p.65
Epidemiology and Inheritance
What is the strongest environmental influence on pancreatic carcinoma risk?
Cigarette smoking, which doubles the risk.
What can chronic pancreatitis lead to regarding digestion?
Malabsorption of nutrients.
What are the two main causes of acute pancreatitis in Western countries?
Biliary tract disease and alcoholism.
p.71
Diagnosis and Treatment of Pancreatic Cancer
What margins are examined during the resection of pancreatic cancer?
Pancreatic neck margin, Portal Vein Groove, Uncinate Margin, Peripancreatic fat margin, Common bile duct margin, Peri pancreatic lymph nodes.
What is notable about the mortality rate of pancreatic carcinoma?
It has one of the highest mortality rates of any cancer.
p.66
Molecular Alterations in Pancreatic Cancer
Who is Erasmus Darwin in relation to Charles Darwin?
He was Charles Darwin's grandfather.
p.58
Diagnosis and Treatment of Pancreatic Cancer
What is the typical prognosis for pancreatic cancer?
Generally poor, with a low five-year survival rate.
What is a common characteristic of autoimmune pancreatitis?
It often presents with a mass-forming lesion in the pancreas.
What is autoimmune pancreatitis?
A chronic pancreatitis associated with IgG4-secreting plasma cells in the pancreas.
What is a key morphological feature of acute pancreatitis related to blood vessels?
Destruction of blood vessels and interstitial hemorrhage.
p.60
Molecular Alterations in Pancreatic Cancer
What type of alterations are found in PanIN that are similar to invasive cancers?
Genetic and epigenetic alterations.
What are hereditary factors in pancreatitis?
Genetic predispositions that increase the risk of developing pancreatitis.
p.36
Cystic Neoplasms of the Pancreas
What is a key feature of IPMNs regarding duct involvement?
They involve the main pancreatic duct and extend into smaller ducts and ductules.
p.49
Cystic Neoplasms of the Pancreas
Is it possible to distinguish intermediate atypia in cytology?
No, it is not possible to distinguish intermediate (moderate) atypia in cytology.
What type of pancreatitis involves the destruction of pancreatic parenchyma?
Acute necrotizing pancreatitis.
p.88
Pathogenesis of Pancreatitis
What pancreatic pathology is associated with Type 1 Diabetes?
Reduction in size and number of islets.
What is a hallmark of severe pancreatitis?
Fat necrosis and saponification.
What is acute pancreatitis?
A sudden inflammation of the pancreas.
What is the primary cause of Alcoholic Chronic Pancreatitis?
Chronic alcohol consumption.
p.58
Molecular Alterations in Pancreatic Cancer
What are some risk factors associated with pancreatic cancer?
Smoking, obesity, diabetes, and family history.
p.16
Pathogenesis of Pancreatitis
How does Alcoholic Chronic Pancreatitis affect digestion?
It impairs the pancreas's ability to produce digestive enzymes.
p.88
Pathogenesis of Pancreatitis
What are some long-term complications of Diabetes Mellitus?
Complications involving blood vessels, kidneys, eyes, and nerves.
p.79
Clinical Features of Pancreatitis
What are the circulating levels of insulin in affected patients?
High circulating levels of insulin and a high insulin-to-glucose ratio.
What autoimmune factors may be involved in chronic pancreatitis?
It may manifest as a systemic or localized autoimmune etiology.
p.28
Pathogenesis of Pancreatitis
When do pseudocysts typically arise?
Following a bout of acute pancreatitis, especially on top of chronic alcoholic pancreatitis.
p.54
Cystic Neoplasms of the Pancreas
What age group is most commonly affected by Solid Pseudo-papillary Tumors?
Young women, usually in their 20s and 30s.
p.55
Endocrine Neoplasms and Hormonal Syndromes
What is the significance of the number 53 in relation to FNA of the pancreas?
It may refer to a specific case or classification related to neuroendocrine tumors.
p.56
Diagnosis and Treatment of Pancreatic Cancer
What is the significance of the number 54 in the context of FNA pancreas?
It may refer to a specific case or classification, but further context is needed.
What can happen to pseudocysts over time?
They can spontaneously resolve or become secondarily infected.
p.71
Diagnosis and Treatment of Pancreatic Cancer
What is the initial treatment for patients with localized pancreatic cancer?
Pre-operative chemotherapy.
p.1
Pathogenesis of Pancreatitis
Who is the author of the pathology of the pancreas content?
Fadi W. Abdul-Karim MD MEd.
p.62
Molecular Alterations in Pancreatic Cancer
What significant cellular change occurs in the epithelial cells of PanIN?
Dramatic telomere shortening.
Who in President J. Carter's family died from pancreatic carcinoma?
His father, two sisters, and one brother.
p.32
Cystic Neoplasms of the Pancreas
What is observed in a cross-section of a serous cystic neoplasm?
Only a thin rim of normal pancreatic parenchyma remains.
p.53
Diagnosis and Treatment of Pancreatic Cancer
What does EUS/FNA stand for?
Endoscopic Ultrasound with Fine Needle Aspiration.
p.56
Cystic Neoplasms of the Pancreas
What type of tumor is associated with the pancreas in FNA?
Neuroendocrine tumor (Islet cell tumor).
p.79
Clinical Features of Pancreatitis
What is the nature of hypoglycemia in 20% of cases?
Mild hypoglycemia, and many cases are asymptomatic.
p.30
Cystic Neoplasms of the Pancreas
What are cystic neoplasms?
Diverse tumors ranging from harmless benign cysts to precursors of invasive cancers.
What is the gross appearance of the pancreas in chronic pancreatitis?
Firm gross appearance with calcification.
p.44
Diagnosis and Treatment of Pancreatic Cancer
From which organs can metastases to the pancreas occur?
Breast, colon, kidney, esophagus, and ovary.
p.79
Clinical Features of Pancreatitis
What is the effect of surgical removal of the tumor?
It results in the reversal of hypoglycemia.
What are common causes of acute pancreatitis?
