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Anatomic pathology > Pancreas > Flashcards

Flashcards in Pancreas Deck (89):
1

Chronic pancreatitis: Associations with pancreatic cancer.

Either one can cause the other; either one can mimic the other.

2

Chronic pancreatitis: Gross-pathology clues to alcoholic origin (2).

Pseudocyst.

Intraductal calculi.

3

Chronic pancreatitis: Possible confounding effects on islets of Langerhans (2).

Aggregations of islets may mimic neoplasm.

Islets may abut nerves.

4

Chronic pancreatitis: Helpful signs of benignity (2).

Preservation of lobular architecture.

No glands adjacent to muscular blood vessels.

5

Genes that predispose to chronic pancreatitis:

A. Names (2).
B. Other implications (2).

A. PRSS1, SPINK1.

B. Acute pancreatitis in childhood; pancreatic cancer.

8

Autoimmune pancreatitis: Histology (3).

Duct-centered lymphoplasmacytic infiltrate.

Interstitial fibrosis.

Venulitis.

9

Autoimmune pancreatitis: Treatment.

May respond to steroids.

10

Pancreatic pseudocyst: Outcomes (3).

Spontaneous resolution.

Infection.

Erosion into adjacent organs.

11

Pancreatic pseudocyst: Cytology (2).

Necrotic and hemorrhagic debris.

Hemosiderin-laden macrophages.

12

Pancreatic pseudocyst: Laboratory findings in cyst fluid.

Elevated amylase and CA19-9.

13

Lymphoepithelial cyst: Epidemiology.

M : F = 4 : 1.

14

Lymphoepithelial cyst: Gross pathology.

Thin wall; keratinous contents.

15

Lymphoepithelial cyst: Histopathology (2).

Lining composed of keratinized squamous epithelium.

Underlying lymphoid tissue.

16

Lymphoepithelial cyst: Main differential diagnosis.

Mature cystic teratoma also contains adnexal structures and sometimes cartilage.

17

Lymphoepithelial cyst: Clinical associations.

None demonstrated.

18

Serous cystic neoplasm: Epidemiology.

More common in women.

19

Serous cystic neoplasm: Association.

Von Hippel-Lindau syndrome.

20

Serous cystic neoplasm: Variants in gross pathology (4).

Microcystic.

Macrocystic.

Solid.

Association with well-differentiation neuroendocrine tumor.

21

Serous cystic neoplasm: Histopathology (3).

Lined by bland cells analogous to normal pancreatic serous cells.

Solid variant consists of the same type of cell.

Central scar (may be seen radiologically).

22

Serous cystic neoplasm: Special stain.

Positive for PAS, sensitive to diastase (contain glycogen).

23

Serous cystic neoplasm: Mutation.

Some tumors have a mutation involving VHL on chromosome 3p.

24

Serous cystic neoplasm: How to distinguish benign from malignant.

Serous cystadenocarcinoma: Extremely rare; diagnosed by its spread to other organs.

25

Mucinous cystic neoplasms: Epidemiology.

F : M = 20 : 1.

26

Mucinous cystic neoplasms: How many are malignant?

About one third.

27

Mucinous cystic neoplasms: Anatomic location (2).

Body or tail of pancreas.

No connection with the ductal system.

28

Mucinous cystic neoplasms: Histopathologic classification (4).

Noninvasive:
− Low-grade dysplasia.
− Intermediate-grade dysplasia.
− High-grade dysplasia.

Invasive: Cystadenocarcinoma.

29

Mucinous cystic neoplasm:

A. Stroma.
B. Cytokeratins (2).

A. Ovarian-like.

B. CK7 in most, CK20 in about ⅔.

30

Mucinous cystic neoplasms: Important gene.

Smad4/DPC4:
− Unmutated in most noninvasive tumors.
− Lost in about half of invasive tumors.

31

Mucinous cystic neoplasm: Other possibly mutated genes (3).

RNF43, KRAS2, TP53.

32

Intraductal papillary mucinous neoplasm: Epidemiology.

