Pancreas Pathology

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Pancreas Pathology создатель Mind Map: Pancreas Pathology

1. Congenital malformations (by gross and micro appearances)


1.1.1. Pancreas divisum failure of fusion Dorsal and ventral duct systems

1.2. Other Congenital Pancreatic Anomalies

1.2.1. Congenital pancreatic cysts Often multiple almost always a/w underlying congenital disease Von Hippel-Lindau syndrome

1.2.2. Ectopic Pancreas Where? Stomach and duodenum (MC) jejunum, meckel diverticula, ileum What? Aberrantly situated pancreatic tissue

1.2.3. Annular pancreas ring of normal pancreas completely encircling second portion of duodenum May cause obstruction

2. Acute vs chronic pancreatitis

2.1. gross and macroscopic appearance

2.2. underlying causes and pathogenesis

2.3. genetic predisposition

2.4. morphology

2.4.1. inflammation

2.4.2. fat necrosis

2.4.3. parenchymal destruction

2.4.4. hemorrhage

2.5. clinical signs and symptoms

2.6. complications

2.7. outcomes

2.8. Pancreatitis

2.8.1. Acute Pancreatitis Main Causes 80% Males Females Morphology Microscopic Gross Clinical Features Plasma findings Signs / Symptoms Diagnosis of Acute Pancreatitis Complications ARDS ARF Pancreatic Abscess Pancreatic pseudocyst Treatment Supportive No PO intake Pathophysiology of Pancreatitis hemorrhage Necrosis parenchymal destruction Inflammation

2.8.2. Chronic pancreatitis Causes / Risk Factors Other Risk Factors Causes Gross appearance fibrosis atrophy dilated ducts with calcified concretions Imaging "Chain of Lakes" Microscopic appearance fibrosis atrophy chronic inflammation Outcomes Atrophy Chronic pain Pancreatic cancer Lab Findings Tests only detect advanced disease

2.8.3. Autoimmune pancreatitis Associated with IgG4-secreting plasma cells in pancreas Signs and Symptoms mimic pancreatic cancer i.e. obstructive jaundice Responds to steroids Histology periductal inflammation periductal fibrosis periductal narrowing

2.8.4. Pathogenesis Normal Zymogens synthesized Trypsin activates proenzymes Trypsin inhibitors

3. Pancreatic neoplasms

3.1. gross and histologic appearance

3.2. location

3.3. risk factors

3.4. clinical findings

3.5. Side effects

3.6. Genetic mutations

3.7. outcomes / survival rates

3.8. Pancreatic cystic neoplasms

3.8.1. Serous Serous cystadenomas F > M Microcystic almost always benign

3.8.2. Mucinous Mucinous cystic neoplasm F - almost exclusively Macrocystic Location Benign or malignant

3.8.3. Intraductal Papillary Mucinous IPMN M > F Location Mucin accumulation leads to cystic dilatation Intraductal proliferation of mucinous cells in papillary arrangements

3.9. Pancreatic ductal adenocarcinoma

3.9.1. Epidemiology AfAm > White M > F 4th leading cause of cancer death in U.S. 5-year survival rate

3.9.2. Risk Factors MAIN Smoking Chronic pancreatitis, DM Diets high in fat / protein Alcohol Genetic mutations (inherited and acquired) BRCA2 mutation Lynch Syndrome - HNPCC KRAS mutation - 90-95% CDKN2A mutation - 95%

3.9.3. Progression Preceded by PanIN progression from normal to PanIN to invasive tumor Morphological progression coincides with Genetic progression KRAS and CDKN2A mutations

3.9.4. Morphology Location 60% - Head 20% - Diffuse 15% - Body 5% - Tail Microscopic high degree of invasiveness desmoplastic Malignant glands, arising from ductal epithelium of pancreas with abundant desmoplasia

3.9.5. Clinical Findings Commonly unresectable Signs and Symptoms Pain Weight Loss Obstructive jaundice Migratory Thrombophlebitis Labs Courvoisier's Sign

3.10. Pancreatic endocrine neoplasms

3.10.1. Insulinoma (MOST COMMON PEN) Beta-Cell Tumors Severe hypoglycemia Whipple Triad Small and encapsulated 10% metastasize

3.10.2. Gastrinoma G-Cell Tumors Location - Gastrinoma Triangle Zollinger-Ellison syndrome over 50% are locally invasive or metastasized at time of diagnosis

3.10.3. Glucagonoma Alpha-Cell Tumors Glucagonoma syndrome 50% have metastases at time of diagnosis F

3.10.4. May be associated with MEN 1 syndrome Parathyroid Pancreas (islet cells) Pituitary

3.10.5. Morphology Gross well-circumscribed yellow tumor Tail of pancreas Microscopic Uniform, monotonous tumor cells Forming nests and trabeculae

4. Pancreas: Anatomy and Histology

5. CF

5.1. GI Clinical Manifestations

5.1.1. Intestinal obstruction

5.1.2. Pancreatic fibrosis and insufficiency malabsorption

5.1.3. Biliary cirrhosis

5.2. Treatment

5.2.1. PERT Pancreatic Enzyme Replacement Therapy Mechanism Contains enzymes (lipase, protease, amylase) to help ensure nutrients are effectively absorbed from food coating dissolves in alkaline medium of duodenum