Gallstones and chronic and excessive alcohol consumption.
p.61
Molecular Alterations in Pancreatic Cancer
What is a common precursor to pancreatic carcinoma?
Pancreatic intraepithelial neoplasia (PanIN).
p.54
Cystic Neoplasms of the Pancreas
What is a characteristic feature of Solid Pseudo-papillary Tumors?
They often have a solid and cystic appearance on imaging.
p.70
Clinical Features of Pancreatitis
What is a common characteristic of pancreatic cancer in its early stages?
It may remain silent until it invades adjacent structures.
p.16
Clinical Features of Pancreatitis
What are common symptoms of Alcoholic Chronic Pancreatitis?
Abdominal pain, weight loss, and diarrhea.
What is the primary difference between acute and chronic pancreatitis?
Acute pancreatitis is a sudden inflammation that lasts for a short time, while chronic pancreatitis is a long-lasting inflammation that can lead to permanent damage.
p.34
Cystic Neoplasms of the Pancreas
What type of epithelium lines the cysts in pancreatic mucinous cystic neoplasms?
Columnar mucinous epithelium.
What is the role of familial history in pancreatitis?
A family history of pancreatitis can indicate a higher risk for individuals.
p.54
Cystic Neoplasms of the Pancreas
What is a Solid Pseudo-papillary Tumor?
A rare pancreatic tumor that typically occurs in young women.
p.88
Pathogenesis of Pancreatitis
What pancreatic pathology is associated with chronic inflammation?
Chronic inflammation of islets.
p.77
Molecular Alterations in Pancreatic Cancer
What is the role of the mTOR signaling pathway in cancer?
It is an oncogenic pathway activated by loss-of-function mutations in tumor suppressor genes.
What is the prevalence of chronic pancreatitis?
Between 0.04% and 5%; most affected patients are middle-aged males.
p.75
Cystic Neoplasms of the Pancreas
What do pancreatic endocrine neoplasms often elaborate?
Pancreatic hormones, or they may be nonfunctional.
p.54
Cystic Neoplasms of the Pancreas
What is the typical prognosis for patients with Solid Pseudo-papillary Tumors?
Generally favorable, with a good chance of surgical cure.
p.61
Cystic Neoplasms of the Pancreas
What is the significance of mucinous cystic neoplasms in relation to pancreatic cancer?
They are considered precursors to pancreatic carcinoma.
p.1
Pathogenesis of Pancreatitis
What are the main conditions discussed in the pathology of the pancreas?
Pancreatitis, Pancreatic Cysts, and Pancreatic Cancer.
p.58
Clinical Features of Pancreatitis
What is a common symptom of pancreatic cancer?
Jaundice, weight loss, and abdominal pain.
p.62
Molecular Alterations in Pancreatic Cancer
What may critical shortening of telomere length in PanIN lead to?
Accumulation of progressive chromosomal abnormalities and development of invasive carcinoma.
p.42
Cystic Neoplasms of the Pancreas
Are serous cystic neoplasms typically benign or malignant?
Virtually all serous cystic neoplasms are benign.
p.49
Cystic Neoplasms of the Pancreas
What grading scheme is recommended for atypia in cysts?
A 2-tier grading scheme: high grade and low grade atypia.
What happens to the exocrine tissue in chronic pancreatitis?
Exocrine atrophy occurs, while often islets are spared.
p.40
Diagnosis and Treatment of Pancreatic Cancer
What is the primary focus of the diagnostic workup for pancreatic neoplasms?
To identify the presence and type of pancreatic tumors.
What is a key characteristic of pancreatic pseudocysts?
They are not true cysts and lack an epithelial lining.
p.35
Cystic Neoplasms of the Pancreas
What are intraductal papillary mucinous neoplasms (IPMNs)?
Mucin-producing neoplasms that involve the larger ducts of the pancreas.
p.53
Diagnosis and Treatment of Pancreatic Cancer
Why is EUS/FNA preferred for diagnosing pancreatic adenocarcinoma?
It allows for precise sampling of pancreatic lesions.
What are the symptoms of chronic pancreatitis?
Abdominal pain, weight loss, and digestive problems.
p.43
Diagnosis and Treatment of Pancreatic Cancer
What is the purpose of Endoscopic Ultrasound Guided Biopsy (EUS)?
To perform fine needle aspiration cytology of lesions in the pancreas, lymph nodes, or liver.
p.61
Molecular Alterations in Pancreatic Cancer
What role do genetic mutations play in pancreatic carcinoma?
They contribute to the development of precursors like PanIN.
p.35
Cystic Neoplasms of the Pancreas
What is a critical aspect of managing IPMNs?
Early detection is critical as they can progress to invasive cancer.
p.77
Molecular Alterations in Pancreatic Cancer
What does the presence of mutations in ATRX or DAXX suggest about their function?
They function in a critical common pathway.
What leads to chronic pancreatitis?
Repeated episodes of acinar cell injury.
p.46
Diagnosis and Treatment of Pancreatic Cancer
What does US-FNA stand for?
Ultrasound-guided Fine Needle Aspiration.
p.22
Clinical Features of Pancreatitis
What is required for the diagnosis of chronic pancreatitis?
A high degree of suspicion.
What role do gallstones play in acute pancreatitis?
They can block the pancreatic duct, leading to inflammation.
What occurs during fat necrosis in acute pancreatitis?
Pancreatic enzymes digest the fat around the pancreas.
p.62
Cystic Neoplasms of the Pancreas
What is Pancreatic intraepithelial neoplasia grade 3 (PanIN-3)?
A precancerous lesion involving a small pancreatic duct.
p.1
Pathogenesis of Pancreatitis
Which institutions is Fadi W. Abdul-Karim associated with?
CWRU/Cleveland Clinic Lerner College of Medicine and University of Balamand.
What are the noninvasive precursor lesions for pancreatic carcinoma called?
Pancreatic intraepithelial neoplasia (PanIN).
p.49
Cystic Neoplasms of the Pancreas
What is necessary to evaluate for atypia in cysts?
The presence of epithelium.
p.85
Endocrine Neoplasms and Hormonal Syndromes
What is the primary purpose of performing FNA on the pancreas?
