Three key tissue components of a normal pancreas are: ____, ____ and ____.
- Acini (glands): produce digestive enzymes
- Islets: produce endocrine products
- Ductal system: drains acrinar products
How do you remember the main categories of diseases?
Hint: memory techniques.
What is the key pathophysiology of the acute pancreatitis?
Answer: Injuries >>Autodigestion.
What are the two main types of acute pancreatitis?
Answer: Hemorrhagic and Interstitial.
Name top four features of autoimmune pancreatitis.
- Markedly elevated serum level of IgG4.
- IgG4+ plasma cell-rich inflammation.
- Phlebitis & prominent fibrosis.
- Prompt resolution upon steroid therapy
The following are histological features of __________:
Tissue necrosis with saponification.
Answer: Hemorrhagic acute pancreatitis.
What are the two major categories of epithelial tumor of the pancrease?
Epithelial tumor: 1. Exocrine tumors.and 2. Endocrine tumors.
What are the major types of exocrine tumor of the pancrease?
- Ductal adenocarcinoma
- Mucinous tumors
- Acinar cell carcinoma
- Solid pseudopapillary tumor
What are the key features of microcystic serous cystadenoma?
- Tail (& body) of the pancreas
- Cystic spaces
- Bland cytology
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
The followings are typical of _______________ of the pancreas:
Head of the pancreas
Cyst(s) with mucoid content
Mucus epithelial lining
Communicate to ductal tree
Answer: Pancreatic intraductal papillary mucinous neoplasm.
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
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.
What are the key morphological features of pancreatic acinar cell carcinoma?
- 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.
What are the key features of pancreatoblastoma?
- Mostly children < 10 years of age
- Large abdominal multinodular mass
- Heterogeneous cellular components.
- Squamoid nests
- Fibrous bands
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
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
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%).
What does MEN-II (Sipple’s syndrome) include?
- Medullar thyroid carcinoma
- Parathyroid adenomas or hyperplasia.
- Adrenal pheochromocytoma
- (No pancreatic islet cell tumors)
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).
What are the key histological changes in chronic cholecystitis?
- Muscular hypertrophy.
- Rokitansky-Aschoff sinuses
- Inflammatory cells