Download Lecture outline of Pancreas tumors insulinoma glucogonoma

Lecture title:
• Hypo/ Hyper secretion of pancreas:
causes, Clinical features,
Primary , secondary tumors, Insulinoma,
glucogonama
Prof Dr Syed Mehmood Hasan
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Non-Neoplastic Cysts
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CONGENITAL CYSTS
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Morphology:
Gross:
Microscopy:
Etiology
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Arise after acute pancreatitis in the setting of
chronic alcoholic pancreatitis and traumatic
injury
Morphology
Gross:
Microscopy:
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CYSTIC NEOPLASMS
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5-15% of all pancreatic cysts are neoplastic
(most cysts are pseudocysts
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Cystic neoplasms (<5% of all pancreatic
neoplasms).
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Serous cystadenoma (benign)
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Mucinous cystic neoplasms (benign or
malignant).
Serous cystadenomas
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Benign cystic neoplasms composed of
glycogen-rich cuboidal cells
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It is surrounding small (1- to 3-mm) cysts
containing clear, thin, straw-colored fluid
Symptoms:
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Abdominal pain
Abdominal masses.
benign
Mucinous cystic neoplasms
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95% arise in women
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They can be associated with an invasive
carcinoma
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Mucinous cystic neoplasms arise in the body
or tail of the pancreas
Presentation:
Gross:
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Diagnosis:
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PANCREATIC CARCINOMA
Infiltrating ductal adenocarcinoma
“Pancreatic cancer,”
4th leading cause of cancer deaths in the United
States
Pancreatic cancer has one of the highest
mortality rates of any cancer.
The 5-year survival rate is less than 5%
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Precursors to Pancreatic Cancer
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The PanIN-invasive carcinoma sequence is
supported by the following observations:
The precursor lesions are called “pancreatic
intraepithelial neoplasias” (PanINs).
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Morphology.
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Two features are characteristic of pancreatic
cancer:
Highly invasive
Desmoplastic response.
Microscopically
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Clinical Features.
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HYPERINSULINISM (INSULINOMA)
β-cell tumors (insulinomas) are the most
common of pancreatic endocrine neoplasms.
Responsible for the elaboration of sufficient
insulin to induce clinically identified
hypoglycemia.
The characteristic clinical picture:
occur with blood glucose levels below 50
mg/dL of serum
Central nervous system manifestations 
confusion, stupor, and loss of consciousness
Precipitated by fasting or exercise and are
promptly relieved by feeding or parenteral
administration of glucose
Morphology
Insulinomas are most often found within the pancreas
Benign nature.
Solitary multiple tumors
10% of cases,
Diagnosed on the basis of local invasion and distant
metastases.
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Solitary tumors  <2 cm in diameter
Encapsulated, pale to red-brown nodules
Histological appearance:
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Clinical Features
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80% of islet cell tumors demonstrate excessive insulin
secretion
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Hypoglycemia is mild
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The differential diagnosis & Other causes of hypoglycemia:
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The critical laboratory findings in insulinoma:
High circulating levels of insulin
High insulin-to-glucose ratio.
Surgical removal of the tumor is usually followed by prompt
reversal of the hypoglycemia.
ZOLLINGER-ELLISON SYNDROME
(GASTRINOMAS)
• Marked hypersecretion of gastrin usually has its
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origin in gastrin-producing tumors (gastrinomas),
Arise in the duodenum and peripancreatic soft
tissues as in the pancreas (gastrinoma triangle).
• Cell of origin  Endocrine cells of either the gut
or the pancreas is the source.
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Clinical Features
More than 50% of the patients have diarrhea
Treatment of Zollinger-Ellison syndrome:
Control of gastric acid secretion by use of H+,K+-ATPase
inhibitors
Excision of the neoplasm.
Morphology.