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2012-09-13 20:48:52
pathology pancreas ZQu essential

MS lecture note
Show Answers:

  1. Three key tissue components of a normal pancreas are: ____, ____ and ____.
    • Answer:
    • Acini (glands): produce digestive enzymes
    • Islets: produce endocrine products
    • Ductal system: drains acrinar products
  2. How do you remember the main categories of diseases?
    Hint: memory techniques.
  3. What is the key pathophysiology of the  acute pancreatitis?
    Answer: Injuries >>Autodigestion.
  4. What are the two main types of acute pancreatitis?
    Answer: Hemorrhagic and Interstitial.
  5. Name top four features of autoimmune pancreatitis.
    • Answer:
    • Markedly elevated serum level of IgG4.
    • IgG4+ plasma cell-rich inflammation.
    • Phlebitis & prominent fibrosis.
    • Prompt resolution upon steroid therapy
  6. The following are histological features of __________:
    Tissue necrosis with saponification.
    Extensive hemorrhage.
    Neutrophils (PMNs).
    Answer: Hemorrhagic acute pancreatitis.
  7. What are the two major categories of epithelial tumor of the pancrease?
    Epithelial tumor: 1. Exocrine tumors.and 2. Endocrine tumors.
  8. What are the major types of exocrine tumor of the pancrease?
    • Ductal adenocarcinoma
    • Mucinous tumors
    • Acinar cell carcinoma
    • Solid pseudopapillary tumor
    • Pancreatoblastoma
  9. What are the key features of microcystic serous cystadenoma?
    • Elderly
    • Feamale
    • Tail (& body) of the pancreas
    • Cystic spaces
    • Bland cytology
  10. What are the key features of pancreatic mucinous cystadenoma?
    • Middle-aged women
    • Body & tail of the pancreas
    • Cyst(s) with mucoid content
    • Mucus epithelial lining
    • Cellular spindle cells ("ovarian") stroma
  11. The followings are typical of _______________ of the pancreas:
    Head of the pancreas
    Cyst(s) with mucoid content
    Mucus epithelial lining
    Intraluminal growth
    Communicate to ductal tree
    Answer: Pancreatic intraductal papillary mucinous neoplasm.
  12. What are the key morphological features of pancreatic ductal adenocarcinoma?
    • Poorly defined mass with destruction growth
    • Loss of normal lobules and components.
    • Atypical ducts, acini, solid nests or cords
    • Dense fibrous stroma.
    • Cytological atypia, pleomophism, mitosis etc.
    • Perinueral invasion
  13. Which pancreatic tumor has the follow features?
    Uncommon: 1% of pancreatic neoplasms
    Predominantly young women
    A large, usually asymptomatic abdominal mass
    Low malignant potential
    Answer: Solid pseudopapillary tumor.
  14. What are the key morphological features of pancreatic acinar cell carcinoma?
    • Hypercellularity
    • Paucity of fibrous stroma
    • Acinar and solid (sheet) patterns
    • Uniform nuclei with single large central nucleolus
    • Frequent mitoses
    • PAS+, diastaseresistant ranules
    • Positive for trypsin, lipase, chymotrypsin or elastase.
  15. What are the key features of pancreatoblastoma?
    • Mostly children < 10 years of age
    • Large abdominal multinodular mass
    • Heterogeneous cellular components.
    • Squamoid nests
    • Fibrous bands
  16. What are the key features of insulinoma of the pancreas?
    • Most common islet tumor.
    • Whipple triad.
    • Over-produces insulin à hyperinsulinimia.
    • > 90% solitary; 10% are malignant.
    • In children: nesidioblastosis
  17. What are the features of gastrinoma of the pancreas?
    • Leads to gastric hyperacidity -> GI ulcers
    • 23% in duodenum
    • Zollinger-Ellison syndrome.
    • Can be part of MEN-I
  18. What does MEN   I (Wermer’s Syndrome) include?
    • Pancreatic islet cell tumors (75%).
    • Pituitary adenomas (60%).
    • Parathyroid adenomas or hyperplasia (90%).
    • Adrenocortical adenomas or hyperplasia (37%).
  19. What does MEN-II (Sipple’s syndrome) include?
    • Medullar thyroid carcinoma
    • Parathyroid adenomas or hyperplasia.
    • Adrenal pheochromocytoma
    • (No pancreatic islet cell tumors)
  20. What is each of the following gallstone associated with?
         - Cholesterol stone
         - Black stone.
         - Brown stone.
    • Cholesterol stone: obesity, hypercholestranemia.
    • Black stone: chronic hemolytic anemia.
    • Brown stone: biliary bacterial infection (esp. E. coli).
  21. What are the key histological changes in chronic cholecystitis?
    • Muscular hypertrophy.
    • Rokitansky-Aschoff sinuses
    • Inflammatory cells
    • (Gallstone)