Pancreas

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Pancreas
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Pancreas
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Pancreas

• Pancreatic acini,
• radial orientation of the pyramidal exocrine
  acinar cells.
• cytoplasm is for the synthesis and packaging of
  digestive enzymes for secretion into a central
  lumen

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• Pancreas
• Congenital anomalies
• 1.Agenesis incompatible with life
• 2. Pancreas Divisum persistence as dorsal and
  ventral pancreas
• Predisposes to Chronic Pancreatitis
• 3. Annular pancreas pancreatic head encircles
  the duodenum
• Risk of Intestinal obstruction
• 4. Aberrant (or Ectopic) pancreas located in
  the stomach, SI, Meckels Diverticulum,
  submucosal, yellow-gray nests

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Pancreas - Pancreas Divisum
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Pancreas - Annular pancreas
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• Pancreas
• Acute Pancreatitis acute abdominal pain,
  radiating to the back
• Types
• Acute interstitial pancreatitis Mild form with
  edema
• Acute necrotizing pancreatitis Severe
  pancreatitis with tissue necrosis
• Acute hemorrhagic pancreatitis Most severe form
  with extensive hemorrhage
• raised levels of pancreatic enzymes (amylase and
  lipase) in Blood or Urine
• MCC cholelithiasis and alcoholism
• Alcohol proposed mechanism of acinar cell
  injury
• misdirected intracellular transport of Proenzymes
• protein plugs within pancreatic ducts,
• local obstruction and inflammation
• Clinical
• Medical emergency with acute abdomen,
• constant and intense abdominal pain with upper
  back radiation,
• peripheral vascular collapse and shock
• Death occurs from shock, ARDS, Acute renal
  failure

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• Pancreas
• Acute Pancreatitis
• Lab findings
• first 24 hours -marked elevation of the serum
  amylase
• within 72 to 96 hours -rising serum lipase,
• Glycosuria occurs in 10 of cases,
• Hypocalcemia, if persistent- poor prognostic sign
• Complications
• pancreatic abscess
• Pseudocyst

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Acute Pancreatitis

• Microscopic field shows a region of fat necrosis
  on the right

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Pathways of Acute pancreatitis
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Acute Pancreatitis

• hemorrhage in the head of the pancreas
• fat necrosis

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• Pancreas
• Chronic Pancreatitis Repeated bouts pancreatitis
  with loss of pancreatic parenchyma pancreatic
  function
• Replacement by fibrous tissue (islets of
  Langerhans are spared)
• Causes
• Ductal obstruction by concretions (as with
  alcohol)
• decreased acinar secretion of lithostatine
  (inhibit intraluminal precipitation of calcium
  carbonates)
• Complications
• Pseudocyst
• diarrhea (malabsorption)
• diabetes

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Chronic Pancreatitis

• A, Extensive fibrosis and atrophy has left only
  residual islets (left) and ducts (right), with a
  sprinkling of chronic inflammatory cells and
  acinar tissue.
• B, A higher-power view demonstrating dilated
  ducts with inspissated eosinophilic ductal
  concretions in a patient with alcoholic chronic
  pancreatitis.

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Sequelae of Acute and Chronic Pancreatitis
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Pancreatitis
Chronic
Acute
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• Pancreas
• Pancreatic Cysts
• Non-neoplastic MC (75) Pseudocyst (Acquired)
• Complication after acute or chronic
  pancreatitis,
• Unilocular cyst, no epithelial lining
• Congenital Part of Poly cystic disease
• congenital polycystic disease coexist with
  kidney and liver cysts
• Neoplastic
• Benign Unilocular
• Malignant Multilocular
• Von-Hippel-Lindau disease Congenital pancreatic
  cysts and angiomas of the CNS (Retina,
  Cerebellum)

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Cystic Neoplasms
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Unilocular Vs Multilocular cysts
Benign
Malignant
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Pancreatic pseudocyst
MC Cyst in Pancreas (non neoplastic)

• A, Cross-section through this previously bisected
  lesion revealing a poorly defined cyst with a
  necrotic brown-black wall.
• B, Histologically, the cyst lacks a true
  epithelial lining and instead is lined by fibrin
  and granulation tissue

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Serous cystadenoma

• A, Cross-section through a serous cystadenoma.
  Only a thin rim of normal pancreatic parenchyma
  remains. The cysts are relatively small and
  contain clear, straw-colored fluid.
• B, The cysts are lined by Cuboidal epithelium
  without atypia.

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Mucinous Cystic Tumor

• A, Cross-section through a mucinous
  multiloculated cyst in the tail of the pancreas.
  The cysts are large and filled with tenacious
  mucin.
• B, The cysts are lined by columnar mucinous
  epithelium, and a dense "ovarian like stroma is
  noted

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3. Intraductal papillary Mucinous Neoplasm

• A, Cross-section through the head of the
  pancreas showing a prominent papillary neoplasm
  distending the main pancreatic duct.
• B, The papillary mucinous neoplasm involved the
  main pancreatic duct (left) and extending down
  into the smaller ducts and ductules (right).

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• Pancreas
• Carcinoma Pancreas carcinomas of the exocrine
  pancreas
• 5 of all cancer deaths in the US at age of 60
  and 80s
• arising from ductal epithelial cells,
• ? incidence in smokers and alcoholics
• Genetics
• K-ras mutations in 90 cases (MC altered
  oncogene)
• p53 mutations in 60 to 80 cases
• P16- MC inactivated tumor suppressor gene
• Site MC in in the head (60)
• Microscopically (adenocarcinoma-MC type)
• Prognosis
• five-year survival - 5

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• Pancreas
• 1.Carcinoma Pancreas
• first year mortality gt80,
• Clinically
• weight loss, pain obstructive jaundice
• massive metastasis to the liver occurs via
  splenic vein invasion,
• migratory thrombophlebitis (Trousseau syndrome)
• Biochemical tests Carcinoembryonic antigen
  (CEA) and CA19-9 antigen
• Diagnosis endoscopic ultrasonography and CT
  FNAC
• 2. Pancreatoblastoma rare neoplasms in children,
  fully malignant
• 3. Periampullary carcinomas pancreatic
  carcinomas at ampulla of Vater
• 85 are unresectable at presentation,

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Carcinoma - Pancreas
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Carcinoma - Pancreas

• A, A cross-section through the head of the
  pancreas and adjacent common bile duct showing
  both an ill-defined mass in the pancreatic
  substance (arrowheads) and the green
  discoloration of the duct resulting from total
  obstruction of bile flow.
• B, Poorly formed glands are present in densely
  fibrotic stroma within the pancreatic substance
  there are some inflammatory cells

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Case

• A 40-year-old woman developed increasingly severe
  abdominal pain over a two day period. In the
  emergency room, physical examination demonstrated
  board-like rigidity of her abdomen along with
  extreme tenderness. A plain film radiograph of
  the abdomen demonstrated dilated loops of bowel,
  several radiopaque gallstones in the gallbladder,
  but no free air. The total bilirubin was 3.8
  mg/dL, AST 25 U/L, ALT 30 U/L, albumin 3.5 g/dL,
  total protein 5.8 g/dL, glucose 120 mg/dL,
  calcium 7.8 mg/dL, phosphorus 3.3 mg/dL, and
  lipase 2,250 U/L. The gross photograph depicts
  the process (image 7.1). The microscopic
  appearance is seen in images 7.2 and 7.3.

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Case
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Case
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Case -1