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Difference between revisions of "Pancreas"
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**Remainder of pancreas. | **Remainder of pancreas. | ||
== | ==Pancreatic surgeries== | ||
Common pancreatic surgeries include: | |||
*Whipple (includes duodenum). | *Whipple (includes duodenum). | ||
*Distal pancreatectomy. | *Distal pancreatectomy. | ||
** | **Removal of tail +/- body. | ||
*Total pancreatectomy. | *Total pancreatectomy. | ||
** | **Often with splenectomy. | ||
==General classification of pancreatic tumours== | ==General classification of pancreatic tumours== | ||
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**No ovarian-like stroma. | **No ovarian-like stroma. | ||
Mnemonic ''SIMS'': Serous, IPMT, Mucinous, Solid pseudopapillary tumour | Mnemonic ''SIMS'': Serous, IPMT, Mucinous, Solid pseudopapillary tumour. | ||
===Mucinous vs. IMPT=== | ===Mucinous vs. IMPT=== | ||
* | IMPT: | ||
* | *No ovarian-like stroma. | ||
*Usually has total pancreatectomy. | |||
==Cystic tumors of pancreas== | ==Cystic tumors of pancreas== | ||
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==Serous cystic tumours== | ==Serous cystic tumours== | ||
General | ===General==== | ||
* | *Cell of origin: intralobular duct cells (ductular cells). | ||
*Glycogen rich | *Glycogen rich - but do not produce mucin. | ||
===Subclassication=== | ===Subclassication=== | ||
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*Serous oligocystic adenoma. | *Serous oligocystic adenoma. | ||
** Large cysts. | ** Large cysts. | ||
*Serous adenocarcinoma - rare.<ref> | *Serous adenocarcinoma - rare.<ref>MK. Half-day.</ref> | ||
Note: | Note: | ||
*If one mucin +ve cell, tumour = a mucinous tumour | *If one mucin +ve cell, tumour = a mucinous tumour. | ||
===Characteristics of serous microcystic adenoma=== | ===Characteristics of serous microcystic adenoma=== | ||
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*Average size 11 cm. | *Average size 11 cm. | ||
===Radiology=== | |||
*Honey comb appearance. | *Honey comb appearance. | ||
*"Coin lesion" - well demarcated border. | *"Coin lesion" - well demarcated border. | ||
*May have central scar. | *May have central scar. | ||
Gross | ===Gross=== | ||
*Bosulated surface. | *Bosulated surface. | ||
**Lobulated. | **Lobulated. | ||
*No (macroscopic) cysts apparent on gross. | *No (macroscopic) cysts apparent on gross. | ||
===Microscopic=== | |||
Features: | |||
*Cuboidal cells. | *Cuboidal cells. | ||
**Glycogen rich. | **Glycogen rich. | ||
DDx | ===DDx=== | ||
*Renal cell carcinoma. | *Renal cell carcinoma. | ||
*Lympangioma. | *Lympangioma. | ||
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Note: | Note: | ||
*Looks | *Looks different than serous tumour. | ||
=== | ===Subclassification=== | ||
*Sucinous cystadenoma. | *Sucinous cystadenoma. | ||
*Borderline mucinous cystic tumour. | *Borderline mucinous cystic tumour. | ||
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*Few mitoses in borderline. | *Few mitoses in borderline. | ||
===Radiology=== | |||
*Mucinous tumours: multilocular. | *Mucinous tumours: multilocular. | ||
*Generally larger than serous. | *Generally larger than serous. | ||
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*Usually tail & body. | *Usually tail & body. | ||
=== | ===Microscopic=== | ||
====Mucinous cystadenoma==== | ====Mucinous cystadenoma==== | ||
** | Features:<ref>GLP P.489.</ref> | ||
** | *Simple tall columnar epithelium with large mucin vacuole on apical aspect. | ||
* | *"Ovarian-type stroma" under epithelium. | ||
**Ovarin-type stroma: high density of small (non-wavy) spindle cells with eosinophilic cytoplasm. | |||
Image: [http://radiology.uchc.edu/eAtlas/Images/GYN/5705b.gif Mucinous cystadenoma - ovary (uchc.edu)]. | |||
Notes: | |||
*Appearance similar to ''mucinous cystadenoma'' in the [[ovarian tumours|ovary]]. | |||
*Mucin stains +ve (intracytoplasmic). | |||
====Borderline mucinous cystic tumour==== | ====Borderline mucinous cystic tumour==== | ||
Features: | |||
*May have finger like projections. | *May have finger like projections. | ||
*Pseudostratification. | *Pseudostratification of epithelium. | ||
Notes: | |||
* Surgery does not change based on diagnosis on frozen section. | * Surgery does not change based on diagnosis on frozen section. | ||
* Only question is "Is the margin clear?". | ** Only question is "Is the margin clear?". | ||
* Borderline tumours are rare. | * Borderline tumours are rare. | ||