Unit 8 - Pancreatic Pathology ~ Endocrine Pancreatic Neoplasms

Islet Cell Tumors are considered __________ or _____________.

Functional or Non-functional (1/3)

Islet Cell Tumors can be benign __________ or __________ tumors.

Adenomas or Malignant (85%)

What is the most common Islet Cell Tumor? And different types?

- Functioning

- Insulinoma (60%); Gastrinoma (18%)

What is this image showing?

- Trans scan of the head of the pancreas

- Showing an irregularly margined mass

What is this image showing?

- Dilated CBD measuring 11.5mm

- Distended GB is half filled-with sludge

What is this image showing?

- Sagittal scan of the distended CBD

- Mass in the head of the pancreas

What is the sonographic appearance of Insulinomas?

- Hard to visualize

- Small: 1-2cm

- Body & Tail

- Well encapsulated

- Possible calcification

- Hyper vascular

- Slow growth

What is the 2nd most common Islet Cell Tumor?

Gastrinoma

What is a Gastrinoma tumor?

Excessive amounts of Gastrin

What percentage of Gastrinoma’s are malignant?

60%

What is important about the blood flow with a Gastrinoma?

Hyper-vascular

What is the most common primary neoplasm of the pancreas?

Adenocarcinoma

What percentage of pancreatic malignant masses are Adenocarcinoma?

90%

Adenocarcinoma is considered ______.

Fatal

Adenocarcinoma affects the _________ portion of the gland.

Exocrine

What is the prevalence of Adenocarcinoma?

- 60-80 years old

- Males > Females

What is the most common site for Adenocarcinoma?

The pancreas head

What are the clinical symptoms of Adenocarcinoma?

- Weight loss

- Malaise

- Painless jaundice

- N/V

- Pain radiating to back

Sonographic appearance of an Adenocarcinoma

- Loss of normal parenchymal pattern

- POORLY DEFINED MASS in region of pancreas

- Enlarged CBD, PD, & GB

Sonographic appearance of an Adenocarcinoma: What surrounding structures are abnormally displaced??

- IVC, PV, SMA, SMV, & other vessels

- If in tail ~ SV

Sonographic appearance of an Adenocarcinoma: What should you check for?

- Metastatic spread

- Tumor invasion

- Doppler Characteristics

What is this image showing?

Adenocarcinoma in a trans pancreas

What is this image showing?

Adenocarcinoma

What is this image showing?

Adenocarcinoma in the long pancreas head

What is this image showing?

Blood flow around an Adenocarcinoma in a long pancreas head

What is this image showing?

Adenocarcinoma; Long CBD near the pancreas head

Specific findings to identify differential diagnosis of pancreatic tumors: Adenocarcinoma

- Irregular, poorly defined

- Homogeneous or heterogeneous

- Hypoechoic mass

Specific findings to identify differential diagnosis of pancreatic tumors: Microcystic lesions

Defined by well-demarcated tiny cysts

Specific findings to identify differential diagnosis of pancreatic tumors: Mucinous cystic tumors

Multilocular mass with septa & solid components

Specific findings to identify differential diagnosis of pancreatic tumors: Choledochal cyst

- Mimic a cystic neoplasm in head of pancreas

- May identify CBD communication

What disease is uncommon to the pancreas?

Mets

Mets disease is reported to be found in __% of CA patients.

10

Mets to the pancreas can be from:

- Melanoma

- Breast

- GI

- Lung

____________ spreads to the pancreas.

Lymphoma

What is the most frequent para-pancreatic neoplasm?

Lymphoma

What is the US appearance of a Lymphoma in the pancreas?

- Hypoechoic mass in pancreas or with necrosis, cystic mass in pancreas

- Displacement anteriorly of superior mesenteric vessels

- Multiple enlarged nodes in area of porta hepatis

- Well defined hypoechoic nodules

What is this image showing?

Lymphoma in the pancreas

What is this image showing?

Lymphoma in the pancreas

What is diabetes?

Lack of insulin

What is insulin produced by?

Beta cells of Islets of Langerhans

What does IDDM stand for?

Insulin dependent

What does NIDDM stand for?

Non-insulin dependent

What are the clinical signs of diabetes?

- Polyuria

- Polydipsia

- Weight loss

- Hyperglycemia

- Glycosuria

- Affects eyes, kidneys, circulation, nervous system

What is the US appearance of diabetes?

Pancreas can be more echogenic or normal