pathology 19 (883-895) pancreas

Question 1

what does the pancreas normally arise from embryologically

Answer 1

from the fusion of dorsal and ventral outpouchings of the foregut

Question 2

what is the most common congenital anomaly of the pancreas

Answer 2

pancreas divisum

Question 3

where does the main pancreatic duct typically join the common bile duct

Answer 3

just proximal to the papilla of vater

Question 4

what is pancreas divisum cased by

Answer 4

failure of fusion of the fetal duct systems of the dorsal and ventral pancreatic primordia

Question 5

what are the favored sites for ectopic pancreas

Answer 5

stomach and duodenum

Question 6

what are most proenzymes from the pancreas activated by

Answer 6

trypsin

Question 7

what is trypsin activated by

Answer 7

duodenal enteropeptidase (enterokinase)

Question 8

what is acute pancreatitis characterized by

Answer 8

reversible pancreatic parenchymal injury associated with inflammation

Question 9

what does acute pancreatitis result from

Answer 9

inappropriate release and activation of pancreatic enzymes, which destroy pancreatic tissue and elicit an acute inflammatory reaction

Question 10

what are the 3 major initiating events for how inappropriate activation of pancreatic enzymes occurs in sporadic forms of acute pancreatitis

Answer 10

pancreatic duct obstruction, primary acinar cell injury, defective intracellular transport of proenzymes within acinar cells

Question 11

what is pancreatic duct obstruction most commonly caused by

Answer 11

gallstones and biliary sludge

Question 12

what is the most common shared feature of most hereditary forms of pancreatitis

Answer 12

defect that increase or sustains the activity of trypsin

Question 13

what are the basic morphological alterations with acute pancreatitis

Answer 13

microvascular leak and edema, fat necrosis, acute inflammation, destruction of pancreatic parenchyma, destruction of blood vessels and interstitial hemorrhage

Question 14

in the more severe case of acute necrotizing pancreatitis, where is necrosis occuring

Answer 14

acing and ductal tissues as well as islets of langerhans

Question 15

describe the macroscopic substance correlated with acute necrotizing pancreatitis

Answer 15

red-back from hemorrhage and contains interspersed foci of yellow-white, chalky fat necrosis

Question 16

what is the cardinal clinical manifestation of acute pancreatitis

Answer 16

abdominal pain

Question 17

where is the pain typically referred with acute pancreatitis

Answer 17

upper back and occasionally left shoulder

Question 18

what lab finding is very common with acute pancreatitis

Answer 18

marked elevation of serum amylase

Question 19

define chronic pancreatitis

Answer 19

prolonged inflammation of the pancreas associated with irreversible destruction of exocrine parenchyma, fibrosis, and in late stages, destruction of endocrine parenchyma

Question 20

what is the most common cause of chronic pancreatitis

Answer 20

long-term alcohol use

Question 21

what is autoimmune pancreatitis associated with

Answer 21

presence of IgG-4 secreting plasma cells in the pancreas

Question 22

what is chronic pancreatitis morphologically characterized by

Answer 22

fibrosis, atrophy and dropout of acini, and variable dilation of pancreatic ducts

Question 23

what is autoimmune pancreatitis characterized by

Answer 23

duct-centric mixed inflammatory cell infiltrate, venalities, and increased numbers of IgG4-secreting plasma cells

Question 24

describe congenital pancreatic cysts

Answer 24

unilocular, thin-walled cysts- believed to result from anomalous development of the pancreatic ducts

Question 25

what is the term for localized collections of necrotic and hemorrhagic material that are rich in pancreatic enzymes and lack an epithelial lining

Answer 25

pseudocysts

Question 26

where are pseudocysts most commonly located

Answer 26

in the lesser mental sac or in the retroperitoneum between the stomach and transverse colon or between the stomach and liver

Question 27

where do serous cystic neoplasms usually occur

Answer 27

in the tail of the pancreas

Question 28

what type of cells are serous cystic neoplasms lined by and what kind of fluid is inside

Answer 28

glycogen-rich cuboidal cells filled with clear, thin, straw-colored fluid

Question 29

do mutinous cystic neoplasms arise more in women or men

Answer 29

95% of the time in women

Question 30

what is the major difference between serous cystic neoplasms and mutinous cystic neoplasms

Answer 30

mutinous can be precursors to invasive carcinomas

Question 31

where do mutinous cystic neoplasms usually occur

Answer 31

in the tail of the pancreas

Question 32

describe the fluid in mutinous cystic neoplasms

Answer 32

thick, tenacious mucin and lined by a columnar mucin-producing epithelium

Question 33

what do intraductal papillary mutinous neoplasms (IPMNs) usually effect and where

Answer 33

larger ducts of the pancreas at the head of the pancreas

Question 34

are IPMNs more common in women or men

Answer 34

men

Question 35

who is solid-pseudopapillary neoplasms most commonly seen in

Answer 35

young women

Question 36

what are solid-pseudopapillary neoplasms filled with

Answer 36

hemorrhagic debris

Question 37

what are invasive pancreatic cancers typically arising from

Answer 37

pancreatic intraepithelial neoplasia

Question 38

what is the most frequently altered oncogene in pancreatic cancer

Answer 38

KRAS

Question 39

what does KRAS do

Answer 39

small, GTP-binding protein that normally participates in signaling events downstream of growth factor receptors with intrinsic tyrosine kinase activity

Question 40

what is the most common inactivated tumor suppressor gene in pancreatic cancers

Answer 40

CDKN2A

Question 41

what is the strongest environmental influence for developing pancreatic cancer

Answer 41

cigarette smoking

Question 42

what is the most common location for cancers of the pancreas

Answer 42

in the head

Question 43

what are the 2 common features of pancreatic cancer

Answer 43

it is highly invasive and it elicits an intense host reaction in the form of dense fibrosis

Question 44

T/F: carcinomas of the body and tail of the pancreas do not impinge on the biliary tree

Answer 44

TRUE

Question 45

what is usually the first symptoms of carcinomas of the pancreas

Answer 45

pain

Question 46

what is the distinct microscopic appearance of pancreatoblastomas

Answer 46

squamous islands admixed with acing cells