Slightly more common in men.

33

Intraductal papillary mucinous neoplasm: How many are invasive?

About one third.

34

Autoimmune pancreatitis: Helpful stains (2).

IHC for IgG4.

Elastin stain or Movat's stain to demonstrate venulitis.

35

Intraductal papillary mucinous neoplasm: Histopathologic classification.

Same as that of mucinous cystic neoplasm.

36

Intraductal papillary mucinous neoplasm: Stroma.

Paucicellular.

37

Intraductal papillary mucinous neoplasm: Invasive types (2).

Tubular (ductal).

Colloid (mucinous non-cystic): At least 80% of the tumor must have mucinous histology.

38

Intraductal papillary mucinous neoplasm: Immunohistochemstry.

Intestinal type: MUC2.

Pancreaticobiliary type: MUC1.

39

Intraductal papillary mucinous neoplasm: Possibly mutated genes (5).

Smad4/DPC4.

RNF43, KRAS2, TP53, GNAS.

40

Intraductal papillary mucinous neoplasm: Favorable prognostic factors (2).

Overall: Absence of invasion.

Invasive tumors: Colloid histology.

41

Pancreatic intraepithelial neoplasia: Size.

Usually less than 0.5 cm.

42

Pancreatic intraepithelial neoplasia: Histopathology (2).

Occurs within smaller pancreatic ducts.

If there are papillae, these are shorter than those of a mucinous papillary neoplasm.

43

Pancreatic intraepithelial neoplasia: Associated histopathologic finding.

Lobular acinar units may show atrophy and scarring.

44

Pancreatic intraepithelial neoplasia: Immunohistochemistry.

Positive for MUC1.

45

Pancreatic intraepithelial neoplasia: Mutated genes.

PanIN-1: Activation of KRAS2.

PanIN-2: Inactivation of p16/CDKN2A.

PanIN-3: Loss of Smad4/DPC4 and of TP53.

46

Pancreatic intraepithelial neoplasia: Surgical significance.

The presence of PanIN at a margin usually does not matter.

47

Invasive ductal adenocarcinoma: Gross-pathology clue to the diagnosis.

"Double-duct" sign: Dilatation of main pancreatic duct and bile duct due to obstruction.

48

Histology of invasive ductal adenocarcinoma: Architectural clues to the diagnosis (5).

Loss of lobular architecture.

Glands immediately adjacent to muscular blood vessels.

Incomplete lumens.

Necrotic lumens.

Perineural or vascular invasion.

49

Histology of invasive ductal adenocarcinoma: Cytologic clue to the diagnosis.

Within a single gland, there is more than a fourfold variation in size of the nuclei.

50

Adenosquamous carcinoma: Definition.

At least 30% of the tumor is squamous.

51

Colloid carcinoma:

A. Definition.
B. Association.

A. At least 80% of the tumor has colloid histology.

B. Intraductal papillary mucinous neoplasm (almost always).

52

Medullary carcinoma: Histopathology (3).

Syncytial growth.

Pushing borders.

Lymphocytic infiltrate.

53

Medullary carcinoma: Mutation.

Microsatellite instability.

54

Signet-ring carcinoma:

A. Stain.
B. Differential diagnosis.

A. Loss of E-cadherin.

B. Signet-ring carcinomas of stomach and breast must be excluded.

55

Undifferentiated carcinoma, NOS: Histologic variants (3).

Anaplastic, sarcomatoid, carcinosarcoma.

56

Undifferentiated carcinoma with osteoclast-like giant cells: Histopathology.

Osteoclast-like giant cells accompanied by pleomorphic mononuclear cells.

57

Pancreatic cancer: Associated cancer-syndrome genes (4).

BRCA2 and PALB2.

STK11.

ATM.

58

Intraductal papillary mucinous neoplasm: Anatomic location (2).

Most tumors arise in the head of the pancreas.

Connection with the ductal system.

60

Autoimmune pancreatitis: Laboratory finding.

Elevated serum IgG4.

61

Autoimmune pancreatitis: Associated autoimmune diseases (5).

