Pathology - S2B2 - Pancreas 2

Front 1

Label

Back 1

-

Front 2

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

Back 2

Serous Cystadenoma

Mucinous Cystadenoma

Front 3

What are the 2 Malignant and Solid tumors of the Exocrine Pancreas?

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Ductal Adenocarcinoma

Acinar Cell Carcinoma

Front 4

What are the 3 Cystic tumors of the Exocrine Pancreas?

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Serous Cystadenoma

Mucinous Cystic Neoplasms

Intraductal Papillary Mucinous Neoplasms (IPMNS)

Front 5

Rare tumors that most frequently occur in females in the 7th decade of life and are almost always benign

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Serous Cystadenomas

Front 6

Describe the microscopic appearance of Serous Cystadenomas

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Multiple cysts lined by CUBOIDAL cells with CLEAR, GLYCOGEN-rich cytoplasm

Front 7

What part of the pancreas are Serous Cystadenomas usually localized?

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Body or Tail

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Serous Cystadenoma

Back 8

What pancreatic tumor is this?

Front 9

Serous Cystadenoma
-multiple cysts
-Cuboidal cells with glycogen-rich cytoplasm

Back 9

What pancreatic tumor is this?

Front 10

Serous Cystadenoma
-cuboidal epithelium with clear cytoplasm (glycogen)

Benign

Back 10

What pancreatic tumor is this?
Benign or Malignant?

Front 11

Rare pancreatic tumor that occurs almost exclusively in WOMEN and differs from Serous Cystadenoma b/c it can be benign, borderline, or malignant

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Mucinous Cystic Neoplasms

Front 12

Where do Mucinous Cystic Neoplasms usually localize in the pancreas?

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Body or Tail

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Describe the microscopic appearance of Mucinous Cystic Neoplasms

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Cysts lined by COLUMNAR MUCINOUS cells with and associated OVARIAN-LIKE STROMA

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With which tumor is complete excision critical: Serous or Mucinous Cystic Neoplasms?
Why?

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Mucinous Cystic Neoplasms

They have malignant potential

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Mucinous Cystic Neoplasm
-lined by columnar mucinous cells

Back 15

What pancreatic tumor is this?

Front 16

Mucinous Cystic Neoplasm
-Columnar smoky white cells
-Ovarian-like stroma
-Goblet-like looking cells

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What pancreatic tumor is this?
What features does it have?

Front 17

Pancreatic tumor that occurs more frequently in MEN and usually is located in the HEAD of the pancreas

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Intraductal Papillary Mucinous Neoplasms

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Where do Intraductal Papillary Mucinous Neoplasms arise from?

How are they different from Mucinous Cystic Neoplasms?

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Main Pancreatic Ducts

Lack Ovarian-like stroma

Front 19

Intraductal Papillary Mucinous Neoplasm

Main Pancreatic Ducts

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What pancreatic tumor is this?

What does it arise from?

Front 20

Intraductal Papillary Mucinous Neoplasm

**can be benign, borderline, or malignant

Back 20

What pancreatic tumor is this?

Front 21

what is the most common tumor of the Pancreas?

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Ductal Adenocarcinoma

Front 22

This is the 4th most common cause of cancer related death

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Pancreatic Ductal Adenocarcinoma

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Describe the age and gender statistics of Pancreatic Ductal Adenocarcinoma

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Tumor of elderly individuals = 60-80 year olds

Male predominance in younger age groups, equal distribution in old age

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What is the most common cause of Pancreatic Ductal Adenocarcinoma?

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Smoking

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What are 6 risks associated with Pancreatic Ductal Adenocarcinoma?

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1. Smoking
2. Chemical carcinogens
3. Dietary factors
4. Diabetes Mellitus
5. Chronic Pancreatitis
6. Molecular genetics

**not associated with Alcohol

Front 26

What 4 genes are associated with Pancreatic Ductal Adenocarcinoma?

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1. K-ras
2. p16
3. SMAD4
4. p53

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Fill in

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-

Front 28

Ductal Adenocarcinoma

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What pancreatic tumor is this?

Front 29

What are 4 clinical presentations of Pancreatic Ductal Adenocarcinoma?

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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

Front 30

What are 2 tumor markers for Ductal Adenocarcinoma?