To obtain tissue samples for diagnosis.
p.42
Cystic Neoplasms of the Pancreas
What are intraductal papillary mucinous neoplasms and mucinous cystic neoplasms?
They are curable noninvasive cystic neoplasms that can progress to incurable invasive carcinoma.
What are the common causes of chronic pancreatitis?
Repeated bouts of acute pancreatitis, chronic alcohol use, and germline mutations in genes like CFTR.
What is chronic pancreatitis?
A long-lasting inflammation of the pancreas that alters its normal structure and functions.
p.53
Diagnosis and Treatment of Pancreatic Cancer
What is the primary purpose of EUS/FNA in relation to pancreatic cancer?
To obtain tissue samples for diagnosis.
What is the significance of the number 50 in relation to adenocarcinoma?
It may refer to age or a statistic, but context is unclear.
p.48
Cystic Neoplasms of the Pancreas
What is a characteristic feature of Mucinous Cystic Neoplasms?
They contain mucin and are typically found in the pancreas.
What are the islets of Langerhans responsible for?
They contain beta cells that produce insulin.
p.12
Clinical Features of Pancreatitis
What are the clinical features of acute pancreatitis?
Acute abdominal pain, systemic inflammatory response syndrome, and elevated serum lipase and amylase levels.
How can pancreatic pseudocysts be diagnosed?
Through imaging techniques such as ultrasound or CT scans.
What are the consequences of acute pancreatitis?
Activation of the clotting cascade, inflammation, vascular injury, and edema.
p.27
Cystic Neoplasms of the Pancreas
What type of epithelium is found in congenital pancreatic cysts?
Glistening, uniform cuboidal epithelium or a flattened and attenuated cell layer.
p.46
Diagnosis and Treatment of Pancreatic Cancer
What is a common method for procuring cytologic specimens for pancreatic cancer diagnosis?
Percutaneous FNA or core biopsy.
p.40
Diagnosis and Treatment of Pancreatic Cancer
Why is a biopsy important in the diagnostic workup of pancreatic neoplasms?
To confirm the diagnosis and determine the type of tumor.
p.36
Cystic Neoplasms of the Pancreas
What does a cross-section of the pancreas reveal in cases of IPMNs?
A prominent papillary neoplasm distending the main pancreatic duct.
p.86
Endocrine Neoplasms and Hormonal Syndromes
What type of tumors can be assessed using FNA of the pancreas?
Neuroendocrine tumors (NET).
p.32
Cystic Neoplasms of the Pancreas
What is the size and appearance of cysts in serous cystic neoplasms?
The cysts are relatively small and contain clear, straw-colored fluid.
p.85
Endocrine Neoplasms and Hormonal Syndromes
What is a characteristic feature of Neuroendocrine Tumors (NET) in the pancreas?
They can produce hormones.
p.48
Cystic Neoplasms of the Pancreas
What does EUS/FNA stand for?
Endoscopic Ultrasound/Fine Needle Aspiration.
What is the term for pancreatitis that results in significant bleeding?
Hemorrhagic pancreatitis.
p.38
Molecular Alterations in Pancreatic Cancer
What pathway is hyperactivated in solid-pseudopapillary neoplasms?
The Wnt signaling pathway.
p.23
Clinical Features of Pancreatitis
What are the clinical features of chronic pancreatitis?
Intermittent or persistent abdominal pain, intestinal malabsorption, and diabetes.
p.79
Clinical Features of Pancreatitis
What are some other causes of hypoglycemia?
Abnormal insulin sensitivity, diffuse liver disease, inherited glycogenosis, ectopic insulin production, self-injection of insulin, and hyperplasia of the islets.
How does chronic pancreatitis affect digestion?
It can lead to malabsorption of nutrients due to insufficient digestive enzymes.
p.40
Diagnosis and Treatment of Pancreatic Cancer
What is the significance of tumor markers in pancreatic neoplasms?
They help in monitoring treatment response and disease progression.
What type of enzymes do Acinar Cell Carcinomas produce?
Exocrine enzymes such as trypsin and lipase.
p.54
Cystic Neoplasms of the Pancreas
What is the common treatment for Solid Pseudo-papillary Tumors?
Surgical resection is the primary treatment.
What is the primary treatment for acute pancreatitis?
Supportive care, including fasting, hydration, and pain management.
What typically happens to acinar cell mass after acute pancreatitis?
Complete resolution occurs with restoration of acinar cell mass.
p.70
Clinical Features of Pancreatitis
What are common systemic symptoms of pancreatic cancer?
Weight loss, anorexia, generalized malaise, and weakness.
p.65
Epidemiology and Inheritance
What dietary factor is implicated in pancreatic carcinoma risk?
A diet rich in fats, though less consistently.
What is the gender incidence for Mixed Acinar-Neuroendocrine Carcinoma?
Men more often than women.
p.82
Endocrine Neoplasms and Hormonal Syndromes
What does brown immunostaining indicate in islet cell tumors?
It indicates that the tumor is making gastrin.
What is the rank of pancreatic carcinoma in cancer deaths in the United States?
Fourth leading cause, after lung, colon, and breast cancers.
p.71
Diagnosis and Treatment of Pancreatic Cancer
What indicates that pancreatic cancer is localized?
No lymph node or liver metastasis.
p.66
Molecular Alterations in Pancreatic Cancer
What term did Erasmus Darwin use to describe pancreatic cancer?
Scirrhous of the pancreas.
p.36
Cystic Neoplasms of the Pancreas
What are intraductal papillary mucinous neoplasms (IPMNs)?
Cystic neoplasms that distend the main pancreatic duct.
p.32
Cystic Neoplasms of the Pancreas
What is a serous cystic neoplasm?
A type of cystic neoplasm also known as serous cystadenoma.
p.34
Cystic Neoplasms of the Pancreas
What type of neoplasm is characterized by low-grade dysplasia in the pancreas?
Pancreatic mucinous cystic neoplasm.
p.34
Cystic Neoplasms of the Pancreas
What is observed in a cross-section of a mucinous multiloculated cyst in the pancreas?