Chronic sclerosis sialadenitis.

PSC, inflammatory bowel disease.

Retroperitoneal fibrosis.

Riedel's thyroiditis.

62

Acinar-cell carcinoma: Epidemiology.

More common in males.

63

Clinical triad of acinar-cell carcinoma:

A. Frequency.
B. Components.
C. Cause.

A. Occurs at presentation in 15% of cases.

B. Metastatic fat necrosis, arthralgias, peripheral eosinophilia.

C. Lipase.

64

Acinar-cell carcinoma: Anatomic location.

Head or tail or pancreas.

65

Acinar-cell carcinoma: Histologic patterns (2).

Acinar or solid.

66

Acinar-cell carcinoma: Cytology.

Granular cytoplasm; basally oriented nucleus with a single large nucleolus.

67

Acinar-cell carcinoma: Variant.

Partial neuroendocrine differentiation.

68

Acinar-cell carcinoma: Mutation.

KRAS2 is rarely implicated.

69

Pancreatoblastoma: Associated syndromes (2).

Beckwith-Wiedemann.

FAP.

70

Pancreatoblastoma: Laboratory abnormality.

Elevated AFP in some cases.

71

Pancreatoblastoma: Anatomic location.

Head or tail of pancreas.

72

Pancreatoblastoma: Components (2,3).

Required: Acinar and squamoid.

Optional: Neuroendocrine, ductal, mesenchymal.

73

Pancreatoblastoma: Immunohistochemistry (4).

Acinar cells: Trypsin, antichymotrypsin, lipase.

Squamoid nests: Nonspecific labeling with biotin.

74

Pancreatoblastoma: Mutation.

Loss of heterozygosity at chromosome 11p near WT-2.

75

Well-differentiated pancreatic neuroendocrine tumors: Possibly associated gene and its location.

MEN1 on chromosome 11q13.

76

Well-differentiated pancreatic neuroendocrine tumors: Definition of microadenoma.

Less than 0.5 cm.

77

Well-differentiated pancreatic neuroendocrine tumors: Important histologic prognostic factor.

Mitotic rate.

78

Glucagonoma: Presentation (3).

Diabetes.

Necrotizing migratory erythema.

Stomatitis.

79

Gastrinoma: Presentation.

Duodenal ulcer.

80

VIPoma: Presentation (3).

Watery diarrhea.

Achlorhydria.

Hypokalemia.

81

Well-differentiated pancreatic neuroendocrine tumors: Histological clues to type of hormone.

Presence of amyloid may indicate an insulinoma.

Presence of psammoma bodies may indicate a somatostatinoma.

82

Well-differentiated pancreatic neuroendocrine tumors: Special stains (2).

Grimelius.

Fontana-Masson.

83

Well-differentiated pancreatic neuroendocrine tumors: Cytokeratin.

Usually negative for CK7, unlike pancreatic ductal adenocarcinoma.

84

Well-differentiated pancreatic neuroendocrine tumors: Relation of size to malignancy.

All tumors larger than 0.5 cm should be considered malignant.

85

High-grade neuroendocrine carcinoma:

A. Synonym.
B. Possible presentation.

A. Small-cell carcinoma.

B. Paraneoplastic syndrome such as Cushing's syndrome.

86

High-grade neuroendocrine carcinoma: Mitotic rate.

More than 20 per 10 high-power fields (by definition).

87

High-grade neuroendocrine carcinoma: Mutated genes (2).

RB, TP53.

88

Solid-pseudopapillary neoplasm: Anatomic location.

Can arise from any region of the pancreas.

89

Solid-pseudopapillary neoplasm: Cytology.

Nuclear grooves.

90

Solid-pseudopapillary neoplasm: Extracellular features (2).

Hyaline globules.

Cholesterol clefts.

91

Solid-pseudopapillary neoplasm: Immunohistochemistry (2).

Positive for CD10, (nuclear) β-catenin.

92

Solid-pseudopapillary neoplasm: Mutation.

β-Catenin.