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CEA & CA19-9

Front 31

List the 3 most common locations of Pancreatic Ductal Adenocarcinoma

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1. Head = 60%
2. Body = 15%
3. Tail = 5%

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Pancreatic Ductal Adenocarcinoma

CBD obstruction causing Jaundice

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What is seen here?
What can this cause?

Front 33

Describe the microscopic pathology of Pancreatic Ductal Adenocarcinoma

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-Malignant glands lined by anaplastic Cuboidal-to-Columnar epithelial cells and secrete mucin
-highly INVASIVE
-Elicit a DESMOPLASTIC STROMAL rxn
-Perineural invasion is common

Front 34

Pancreatic Ductal Adenocarcinoma
-tumor is present in the pancreatic duct

Back 34

What pancreatic tumor is this?

Front 35

Pancreatic Ductal Adenocarcinoma
-arise from duct epithelium
-stromal fibrosis

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What pancreatic tumor is this?

Front 36

Pancreatic Ductal Adenocarcinoma with PERINEURAL invasion
-causes pain

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Describe what you see here

Front 37

Pancreatic Ductal Adenocarcinoma that is present in the Lymph Node
-blue circles are nodes of Lymphocytes

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Describe what this is

Front 38

Where do Pancreatic Ductal Adenocarcinomas most commonly metastasize to?

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Regional Lymph nodes and the LIVER

Front 39

What is the prognosis of Ductal Adenocarcinoma?

What is the treatment?

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Poor: 1 year survival = 10%

Surgical Excision = Whipple procedure

**Early detection is critical

Front 40

An uncommon pancreatic tumor that is more frequent in MALES than females, age 50-80 years. Grossly well-circumscribed nobular mass with SOFT consistency

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Acinar Cell Carcinoma

**Ductal Adenocarcinoma is hard

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Acinar Cell Carcinoma
-uniform tumor cells with rich GRANULAR cytoplasm

Back 41

What pancreatic tumor?

Front 42

Acinar Cell Carcinoma
-granulocytes containing enzymes

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What pancreatic tumor is this? How do you know?

Front 43

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

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Acinar Cell Carcinoma

Front 44

Beta cell tumors = 1
Pancreatic Gastrinomas = 2
Alpha cell tumors = 3
Delta cell tumors = 4
D1 tumors = 5

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1. Insulinomas
2. Zollinger-Ellison syndrome
3. Glucagonomas
4. Somatostatinomas
5. VIPomas

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Most common of the Islet Cell tumors (75%)

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Insulinomas

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Where do most Insulinomas occur in the Pancreas?

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Body or Tail

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Are most Insulinomas benign or malignant?

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Benign

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What are the 3 unequivocal criteria for Insulinomas to be considered malignant?

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1. metastases to regional lymph nodes or distant organs
2. Vascular invasion
3. Gross invasion of adjacent organs

Front 49

What is the triad called in Insulinomas and what does it consist of?

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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

Front 50

Second most common Islet cell tumor

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Pancreatic Gastrinoma = Zollinger-Ellison Syndrome

Front 51

Describe Pancreatic Gastrinoma (Zollinger-Ellison Syndrome)

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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

Front 52

Describe the age and gender predominances of Zollinger-Ellison Syndrome

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Most common between ages 30 and 50

MALE predominance

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Are the majority of Pancreatic Gastrinomas benign or malignant?

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MALIGNANT

Front 54

Describe Multiple Endocrine Neoplasia Syndrome Type 1 (MEN type 1)

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3 P's:

Adenomas in the Pituitary, Parathyroid, and endocrine Pancreas

**infrequent familial disorder

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What is MEN type 1 frequently associated with?

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Zollinger-Ellison Syndrome

Front 56

How would you decipher between exogenous Insulin and Insulin overproduced by an Insulinoma?

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C-peptide marker is present in Insulinomas but absent in exogenous Insulin (removed during the purification of commercial insulin preps)

Front 57

Islet cell tumor that may cause Mild Diabetes and Hyperglycemia

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Glucagonoma

*Glucagon causes an increase in Blood glucose

Front 58

What characteristic lesion is associated with Glucagonoma?

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Necrotizing Migratory Erythema

*Anemia may also occur
**Hyperglycemia may occur as well

Front 59

Describe the symptoms of VIPoma

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WDHA syndrome:
1. Water Diarrhea
2. Hypokalemia
3. Achlorohydria

Front 60

Insulinoma

Back 60

What pancreatic tumor is this?