Large cysts filled with tenacious mucin.
p.16
Pathogenesis of Pancreatitis
What is a significant risk factor for developing Alcoholic Chronic Pancreatitis?
Heavy and prolonged alcohol use.
What is a key diagnostic marker for autoimmune pancreatitis?
Elevated serum IgG4 levels.
How can genetics influence pancreatitis?
Certain genetic mutations can lead to conditions that cause pancreatitis.
p.81
Endocrine Neoplasms and Hormonal Syndromes
What is the status of more than half of gastrin-producing tumors at the time of diagnosis?
They are locally invasive or have already metastasized.
How can germline mutations contribute to chronic pancreatitis?
Particularly when combined with environmental stressors.
What are the symptoms of acute pancreatitis?
Severe abdominal pain, nausea, vomiting, and fever.
p.48
Cystic Neoplasms of the Pancreas
What type of neoplasm is associated with EUS/FNA?
Mucinous Cystic Neoplasm.
p.12
Pathogenesis of Pancreatitis
What are common causes of acute pancreatitis?
Excessive alcohol intake, pancreatic duct obstruction, genetic factors, traumatic injuries, medications, infections, metabolic disorders, and ischemia.
p.40
Diagnosis and Treatment of Pancreatic Cancer
Which imaging techniques are commonly used in the diagnosis of pancreatic neoplasms?
CT scans, MRI, and ultrasound.
What is the primary effect of acute pancreatitis on the pancreas?
It causes inflammation and damage to the pancreas.
What causes duct obstruction in chronic pancreatitis?
Obstruction by protein plugs.
p.75
Cystic Neoplasms of the Pancreas
How do pancreatic neuroendocrine tumors resemble carcinoid tumors?
They can be single or multiple and can be benign or malignant.
p.76
Endocrine Neoplasms and Hormonal Syndromes
What are unequivocal criteria for malignancy in pancreatic endocrine neoplasms?
Metastases, vascular invasion, and local infiltration.
p.28
Pathogenesis of Pancreatitis
What can also lead to the formation of pseudocysts?
Traumatic injury to the pancreas.
How does chronic pancreatitis affect digestion?
It can lead to malabsorption of nutrients due to insufficient digestive enzymes.
p.20
Clinical Features of Pancreatitis
What can autoimmune pancreatitis mimic?
The signs and symptoms of pancreatic carcinoma.
How does autoimmune pancreatitis respond to treatment?
It responds to steroid therapy.
p.81
Endocrine Neoplasms and Hormonal Syndromes
What is Zollinger-Ellison Syndrome associated with?
Marked hypersecretion of gastrin due to gastrin-producing tumors (gastrinomas).
p.85
Endocrine Neoplasms and Hormonal Syndromes
What type of tumors can be evaluated using FNA of the pancreas?
Neuroendocrine Tumors (NET).
p.36
Cystic Neoplasms of the Pancreas
How do IPMNs differ from mucinous cystic neoplasms (MCNs)?
IPMNs lack the dense 'ovarian' stroma and involve a pancreatic duct.
What is the main characteristic of chronic pancreatitis?
Irreversible injury of the pancreas leading to fibrosis and loss of function.
p.86
Diagnosis and Treatment of Pancreatic Cancer
What is the primary purpose of performing FNA on the pancreas?
To obtain tissue samples for diagnosis.
What is characterized by microvascular leak and edema in acute pancreatitis?
Acute interstitial pancreatitis.
p.44
Diagnosis and Treatment of Pancreatic Cancer
Why is tissue diagnosis necessary in EUS-FNA of pancreatic masses?
To determine the nature of the mass, especially if deemed unresectable.
p.32
Cystic Neoplasms of the Pancreas
What type of epithelium lines the cysts in serous cystic neoplasms?
Cuboidal epithelium without atypia.
What are common causes of acute pancreatitis?
Gallstones and excessive alcohol consumption.
What are pseudocysts in the pancreas?
Localized collections of necrotic and hemorrhagic material rich in pancreatic enzymes and lacking an epithelial lining.
What is acute pancreatitis?
A form of reversible pancreatic parenchymal injury associated with inflammation.
p.44
Diagnosis and Treatment of Pancreatic Cancer
What types of masses may not be primary adenocarcinomas?
Pancreatic lymphoma, small cell carcinoma of the pancreas, and metastases from other organs.
p.38
Cystic Neoplasms of the Pancreas
What are the characteristics of solid-pseudopapillary neoplasms?
Large, well-circumscribed malignant neoplasms with solid and cystic components filled with hemorrhagic debris.
What part of the pancreas is affected by adenocarcinoma in this context?
Tail and body of the pancreas.
What are common causes of chronic pancreatitis?
Alcohol abuse, genetic factors, and certain medical conditions.
p.76
Endocrine Neoplasms and Hormonal Syndromes
What makes predicting the behavior of pancreatic endocrine neoplasms difficult?
Their light microscopic appearance.
What is a common complication of chronic pancreatitis?
Diabetes due to damage to insulin-producing cells.
What is chronic pancreatitis?
Prolonged inflammation of the pancreas associated with irreversible destruction of exocrine parenchyma and fibrosis.
p.40
Diagnosis and Treatment of Pancreatic Cancer
What role does endoscopic ultrasound play in diagnosing pancreatic neoplasms?
It helps in visualizing the pancreas and obtaining tissue samples.
p.38
Molecular Alterations in Pancreatic Cancer
What mutations are associated with solid-pseudopapillary neoplasms?
Acquired activating mutations of the CTNNB1 (β-catenin) oncogene.
What are pancreatic cysts?
Fluid-filled sacs that can form in the pancreas.
p.48
Cystic Neoplasms of the Pancreas
What is the significance of EUS/FNA in diagnosing Mucinous Cystic Neoplasms?
It allows for the collection of tissue samples for analysis.
Where is PanIN often found in relation to infiltrating carcinoma?
