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Endoscopy finding in IPMN?
Mucus extruding through a large, fish-mouth like papillary orifice is virtually diagnostic of IPMNQ
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Treatment of IPMN?
- Partial pancreatectomy: For main duct, symptomatic, and large branch-type IPMNs (>3 cm), or IPMNs with an invasive component
- Observation: For asymptomatic small (<3 cm) branch duct IPMNs without associated nodularity
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MC cystic neoplasmQ of the pancreas?
MCN
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Pathology of mucinous cystic neoplasm?
- • MCNs contain mucin-producing epitheliumQ, macrocystic
- • Histology: Presence of mucin-rich cells and ovarian-like stromaQ
- • Estrogen and progesterone staining are positive in most casesQ
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CT finding of MCN?
Presence of a solitary cyst with fine septations and rim of calcificationQ
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Treatment of Pancreatic MCN?
Pancreatic resection
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Gross appearance of cystic neoplasm of pancreas?
- SCN - Multiple small cysts (microcyst) separated by internal septations with central sunburst calcificationsQ
- MCN - Thick-walled, septated macrocystQ with smooth contour; ± solid component, egg-shell calcificationsQ
- IPMN - Poorly demarcated, lobulated, polycystic mass with dila¬tion of main or branch ductsQ
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Location of cystic neoplasm of pancreas?
- SCN - HeadQ
- MCN - Body and tailQ
- IPMN – HeadQ
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Most common gene mutation associated with pancreatic cancer?
k-rasQ
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Risk factors for pancreatic cancer?
- • Established risk factors: Smoking (Tobacco) and Inherited susceptibility
- • H. pylori colonization, and ABO blood groups – associated with pancreatic carcinoma
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Pathology of pancreatic adenocarcinoma?
- • Macroscopically, ductal adenocarcinoma is a scirrhous (scar forming)Q type of carcinoma
- • It is associated with abundant desmoplastic stromaQ, in which the neoplastic glands are widely scatteredQ
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What is Blumer’s shelfQ?
In peritoneal dissemination, perirectal tumor involvement may be palpable via digital rectal examination
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Tumor markers for PDAC?
CA19-9 (most sensitive)Q and CEA
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MC complication of pancreaticoduodenectomy?
Delayed gastric emptying
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MC cause of death following pancreaticoduodenectomy?
Cardiopulmonary complicationsQ.
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Most important predictor of post-operative survival?
R0 resection.
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Most important margin in pancreaticoduodenectomy?
Retroperitoneal or uncinate margin
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Chemotherapy for metastatic pancreatic cancer?
GemcitabineQ
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Indications for Staging Laparoscopy in pancreatic carcinoma?
- 1. Tumor >3 cm in diameterQ
- 2. Body or tail tumorsQ
- 3. Equivocal findings of metastasis on CTQ
- 4. CA19-9 levels >100 U/mLQ
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What is Trousseau’s syndrome?
Migratory thrombophlebitisQ
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What is Trousseau’s sign?
Carpopedal spasm in hypocalcemiaQ
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What is Troisier’s sign?
Palpable left supraclavicular LN (Virchow’s node) Q
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MC site of primary in Metastatic Tumors to Pancreas?
RCCQ > Malignannt melanoma
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MC site of primary in Metastatic Tumors to Pancreas on autopsy?
MC site of primary: CA lungQ
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Surgery of choice for Pancreatic adenocarcinoma?
- • Pylorus Preserving Pancreaticoduodenectomy (PPPD) or Longmire-Traverso Procedure is the preferred surgery for carcinoma head of pancreasQ.
- • The Whipple procedure is now reserved for situations in which the entire duodenum has to be removed (e.g. in FAP) or where the tumour encroaches on the 1st part of the duodenum or the distal stomach and a PPPD would not achieve a clear resection marginQ.
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Types of Periampullary Carcinoma?
- 1. Adenocarcinoma of head of the pancreas (40-60%)Q – Most common
- 2. Adenocarcinoma of ampulla of vater (10-20%)
- 3. Distal bile duct adenocarcinoma (10%)
- 4. Duodenal adenocarcinoma (5-10%)
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Best prognosis in periampullary carcinoma?
Duodenal adenocarcinoma >Ampullary carcinoma >Distal Bile duct adenocarcinoma >Head of pancreas >Body and tail of Pancreas (DAD Head Body and Tail)Q
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Chemotherapy of choice for GI malignancy?
- • CA Esophagus - ECF (Epirubicin + Cisplatin + 5-FU)Q
- • CA Stomach - ECF (Epirubicin + Cisplatin + 5-FU)Q
- • CA Pancreas - GemcitabineQ
- • NET of pancreas - Streptozocin + 5-FUQ
- • Cholangiocarcinoma - Gemcitabine + CisplatinQ
- • CA GB - Gemcitabine + CisplatinQ
- • Small intestine adenocarcinoma - 5-FUQ
- • Colorectal carcinoma - FOLFOX-IV (5-FU + Leucovorin + Oxaliplatin)Q
- • CA anal canal - Nigro Regimen: Chemoradiation (5-FU + Mitomycin C + Radiation)Q
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