Difference between revisions of "Pancreas"

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→‎Pancreatic neuroendocrine tumour: split out
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==Pancreatic neuroendocrine tumour==
==Pancreatic neuroendocrine tumour==
{{Main|Neuroendocrine tumour}}
*Abbreviated ''PanNET''.<ref name=pmid22198808/>
*Abbreviated ''PanNET''.<ref name=pmid22198808/>
*[[AKA]] ''pancreatic islet cell tumour''<ref name=pmid22198808>{{Cite journal  | last1 = Burns | first1 = WR. | last2 = Edil | first2 = BH. | title = Neuroendocrine Pancreatic Tumors: Guidelines for Management and Update. | journal = Curr Treat Options Oncol | volume =  | issue =  | pages =  | month = Dec | year = 2011 | doi = 10.1007/s11864-011-0172-2 | PMID = 22198808 }}</ref> - considered to be an outdated term.
*[[AKA]] ''pancreatic islet cell tumour''<ref name=pmid22198808>{{Cite journal  | last1 = Burns | first1 = WR. | last2 = Edil | first2 = BH. | title = Neuroendocrine Pancreatic Tumors: Guidelines for Management and Update. | journal = Curr Treat Options Oncol | volume =  | issue =  | pages =  | month = Dec | year = 2011 | doi = 10.1007/s11864-011-0172-2 | PMID = 22198808 }}</ref> - considered to be an outdated term.
*[[AKA]] ''islet cell tumour'' - considered to be an outdated term.
*[[AKA]] ''islet cell tumour'' - considered to be an outdated term.
 
{{Main|Neuroendocrine tumour of the pancreas}}
===General===
*Rare.
*Presentation depends on subtype, e.g. for ''insulinoma'' the typical presentation is hypoglycemia.
*May be part of a syndrome:
**[[MEN 1|Multiple endocrine neoplasia I]].
**[[Von Hippel-Lindau disease]].<ref name=pmid22370733>{{Cite journal  | last1 = Charlesworth | first1 = M. | last2 = Verbeke | first2 = CS. | last3 = Falk | first3 = GA. | last4 = Walsh | first4 = M. | last5 = Smith | first5 = AM. | last6 = Morris-Stiff | first6 = G. | title = Pancreatic Lesions in von Hippel-Lindau Disease? A Systematic Review and Meta-synthesis of the Literature. | journal = J Gastrointest Surg | volume =  | issue =  | pages =  | month = Feb | year = 2012 | doi = 10.1007/s11605-012-1847-0 | PMID = 22370733 }}</ref>
**[[Neurofibromatosis type 1]].<ref name=pmid15249710>{{Cite journal  | last1 = Alexakis | first1 = N. | last2 = Connor | first2 = S. | last3 = Ghaneh | first3 = P. | last4 = Lombard | first4 = M. | last5 = Smart | first5 = HL. | last6 = Evans | first6 = J. | last7 = Hughes | first7 = M. | last8 = Garvey | first8 = CJ. | last9 = Vora | first9 = J. | title = Hereditary pancreatic endocrine tumours. | journal = Pancreatology | volume = 4 | issue = 5 | pages = 417-33; discussion 434-5 | month =  | year = 2004 | doi = 10.1159/000079616 | PMID = 15249710 }}</ref>
 
====Classification====
Based on peptide produced in the pancreatic islets:
#Glucagon from alpha cells ([[glucagonoma]]).
#Insulin from beta cells (insulinoma) - most common ~ 50% of islet cell tumours.
#Somatostatin from D cells ([[somatostatinoma]]).
#Pancreatic polypeptide from PP cells.
 
Others:
#Vasoactive intestinal peptide (VIPoma).
#Gastrin (gastrinoma).
#*May be seen in ''[[Zollinger-Ellison syndrome]]''.
#**Triad: pancreatic gastrinoma, gastric acid hypersecretion, marked peptic ulcers in the small bowel.<ref name=pmid13259432>{{cite journal |author=Zollinger RM, Ellison EH |title=Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas |journal=Ann. Surg. |volume=142 |issue=4 |pages=709–23; discussion, 724–8 |year=1955 |pmid=13259432|doi=10.1097/00000658-195510000-00015 |PMC = 1465210 |URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1465210/?page=1 }}</ref>
 
===Gross===
*Usually in the head of the pancreas - 68% in one series,<ref name=pmid22869477>{{Cite journal  | last1 = Oh | first1 = TG. | last2 = Chung | first2 = MJ. | last3 = Park | first3 = JY. | last4 = Bang | first4 = SM. | last5 = Park | first5 = SW. | last6 = Chung | first6 = JB. | last7 = Song | first7 = SY. | title = Prognostic factors and characteristics of pancreatic neuroendocrine tumors: single center experience. | journal = Yonsei Med J | volume = 53 | issue = 5 | pages = 944-51 | month = Sep | year = 2012 | doi = 10.3349/ymj.2012.53.5.944 | PMID = 22869477 | PMC = 3423842}}</ref> and 50% in another series.<ref name=pmid22869477>{{Cite journal  | last1 = Oh | first1 = TG. | last2 = Chung | first2 = MJ. | last3 = Park | first3 = JY. | last4 = Bang | first4 = SM. | last5 = Park | first5 = SW. | last6 = Chung | first6 = JB. | last7 = Song | first7 = SY. | title = Prognostic factors and characteristics of pancreatic neuroendocrine tumors: single center experience. | journal = Yonsei Med J | volume = 53 | issue = 5 | pages = 944-51 | month = Sep | year = 2012 | doi = 10.3349/ymj.2012.53.5.944 | PMID = 22869477 }}</ref>
 
===Microscopic===
Features:
*Nests of cells.
*Stippled chromatin.
*+/-Hyaline globules.
 
DDx:
*[[Solid pseudopapillary neoplasm]].
*[[Acinar cell carcinoma]].
 
Images:
*[http://path.upmc.edu/cases/case172/micro.html Islet cell tumour (upmc.edu)].
*[http://path.upmc.edu/cases/case339.html Pancreatic NET with features of SPT (upmc.edu)].
*[http://path.upmc.edu/cases/case501.html Pancreatic NET - another case (upmc.edu)].
===IHC===
*CK19 +ve -- should be done as a routine in pancreatic NETs; poor prognostic factor.<ref name=pmid19956064>{{Cite journal  | last1 = Jain | first1 = R. | last2 = Fischer | first2 = S. | last3 = Serra | first3 = S. | last4 = Chetty | first4 = R. | title = The use of Cytokeratin 19 (CK19) immunohistochemistry in lesions of the pancreas, gastrointestinal tract, and liver. | journal = Appl Immunohistochem Mol Morphol | volume = 18 | issue = 1 | pages = 9-15 | month = Jan | year = 2010 | doi = 10.1097/PAI.0b013e3181ad36ea | PMID = 19956064 }}</ref>
 
Note:
*''CK19'' should '''not''' be confused with ''CA19-9''.


==Acinar cell carcinoma of the pancreas==
==Acinar cell carcinoma of the pancreas==
Michael
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