In pancreatic parenchyma adjacent to infiltrating carcinoma.
p.53
Diagnosis and Treatment of Pancreatic Cancer
What type of cancer is commonly diagnosed using EUS/FNA?
Pancreatic Adenocarcinoma.
p.42
Cystic Neoplasms of the Pancreas
Do major cystic neoplasms have specific mutational profiles?
Yes, each of the major cystic neoplasms has a relatively specific mutational profile.
What complications can arise from Alcoholic Chronic Pancreatitis?
Diabetes, pancreatic cancer, and malnutrition.
p.56
Molecular Alterations in Pancreatic Cancer
Which markers are used to identify neuroendocrine tumors?
Chromogranin and Synaptophysin.
p.75
Cystic Neoplasms of the Pancreas
Where can PanNETs occur in the pancreas?
Anywhere along the length of the pancreas, embedded in the substance or arising in immediate peripancreatic tissues.
What typically causes pancreatic pseudocysts?
They usually result from pancreatitis or pancreatic injury.
Can hereditary pancreatitis be passed down through generations?
Yes, it can be inherited in an autosomal dominant pattern.
p.65
Epidemiology and Inheritance
What age group accounts for 80% of pancreatic carcinoma cases?
People aged 60 to 80 years.
p.35
Cystic Neoplasms of the Pancreas
Which part of the pancreas is more often involved in IPMNs?
The head of the pancreas.
p.38
Cystic Neoplasms of the Pancreas
Are solid-pseudopapillary neoplasms aggressive?
Some are locally aggressive, but most patients are cured following complete surgical resection.
How is chronic pancreatitis diagnosed?
Through imaging tests, blood tests, and assessment of symptoms.
What syndrome can develop in up to 15% of patients with Acinar Cell Carcinoma?
Metastatic fat necrosis syndrome due to lipase release into circulation.
p.13
Pathogenesis of Pancreatitis
How often does chronic pancreatitis follow acute pancreatitis?
Chronic pancreatitis most often follows repeated episodes of acute pancreatitis.
What is a long-term consequence of chronic pancreatitis?
Permanent damage to the pancreas.
p.74
Diagnosis and Treatment of Pancreatic Cancer
How are pancreatic neuroendocrine tumors typically diagnosed?
Through imaging studies, blood tests for hormone levels, and biopsy.
p.84
Endocrine Neoplasms and Hormonal Syndromes
What are glucagonomas associated with?
Increased serum levels of glucagon, mild diabetes mellitus, a characteristic skin rash (necrolytic migratory erythema), and anemia.
What is a risk associated with chronic pancreatitis?
Development of pancreatic cancer.
What symptoms might indicate the presence of pancreatic cysts or neoplasms?
Abdominal pain, nausea, or unexplained weight loss.
p.10
Clinical Features of Pancreatitis
What laboratory findings are indicative of acute pancreatitis within the first 24 hours?
Marked elevation of serum amylase levels.
What characterizes a serous cyst?
It is a type of pancreatic cyst that is typically benign and filled with a clear, watery fluid.
What can happen to the pain in chronic pancreatitis over time?
It may become chronic and persistent.
p.10
Clinical Features of Pancreatitis
What sequelae can occur following acute pancreatitis?
Sterile pancreatic abscess and pancreatic pseudocyst.
p.78
Endocrine Neoplasms and Hormonal Syndromes
What complications can arise from pancreatic neuroendocrine tumor carcinomas?
Local invasion and distant metastases.
What are lymphoepithelial cysts?
Rare cysts that can occur in the pancreas, often associated with lymphoid tissue.
p.64
Molecular Alterations in Pancreatic Cancer
What is the function of the p53 protein encoded by the TP53 gene?
It responds to DNA damage by arresting cell growth, inducing apoptosis, or causing cellular senescence.
Which genetic mutations are commonly associated with hereditary pancreatitis?
Mutations in the PRSS1, SPINK1, and CFTR genes.
p.12
Pathogenesis of Pancreatitis
What is a key feature common to all causes of acute pancreatitis?
Inappropriate activation of digestive enzymes within the pancreas.
p.27
Cystic Neoplasms of the Pancreas
What are congenital cysts in the pancreas?
Unilocular, thin-walled cysts from anomalous development of the pancreatic ducts.
What are the typical symptoms of acute pancreatitis?
Severe abdominal pain, nausea, vomiting, and fever.
p.76
Endocrine Neoplasms and Hormonal Syndromes
What is the prognosis for insulin-producing tumors?
Approximately 90% are benign.
What is a potential complication of chronic pancreatitis?
Diabetes due to damage to insulin-producing cells.
What condition can result from the injury or destruction of beta cells during acute pancreatitis?
Hyperglycemia (elevated blood glucose levels).
What complications can larger pseudocysts cause?
They may compress or perforate into adjacent structures.
What complications can arise from acute pancreatitis?
Infection, necrosis, and organ failure.
p.73
Molecular Alterations in Pancreatic Cancer
What genetic mutations are associated with Acinar Cell Carcinoma?
Loss-of-function mutations of the APC tumor suppressor gene or activating point mutations of CTNNB1.
What lifestyle changes can help prevent acute pancreatitis?
Avoiding excessive alcohol consumption and maintaining a healthy diet.
Which profibrogenic cytokines are produced in chronic pancreatitis?
Transforming growth factor β (TGFβ) and platelet-derived growth factor (PDGF).
What percentage of patients with gallstones develop acute pancreatitis?
About 5% of patients with gallstones.
What are the effects of profibrogenic cytokines in chronic pancreatitis?
Myofibroblast proliferation, collagen synthesis, and ECM remodeling.
p.46
Diagnosis and Treatment of Pancreatic Cancer
What procedure involves brushings, washings, or suction of fluid for pancreatic cancer diagnosis?
ERCP (Endoscopic Retrograde Cholangiopancreatography).
p.74
Molecular Alterations in Pancreatic Cancer
What is the prognosis for patients with pancreatic neuroendocrine tumors?
Prognosis varies based on tumor type, size, and whether it has spread.
p.22
Diagnosis and Treatment of Pancreatic Cancer
How can calcifications within the pancreas be visualized?
