Pancreatic and Periampullary Tumors

This flashcard set covers the anatomy, clinical diagnosis, classification, and surgical management of periampullary and pancreatic neoplasms, including both benign cystic lesions and malignant adenocarcinomas.

Periampullary region

A complex anatomic area comprising the Ampulla of Vater, the distal common bile duct, the second portion of the duodenum, and the head of the pancreas.

Periampullary cancer

Tumors arising within $1\,cm$ of the Ampulla of Vater, classified according to their specific anatomic location.

CA 19-9

A serum tumor marker used to establish a baseline for monitoring treatment response and assessing recurrence, though levels correlate with bilirubin and can show false positives in cholestasis.

Courvoisier sign

A clinical finding characterized by painless jaundice and a palpable gallbladder, often serving as the initial symptom of pancreatic head cancer.

Pseudocyst

The most common cystic lesion of the pancreas ($90\%$), arising as a complication of pancreatitis rather than being a true neoplastic cyst.

Serous cystadenoma (SCN)

A benign, slow-growing neoplasm predominant in women aged $50-70$ years, often showing a microcystic or honeycomb appearance and a central stellate scar on imaging.

Mucinous cystic neoplasm (MCN)

A mucin-producing, thick-walled multiloculated mass with malignant potential, typically found in the pancreatic tail of women aged $40-60$ years and characterized by lack of communication with the pancreatic duct.

Intraductal papillary mucinous neoplasm (IPMN)

A mucin-producing epithelial neoplasm arising within the pancreatic ducts that causes ductal dilation and always communicates with the pancreatic duct system.

Main duct IPMN (MD-IPMN)

A type of IPMN predominantly found in men and localized in the pancreatic head, carrying a five-year risk of invasive cancer of approximately $60\%$.

Solid pseudo-papillary neoplasm

A rare, low-grade malignant tumor occurring mostly in women under $40$ years of age, showing both solid and cystic components.

Double-duct sign

A CT imaging finding showing the simultaneous dilation of the common bile duct and the pancreatic duct, often caused by a tumor in the head of the pancreas.

Pancreatic intraepithelial neoplasia, grade 3 (PanIN-3)

A microscopic, non-invasive epithelial proliferation considered to be carcinoma in situ with a high risk of progression to invasive ductal adenocarcinoma.

Trousseau's syndrome

An unexplained thrombotic event or venous thromboembolism that precedes or appears concomitantly with an occult visceral malignancy like pancreatic cancer.

Ductal adenocarcinoma

The most common form of pancreatic cancer, accounting for approximately $80\%$ of all cases.

Borderline resectable tumor (Type A)

A pancreatic tumor classification indicating local growth with vascular involvement but no evidence of distant metastasis.

Pancreaticoduodenectomy (Whipple procedure)

A surgical procedure that removes the head of the pancreas, duodenum, gallbladder, and bile duct while preserving the stomach and the rest of the pancreas.

Brittle diabetes

A potential post-surgical complication of a pancreaticoduodenectomy (Whipple procedure) characterized by difficult-to-manage blood glucose levels.

KRAS activation

A genetic alteration responsible for approximately $5-10\%$ of pancreatic cancers.