancreatic NET is associated with Wnt abnormalities?

Answer 46

solid psuedopapillary tumors (young, females, uncertain malignant potential)

Question 47

What tumor which looks like a pancreatic NET is associated with beta catenin/APC abnormalities?

Answer 47

acinar cell carcinoma (males, 50% survival @5 years, lipase secretion)

Question 48

Most common biliary tract cancer

Answer 48

gallbladder cancer

Question 49

prognosis of gallbladder cancer

Answer 49

poor: 5 year survival = 32%

Question 50

2 pathways to GBC

Answer 50

1. genetic predisposition + F --> abnormal bile metabolism --> gallstones --> chronic inflammation --> dysplasia, etc. 2. congenital abnormality --> APBDJ --> pancreatic reflux --> hyperplasia, dysplasia etc

Question 51

Goblet cell metaplasia is associated with kind of dysplasia of GB epithelium?

Answer 51

low grade

Question 52

How long does it take for GB dysplasia to become cancer?

Answer 52

12 years

Question 53

What mutation is associated with GB cancer?

Answer 53

kras

Question 54

Are GB adenomas common?

Answer 54

no