By CT and ultrasonography.
p.33
Cystic Neoplasms of the Pancreas
What is the typical growth pattern of mucinous cystic neoplasms?
Painless, slow-growing masses.
What is a mucinous cystic neoplasm?
A type of pancreatic cyst that has the potential to become cancerous and is characterized by mucin production.
p.84
Endocrine Neoplasms and Hormonal Syndromes
What do pancreatic carcinoid tumors produce?
Serotonin and an atypical carcinoid syndrome.
What is the composition of pancreatic pseudocysts?
They are filled with fluid, necrotic tissue, and enzymes.
p.43
Diagnosis and Treatment of Pancreatic Cancer
What type of lesions can EUS target?
Lesions in the pancreas, lymph nodes, or liver.
p.25
Cystic Neoplasms of the Pancreas
What are the common types of pancreatic neoplasms?
Serous cystadenomas, mucinous cystadenomas, and intraductal papillary mucinous neoplasms (IPMNs).
p.43
Diagnosis and Treatment of Pancreatic Cancer
What is fine needle aspiration cytology used for?
To obtain samples from pancreatic cysts or solid masses for pathology findings.
How does chronic pancreatitis relate to pancreatic carcinoma?
It is a risk factor that can lead to the development of precursors.
What lifestyle changes can help manage chronic pancreatitis?
Avoiding alcohol, eating a low-fat diet, and maintaining a healthy weight.
p.74
Clinical Features of Pancreatitis
What is a common symptom of pancreatic neuroendocrine tumors?
Symptoms can vary but may include abdominal pain, weight loss, and changes in blood sugar levels.
p.25
Cystic Neoplasms of the Pancreas
What is the significance of intraductal papillary mucinous neoplasms (IPMNs)?
They have the potential to progress to pancreatic cancer.
p.83
Endocrine Neoplasms and Hormonal Syndromes
How do MEN-1-associated gastrinomas differ from sporadic gastrinomas?
MEN-1-associated gastrinomas are frequently multifocal, while sporadic gastrinomas are usually single.
p.39
Cystic Neoplasms of the Pancreas
What is noted by the progressive increase of atypia/dysplasia in the lining epithelium?
Progression from low-grade to high-grade to invasive carcinoma.
How does the survival rate of Pancreatoblastoma compare to pancreatic ductal adenocarcinomas?
Survival is better than with pancreatic ductal adenocarcinomas.
What condition can result from chronic pancreatitis?
Exocrine pancreatic insufficiency.
p.78
Endocrine Neoplasms and Hormonal Syndromes
How are hypoglycemic episodes relieved in insulinoma patients?
By feeding or parenteral administration of glucose.
p.72
Clinical Features of Pancreatitis
What symptoms do patients with pancreatic cancer often present?
Abdominal pain, weight loss, jaundice, and deep vein thrombosis.
p.31
Cystic Neoplasms of the Pancreas
In which decades of life are serous cystic neoplasms most commonly diagnosed?
Sixth to seventh decade of life.
What happens to pancreatic function in chronic pancreatitis?
There is a loss of both exocrine and endocrine function.
How is acute pancreatitis diagnosed?
Through blood tests, imaging studies, and clinical evaluation.
p.25
Cystic Neoplasms of the Pancreas
What is a key characteristic of serous cystadenomas?
They are typically benign and filled with a thin, clear fluid.
How common is acute pancreatitis?
It occurs in 10 to 20 cases per 100,000 people.
p.61
Diagnosis and Treatment of Pancreatic Cancer
What is the importance of early detection of precursors in pancreatic carcinoma?
It can lead to better treatment outcomes and potentially prevent cancer progression.
What is Pancreatoblastoma?
A rare neoplasm that primarily occurs in children aged 1 to 15 years.
p.22
Clinical Features of Pancreatitis
What are common clinical features of chronic pancreatitis?
Mild fever and mild-to-moderate elevations of serum amylase.
What is the life expectancy for patients with hepatic metastases from Zollinger-Ellison Syndrome?
Shortened, usually leading to liver failure within 10 years.
p.31
Cystic Neoplasms of the Pancreas
Where do multi-cystic serous cystic neoplasms usually occur in the pancreas?
In the tail of the pancreas.
What symptoms are commonly associated with Acinar Cell Carcinoma?
Pain and lipase hypersecretion.
p.84
Endocrine Neoplasms and Hormonal Syndromes
What characterizes pancreatic polypeptide-secreting endocrine tumors?
They present as mass lesions, and high plasma levels of this hormone fail to cause symptoms.
What is a solid pseudo-papillary neoplasm?
A rare type of pancreatic tumor that can present with cystic features.
p.31
Cystic Neoplasms of the Pancreas
What is the most common genetic abnormality in serous cystic neoplasms?
Inactivation of the VHL tumor suppressor gene.
What are other causes of chronic pancreatitis besides alcohol?
Long-standing obstruction of the pancreatic duct, autoimmune injury, and hereditary pancreatitis.
What is acute pancreatitis?
A reversible pancreatic parenchymal injury associated with inflammation.
p.47
Cystic Neoplasms of the Pancreas
What is the significance of a full cyst in pancreatic neoplasms?
It may indicate the presence of a neoplasm.
p.39
Cystic Neoplasms of the Pancreas
What types of cystic neoplasms are curable and noninvasive?
Mucinous cystic neoplasms and intraductal papillary mucinous neoplasms.
What treatments are available for chronic pancreatitis?
Pain management, enzyme replacement therapy, and sometimes surgery.
p.70
Clinical Features of Pancreatitis
What is the Trousseau sign associated with pancreatic cancer?
Migratory thrombophlebitis.
How are pancreatic cysts typically diagnosed?
Through imaging techniques such as ultrasound, CT scans, or MRI.
What is a pseudocyst?
A fluid-filled sac that forms in the pancreas due to inflammation or injury.
p.39
Cystic Neoplasms of the Pancreas
Do major cystic neoplasms have specific mutational profiles?
Yes, each has a relatively specific mutational profile.
