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60 Cards in this Set

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What are the 2 potential benign tumors of the Exocrine Pancreas?
Serous Cystadenoma

Mucinous Cystadenoma
What are the 2 Malignant and Solid tumors of the Exocrine Pancreas?
Ductal Adenocarcinoma

Acinar Cell Carcinoma
What are the 3 Cystic tumors of the Exocrine Pancreas?
Serous Cystadenoma

Mucinous Cystic Neoplasms

Intraductal Papillary Mucinous Neoplasms (IPMNS)
Rare tumors that most frequently occur in females in the 7th decade of life and are almost always benign
Serous Cystadenomas
Describe the microscopic appearance of Serous Cystadenomas
Multiple cysts lined by CUBOIDAL cells with CLEAR, GLYCOGEN-rich cytoplasm
What part of the pancreas are Serous Cystadenomas usually localized?
Body or Tail
Serous Cystadenoma
What pancreatic tumor is this?
Serous Cystadenoma
-multiple cysts
-Cuboidal cells with glycogen-rich cytoplasm
What pancreatic tumor is this?
Serous Cystadenoma
-cuboidal epithelium with clear cytoplasm (glycogen)

Benign
What pancreatic tumor is this?
Benign or Malignant?
Rare pancreatic tumor that occurs almost exclusively in WOMEN and differs from Serous Cystadenoma b/c it can be benign, borderline, or malignant
Mucinous Cystic Neoplasms
Where do Mucinous Cystic Neoplasms usually localize in the pancreas?
Body or Tail
Describe the microscopic appearance of Mucinous Cystic Neoplasms
Cysts lined by COLUMNAR MUCINOUS cells with and associated OVARIAN-LIKE STROMA
With which tumor is complete excision critical: Serous or Mucinous Cystic Neoplasms?
Why?
Mucinous Cystic Neoplasms

They have malignant potential
Mucinous Cystic Neoplasm
-lined by columnar mucinous cells
What pancreatic tumor is this?
Mucinous Cystic Neoplasm
-Columnar smoky white cells
-Ovarian-like stroma
-Goblet-like looking cells
What pancreatic tumor is this?
What features does it have?
Pancreatic tumor that occurs more frequently in MEN and usually is located in the HEAD of the pancreas
Intraductal Papillary Mucinous Neoplasms
Where do Intraductal Papillary Mucinous Neoplasms arise from?

How are they different from Mucinous Cystic Neoplasms?
Main Pancreatic Ducts

Lack Ovarian-like stroma
Intraductal Papillary Mucinous Neoplasm

Main Pancreatic Ducts
What pancreatic tumor is this?

What does it arise from?
Intraductal Papillary Mucinous Neoplasm

**can be benign, borderline, or malignant
What pancreatic tumor is this?
what is the most common tumor of the Pancreas?
Ductal Adenocarcinoma
This is the 4th most common cause of cancer related death
Pancreatic Ductal Adenocarcinoma
Describe the age and gender statistics of Pancreatic Ductal Adenocarcinoma
Tumor of elderly individuals = 60-80 year olds

Male predominance in younger age groups, equal distribution in old age
What is the most common cause of Pancreatic Ductal Adenocarcinoma?
Smoking
What are 6 risks associated with Pancreatic Ductal Adenocarcinoma?
1. Smoking
2. Chemical carcinogens
3. Dietary factors
4. Diabetes Mellitus
5. Chronic Pancreatitis
6. Molecular genetics

**not associated with Alcohol
What 4 genes are associated with Pancreatic Ductal Adenocarcinoma?
1. K-ras
2. p16
3. SMAD4
4. p53
Fill in
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Ductal Adenocarcinoma
What pancreatic tumor is this?
What are 4 clinical presentations of Pancreatic Ductal Adenocarcinoma?
1. gradually increasing upper abdominal pain radiating to the back
2. weight loss, anorexia
3. painless obstructive jaundice = blockage of CBD
4. Migratory thrombophlebitis = Trousseau syndrome
-redness and tenderness on palpation of his extremities
What are 2 tumor markers for Ductal Adenocarcinoma?
CEA & CA19-9
List the 3 most common locations of Pancreatic Ductal Adenocarcinoma
1. Head = 60%
2. Body = 15%
3. Tail = 5%
Pancreatic Ductal Adenocarcinoma

