Pathology- Endocrine Pancreas

Question 1

What is a characteristic of nondiabetic newborns of diabetic mothers?

Answer 1

Increase in the number and size of islets

Question 2

What happens to fetal islets secondary to meternal hyperglycemia?

Answer 2

They undergo hyperplasia

Question 3

What are prime targets of diabetes?

Answer 3

Kidneys

Question 4

What is second only to MU as cause of death in diabetes?

Answer 4

Renal failure

Question 5

What are 3 lesions seen in kidneys with diabetes?

Answer 5

1. Glomerular lesions
2. Renal vascular lesions
3. Pyelonephritis (including necrotizing papilitis)

Question 6

What is nodular glomerulosclerosis also called?

Answer 6

1. Intercapillary glomerulusclerosis

2. Kimmelstiel-Wilson disease

Question 7

What is seen in nodular glomerulosclerosis?

Answer 7

Ovoid or spherical, laminated, nodules of matrix

Question 8

Where are nodules in the glomerulus in nodular glomerulosclerosis?

Answer 8

Peripephery

Question 9

True or False: Nodules in nodular glomerulosclerosis are PAS positive?

Answer 9

TRUE

Question 10

What are nodules surrounded by in nodular glomerulosclerosis?

Answer 10

Patent peripheral capillary loops or loops that are markedly dilated

Question 11

What is seen in advanced nodular glomerulosclerosis?

Answer 11

Enlarged nodules

Question 12

What are 3 consequences of glomerular and arteriolar lesions?

Answer 12

1. Kidney suffers from ischemia
2. Develops tubular atrophy
3. Interstitial fibrosis

Question 13

What does the picture of nodular glomerulosclerosis look like?

Answer 13

Petals on a flower

Question 14

What is an insulinoma?

Answer 14

B-cell tumor

Question 15

True or False: Insulinoma is the most common of pancreatic endocrine neoplasms?

Answer 15

TRUE

Question 16

What happens in an insulinoma that induces clinically significant hypoglycemia?

Answer 16

Elaboration of sufficient insulin

Question 17

What is the clinical picture of an insulinoma?

Answer 17

Hypoglycemia episodes: Blood glucose under 50, CNS manifestations (confusion, stupor, loss of consciousness), precipitated by fasting or exercise (promptly relieved by feeding/parenteral administration of glucose)

Question 18

Describe some characteristics of insulinoma

Answer 18

Benign, solitary, small (under 2 cm), encapsulated, pale to red-brown nodules

Question 19

What % of cases of insulinoma are carcinomas?

Answer 19

10%… local invasion and distant mets

Question 20

What is seen microscopically in an insulinoma?

Answer 20

Giant islets with preservation of regulat cords and preservation of orientation to vasculature

Question 21

What is deposited in extracellular tissue in an insulinoma?

Answer 21

Amyloid

Question 22

What labs are seen with insulinoma?

Answer 22

High circulating levels of insulin

High insulin-to-glucose ratio

Question 23

What is treatment for an insulinoma?

Answer 23

Surgical removal of tumor… followed by prompt reversal of the hypoglycemia

Question 24

What is in the Ddx of insulinoma?

Answer 24

1. Abnormal insulin sensitivity
2. Diffuse liver disease
3. Inherited glycogenoses
4. Ectopic production of insulin (retroperitoneal fibromas and fibrosarcomas)
5. Self-injection of insulin

Question 25

What has a marked hypersecretion of gastrin?

Answer 25

Gastrinoma

Question 26

What is Zollinger-Ellison Syndrome?

Answer 26

1. Pancreatic islet cell lesions 2. Hypersecretion of gastric acid 3. Severe peptic ulceration

Question 27

Where is a gastrinoma located?

Answer 27

Pancreas, peripancreatic region, or wall of duodenum

Question 28

True or False: More than 50% of gastrin-producing tumors are locally invasive and have already metastasized at the time of diagnosis

Answer 28

TRUE

Question 29

Are MEN-1 associated gastrinomas multifocal or single?

Answer 29

Multifocal

Question 30

Are sporadic gastinomas multifocal or single?

Answer 30

Single

Question 31

How is a gastrinoma histologically?

Answer 31

BLAND

Question 32

What do the duodenal and gastric ulcers in gastrinoma look like?

Answer 32

Multiple, but identical to those found in the general population and unresponsive to therapy

Question 33

What is weird about uclers with gastrinoma?

Answer 33

Can occur in weird locations like jejunum

Question 34

If you have intractible jejunal ulcers, what do you have?

Answer 34

ZES

Question 35

What is a big symptom with gastrinoma?

Answer 35

Diarrhea

Question 36

What is treatment of gastinoma?

Answer 36

Control gastric acid secretions using a H, K-ATPase inhbiitor and exision of the neoplasm

Question 37

What shortens life expectancy with gastrinoma?

Answer 37

Hepatic mets...progressive tumor growth and liver failure within 10 years

Question 38

What kind of adenoma is separated from the pancreas by a thin collagenous capsule?

Answer 38

Islet cell adenoma (gastrinoma)