What is a neoplastic mucinous cyst?
A type of pancreatic cyst that is associated with neoplastic changes and produces mucin.
What is a mucinous cystic neoplasm?
A type of pancreatic cyst that has the potential to become cancerous and is characterized by mucin production.
p.31
Cystic Neoplasms of the Pancreas
What is the gender prevalence for serous cystic neoplasms?
Women are affected twice as often as men.
p.31
Cystic Neoplasms of the Pancreas
What are the common symptoms associated with serous cystic neoplasms?
Nonspecific symptoms like abdominal pain or incidental findings.
p.84
Endocrine Neoplasms and Hormonal Syndromes
How are multihormonal tumors different from MEN syndromes?
Multihormonal tumors produce multiple hormones from a single gland, while MEN syndromes involve multiple hormones from different glands.
What triggers the cascade of events in acute pancreatitis?
Acinar injury resulting in the release of digestive enzymes.
What lifestyle changes can help manage chronic pancreatitis?
Avoiding alcohol, following a low-fat diet, and maintaining hydration.
p.65
Epidemiology and Inheritance
Which racial group has a higher incidence of pancreatic carcinoma?
Blacks, compared to whites.
p.83
Clinical Features of Pancreatitis
What is Zollinger-Ellison Syndrome associated with?
Pancreatic islet cell lesions, hypersecretion of gastric acid, and severe peptic ulceration.
p.25
Cystic Neoplasms of the Pancreas
What distinguishes mucinous cystadenomas from serous cystadenomas?
Mucinous cystadenomas are often larger and can be precursors to cancer.
What happens in the early stage of chronic pancreatitis?
Destruction of exocrine parenchyma.
What is a congenital cyst?
A type of pancreatic cyst that is present at birth.
p.31
Cystic Neoplasms of the Pancreas
What type of cystic neoplasm is characterized by small cysts lined by glycogen-rich cuboidal cells?
Serous cystic neoplasms (serous cyst adenoma).
p.78
Endocrine Neoplasms and Hormonal Syndromes
What symptoms occur during hypoglycemic episodes caused by insulinoma?
Confusion, stupor, and loss of consciousness.
p.46
Diagnosis and Treatment of Pancreatic Cancer
What is intraoperative FNA/biopsy used for?
To obtain cytologic specimens during surgery.
p.84
Endocrine Neoplasms and Hormonal Syndromes
What syndrome is caused by VIPoma?
Watery diarrhea, hypokalemia, achlorhydria (WDHA syndrome).
p.78
Endocrine Neoplasms and Hormonal Syndromes
Can multiple insulinomas occur in a patient?
Yes, although most are solitary.
What is the histological characteristic of Pancreatoblastoma?
Solid nests, acini, squamoid corpuscles, cellular stroma.
p.84
Endocrine Neoplasms and Hormonal Syndromes
What hormones can pancreatic endocrine tumors produce?
Insulin, glucagon, gastrin, ACTH, MSH, ADH, serotonin, and norepinephrine.
What is a common treatment for symptomatic pancreatic pseudocysts?
Drainage procedures may be performed.
p.74
Endocrine Neoplasms and Hormonal Syndromes
What are pancreatic neuroendocrine tumors?
Tumors that arise from the hormone-producing cells of the pancreas.
What happens when blood glucose levels exceed the kidney’s threshold for reabsorption?
Glucose spills into the urine, causing glycosuria.
What is pancreatic cancer known for?
It is one of the most aggressive solid cancers.
p.47
Cystic Neoplasms of the Pancreas
What does a collapsed cyst suggest in pancreatic imaging?
It may indicate a benign condition or resolution of a neoplasm.
p.10
Clinical Features of Pancreatitis
What are common clinical features of acute pancreatitis?
Abdominal pain, anorexia, nausea, and vomiting.
Who are the authors of the study on pancreatic neoplasms published in 2002?
Hernandez LV and Bhutani MS.
p.46
Diagnosis and Treatment of Pancreatic Cancer
What is EUS-FNA?
Endoscopic Ultrasound-guided Fine Needle Aspiration.
What is the microscopic appearance of Pancreatoblastoma?
Distinct appearance consisting of squamous islands admixed with acinar cells.
What is a significant outcome of repeated injury in chronic pancreatitis?
Irreversible loss of acinar cell mass and fibrosis.
p.70
Clinical Features of Pancreatitis
What is a limitation of serum markers like CA19-9 in pancreatic cancer?
They are relatively nonspecific and lack sensitivity for screening.
What is a neoplastic mucinous cyst?
A type of pancreatic cyst that can be precancerous and is filled with thick, mucous fluid.
p.64
Molecular Alterations in Pancreatic Cancer
What pathways are activated by KRAS signaling?
MAPK and PI3K/AKT pathways.
p.33
Cystic Neoplasms of the Pancreas
What is associated with the dense stroma in mucinous cystic neoplasms?
Similar to ovarian stroma.
p.33
Cystic Neoplasms of the Pancreas
What is the mortality rate for patients with invasive carcinoma arising from mucinous cystic neoplasms?
½ of patients will die of their disease.
p.65
Epidemiology and Inheritance
Which ethnic group is slightly more affected by pancreatic carcinoma?
Individuals of Ashkenazi Jewish descent.
p.83
Clinical Features of Pancreatitis
What should be suspected in patients with intractable jejunal ulcers?
Zollinger-Ellison Syndrome (ZE).
p.27
Cystic Neoplasms of the Pancreas
What is an example of an inherited condition associated with pancreatic cysts?
Autosomal-dominant polycystic kidney disease.
What percentage of acute pancreatitis cases have gallstones present?
Gallstones are present in 35% to 60% of cases.
p.27
Cystic Neoplasms of the Pancreas
What disease is associated with vascular neoplasms in the retina and brain stem along with pancreatic cysts?
von Hippel-Lindau disease.
p.65
Epidemiology and Inheritance
What are two risk factors for pancreatic cancer?
Chronic pancreatitis and diabetes mellitus (DM).
p.70
Clinical Features of Pancreatitis
Which serum markers are often elevated in pancreatic cancer?