CBD obstruction causing Jaundice
What is seen here?
What can this cause?
Describe the microscopic pathology of Pancreatic Ductal Adenocarcinoma
-Malignant glands lined by anaplastic Cuboidal-to-Columnar epithelial cells and secrete mucin
-highly INVASIVE
-Elicit a DESMOPLASTIC STROMAL rxn
-Perineural invasion is common
Pancreatic Ductal Adenocarcinoma
-tumor is present in the pancreatic duct
What pancreatic tumor is this?
Pancreatic Ductal Adenocarcinoma
-arise from duct epithelium
-stromal fibrosis
What pancreatic tumor is this?
Pancreatic Ductal Adenocarcinoma with PERINEURAL invasion
-causes pain
Describe what you see here
Pancreatic Ductal Adenocarcinoma that is present in the Lymph Node
-blue circles are nodes of Lymphocytes
Describe what this is
Where do Pancreatic Ductal Adenocarcinomas most commonly metastasize to?
Regional Lymph nodes and the LIVER
What is the prognosis of Ductal Adenocarcinoma?

What is the treatment?
Poor: 1 year survival = 10%

Surgical Excision = Whipple procedure

**Early detection is critical
An uncommon pancreatic tumor that is more frequent in MALES than females, age 50-80 years. Grossly well-circumscribed nobular mass with SOFT consistency
Acinar Cell Carcinoma

**Ductal Adenocarcinoma is hard
Acinar Cell Carcinoma
-uniform tumor cells with rich GRANULAR cytoplasm
What pancreatic tumor?
Acinar Cell Carcinoma
-granulocytes containing enzymes
What pancreatic tumor is this? How do you know?
Pancreatic tumor associated with a syndrome characterized by Polyarthralgia-polyarthritis and disseminated fat necrosis (mainly subcutaneous) that is most likely due to unregulated release of pancreatic enzymes
Acinar Cell Carcinoma
Beta cell tumors = 1
Pancreatic Gastrinomas = 2
Alpha cell tumors = 3
Delta cell tumors = 4
D1 tumors = 5
1. Insulinomas
2. Zollinger-Ellison syndrome
3. Glucagonomas
4. Somatostatinomas
5. VIPomas
Most common of the Islet Cell tumors (75%)
Insulinomas
Where do most Insulinomas occur in the Pancreas?
Body or Tail
Are most Insulinomas benign or malignant?
Benign
What are the 3 unequivocal criteria for Insulinomas to be considered malignant?
1. metastases to regional lymph nodes or distant organs
2. Vascular invasion
3. Gross invasion of adjacent organs
What is the triad called in Insulinomas and what does it consist of?
Whipple's Triad
1. Hypoglycemia (<50 mg/dl)
2. Symptoms of Hypoglycemia: confusion, lethargy, sweating, tachycardia, tremor
3. Symptoms relieved by glucose intake

**too much insulin causes Glucose to be stored
Second most common Islet cell tumor
Pancreatic Gastrinoma = Zollinger-Ellison Syndrome
Describe Pancreatic Gastrinoma (Zollinger-Ellison Syndrome)
G cells in the Pancreas (not normal in Islets) that secrete Gastrin
-cause Parietal cells in the stomach to release HCl
-intractable Stomach hypersecretion
-Severe, multiple Peptic Ulcers (unusual sites)
-high levels of Gastrin in the blood
Describe the age and gender predominances of Zollinger-Ellison Syndrome
Most common between ages 30 and 50

MALE predominance
Are the majority of Pancreatic Gastrinomas benign or malignant?
MALIGNANT
Describe Multiple Endocrine Neoplasia Syndrome Type 1 (MEN type 1)
3 P's:

Adenomas in the Pituitary, Parathyroid, and endocrine Pancreas

**infrequent familial disorder
What is MEN type 1 frequently associated with?
Zollinger-Ellison Syndrome
How would you decipher between exogenous Insulin and Insulin overproduced by an Insulinoma?
C-peptide marker is present in Insulinomas but absent in exogenous Insulin (removed during the purification of commercial insulin preps)
Islet cell tumor that may cause Mild Diabetes and Hyperglycemia
Glucagonoma

*Glucagon causes an increase in Blood glucose
What characteristic lesion is associated with Glucagonoma?
Necrotizing Migratory Erythema

*Anemia may also occur
**Hyperglycemia may occur as well
Describe the symptoms of VIPoma
WDHA syndrome:
1. Water Diarrhea
2. Hypokalemia
3. Achlorohydria
Insulinoma
What pancreatic tumor is this?