Pancreatic Diseases & Malignancy Flashcards
What are the congenital true cysts of the pancreas?
- solitary cyst
- enterogenous cysts
- dermoid cysts
- multiple congenital pancreatic cysts -> Von Hippel Lindau syndrome
- fibrocystic disease of pancreas -> caucasians
What is the acquired true pancreatic cyst?
Retention cyst
What are the neoplastic cysts of the pancreas?
- microcystic adenoma
- mucinous cystic neoplasm
- cystic neuroendocrine tumors
- ductal adenocarcinoma with central necrosis
What is the lining of multiple congenital pancreatic cysts?
Smaller than 5cm -> lined by cuboidal epithelium
What are the clinical features of cystic neoplasms of the pancreas?
- vague abdominal pain with weight loss
- stomach or duodenal compression
- palpable epigastric mass (in tail & body retains large size)
- spontaneous hemorrhage -> papillary cystic neoplasm
What investigations are used to diagnose cystic neoplasms of the pancreas?
LAB
- serum amylase may be normal
- intracystic amylase -> if normal -> no communication with pancreatic duct -> true cyst
- CEA elevated in malignant cysts
RADIOLOGICAL
- Ultrasound & CT -> cystic & solid components of mass
- > calcifications in the wall of mass
- > internal septa & multiloculated cysts -> increase suspicion of tumor - ERCP -> true cysts do not communicate with ductal system
- Angiography -> hypervascularity or tumor vessels
- > splenic, portal or SMV obstruction
- > hemorrhage inside cyst
How should a pancreatic cystic neoplasm be treated?
COMPLETE EXCISION
- lesion in body & tail -> distal pancreatectomy with splenectomy
- lesion in the head -> Whipple (pancreaticoduodenectomy)
- debulking if inoperable
- presence of metastasis -> not contraindication to resection
- excision of isolated liver metastasis -> may be curative
What is the prognosis of pancreatic carcinoma?
- 5 years survival -> 2% or less
75% of patients > 60 years
What are the causes of pancreatic cancer?
- cigarette smoking -> carcinogenic nitrosamines
- diet high in animal fats -> cholecystokinin & pancreozymin -> ductal hyperplasia & hypertrophy of acinar cells
- diabetes -> abrupt onset of diabetes after 40 is a clue to the diagnosis
- chemical & industrial carcinogens
- polyposis of the colon (Gardner’s syndrome) -> increase in periampullary malignancy
- hereditary pancreatitis
What is the pathological classification of pancreatic exocrine carcinoma?
PRIMARY
- Duct cell origin 90% -> ductal cell adenocarcinoma, mucinous adenocarcinoma, cystadenocarcinoma
- Acinar cell origin 1% -> acinar cell carcinoma, cystadenocarcinoma (acinar cell)
METASTATIC
- 7%
What are the stages of pancreatic carcinoma?
I -> confined to gland
II -> involvement of regional lymph nodes
III -> distant metastasis to liver, regional lymph nodes, peritoneum & lungs
What are the clinical manifestations seen after micro metastasis has occurred in pancreatic carcinoma?
- obstruction of bile duct -> jaundice, pruritis
- gastric outlet obstruction -> obstruction of duodenum, or stomach
- ulceration -> GIT hemorrhage
- pain -> infiltration of peripancreatic nerve roots
non-specific tumor symptoms
- malaise, early satiety, weight loss, anorexia
- enlarged gallbladder (Courvoisier’s law)
- postprandial epigastric pain -> obstructed pancreatic or bile duct
- deep seated back pain present at night -> retroperitoneal extension of the neoplasm -> unresectable
What is abutment?
tumor-vascular contact < 180
What is encasement?
tumor-vascular contact > 180 OR vascular deformity, occlusion, or tumor thrombosis
When is pancreatic cancer considered resectable?
ARTERY
- no contact with CA, SMA, or CHA
VEIN
- no contact with SMV or PV
- abutment without vein contour irregularity