Carcinoembryonic antigen and CA19-9 antigen.
What histological feature is characteristic of Solid Pseudopapillary Neoplasm?
Pseudopapillae, no lumina, various degrees of stroma.
p.72
Molecular Alterations in Pancreatic Cancer
Which genes are frequently mutated in pancreatic cancer?
KRAS, p16/CDKN2A, TP53, and SMAD4.
What is a pancreatic endocrine neoplasm?
A type of tumor that arises from the hormone-producing cells of the pancreas, which can form cysts.
p.31
Cystic Neoplasms of the Pancreas
What is the recommended management for small serous cystic neoplasms?
They can be safely observed.
p.39
Cystic Neoplasms of the Pancreas
What can mucinous cystic neoplasms and intraductal papillary mucinous neoplasms progress to?
Incurable invasive carcinoma.
What is a congenital cyst?
A type of pancreatic cyst that is present at birth.
What happens in the late stages of chronic pancreatitis?
Destruction of endocrine parenchyma.
p.74
Diagnosis and Treatment of Pancreatic Cancer
What is the treatment approach for pancreatic neuroendocrine tumors?
Treatment may include surgery, targeted therapy, and hormone therapy.
What is a pseudocyst?
A fluid-filled sac that forms in the pancreas due to inflammation or injury.
p.84
Endocrine Neoplasms and Hormonal Syndromes
What is required for the diagnosis of somatostatinomas?
High plasma somatostatin levels.
p.10
Clinical Features of Pancreatitis
What complications can arise from acute pancreatitis?
Acute respiratory distress syndrome and acute renal failure.
What is cystic degeneration of typically solid tumors?
A process where solid tumors in the pancreas develop cystic features.
p.10
Clinical Features of Pancreatitis
What is the risk associated with necrotic debris in acute pancreatitis?
40% to 60% of necrotic debris can become infected, usually by gram-negative organisms.
How does acute pancreatitis lead to glycosuria?
By causing damage to beta cells, leading to decreased insulin production and resulting in hyperglycemia.
p.84
Endocrine Neoplasms and Hormonal Syndromes
In which demographic do glucagonomas most frequently occur?
Perimenopausal and postmenopausal women.
What characterizes a serous cyst?
It is a type of pancreatic cyst that is typically benign and filled with a clear, straw-colored fluid.
What is the treatment approach for symptomatic pancreatic cysts?
Surgical intervention may be required, depending on the type and symptoms.
p.10
Clinical Features of Pancreatitis
What happens to serum lipase levels in acute pancreatitis?
They rise by 72 to 96 hours after the onset.
What causes weight loss and edema in chronic pancreatitis patients?
Low albumin from malabsorption due to pancreatic exocrine insufficiency.
What does IPMN stand for?
Intra-ductal papillary mucinous neoplasm.
What are lymphoepithelial cysts?
Rare cysts that can occur in the pancreas, often associated with lymphoid tissue.
What are developmental cysts?
Cysts that arise due to developmental anomalies in the pancreas.
p.64
Molecular Alterations in Pancreatic Cancer
Which signaling pathway has been shown to be activated in pancreatic cancer and represents a potential therapeutic target?
Hedgehog signaling pathway.
p.10
Clinical Features of Pancreatitis
Why is full-blown acute pancreatitis considered a medical emergency?
Due to the release of toxic enzymes and a systemic inflammatory response.
What symptoms are associated with Pancreatic Neuroendocrine Tumors?
Pain and neuroendocrine paraneoplastic syndrome.
p.84
Endocrine Neoplasms and Hormonal Syndromes
What are the symptoms associated with somatostatinomas?
Diabetes mellitus, cholelithiasis, steatorrhea, and hypochlorhydria.
p.73
Molecular Alterations in Pancreatic Cancer
What signaling pathway is frequently activated in Pancreatoblastoma?
The Wnt signaling pathway.
p.31
Cystic Neoplasms of the Pancreas
What is the fluid characteristic of serous cystic neoplasms?
Clear, straw-colored fluid.
p.72
Molecular Alterations in Pancreatic Cancer
What are the two subtypes of pancreatic cancer defined by transcriptional profiles?
Basal-like and classical subtypes.
p.33
Cystic Neoplasms of the Pancreas
What type of epithelium lines mucinous cystic neoplasms?
Columnar mucin-producing epithelium.
What is cystic degeneration of typically solid tumors?
A process where solid tumors in the pancreas develop cystic features.
p.64
Molecular Alterations in Pancreatic Cancer
What is the role of the SMAD4 tumor suppressor gene?
It plays an important role in signal transduction from TGF-β receptors.
p.10
Clinical Features of Pancreatitis
What are poor prognostic findings in acute pancreatitis?
Systemic organ failure and necrosis in the pancreas.
p.64
Molecular Alterations in Pancreatic Cancer
What type of abnormalities are associated with pancreatic cancer regarding tumor suppressor genes?
DNA methylation abnormalities, including hypermethylation of CDKN2A.
p.83
Diagnosis and Treatment of Pancreatic Cancer
What is the treatment for Zollinger-Ellison Syndrome?
Control of gastric acid secretion using H+ K+-ATPase inhibitors and excision of the neoplasm.
p.72
Pathogenesis of Pancreatitis
What is the most common precursor lesion for invasive pancreatic cancer?
Pancreatic intraepithelial neoplasia (PanIN).
p.22
Clinical Features of Pancreatitis
What symptoms may indicate gallstone-induced chronic pancreatitis?
Jaundice or elevations in serum levels of alkaline phosphatase.
What is an intraductal papillary mucinous neoplasm?
A type of pancreatic cyst that arises from the pancreatic ducts and produces mucin.
What is a pancreatic endocrine neoplasm?
A type of tumor that arises from the hormone-producing cells of the pancreas and can form cysts.
What is a solid pseudopapillary neoplasm?
A rare type of pancreatic tumor that can present as a cystic lesion.
What are developmental cysts?
Cysts that arise during the development of the pancreas, often congenital in nature.
