CARCINOMA PANCREAS EXOCRINE PANCREASE 5 TH MOST FREQUENT

CARCINOMA PANCREAS EXOCRINE PANCREASE 5 TH MOST FREQUENT CAUSE OF CANCER DEATH PRECEDED BY LUNG, COLON, BREAST PROSTATE CANCER.

CARCINOMA PANCREAS 1. EPIDEMIOLOGY 2. PATHOGENESIS INCLUDING MOLECULAR LEVEL 3. PATHOLOGY GROSS MICROSCOPY 4. DIAGNOSIS 5. CLINICAL FEATURES 6. PROGNOSIS

CARCINOMA PANCREAS EVERY YEAR 28, 000 NEW PATIENTS ARE IDENTIFIED. AGE- PEAK INCIDENCE BETWEEN 60 & 80 YEARS

ETIOLOGY OF CARCINOMA PANCREAS 1. HIGHER IN SMOKERS THAN IN NONSMOKERS

ETIOLOGY OF CARCINOMA PANCREAS 2. DIET & OBESITYHIGH TOTAL CALORIC VALUE, CONSUMPTION OF ANIMAL PROTEINS & FATS. OBESITY IS A RISK FACTOR.

ETIOLOGY OF CARCINOMA PANCREAS 3. CHEMICAL CARCINOGENSEXPOSURE TO BETA NAPHTHYLAMINE, BENZIDINE, NITROSAMINES

ETIOLOGY OF CARCINOMA PANCREAS 4. DIABETES MELLITUS 5. CHRONIC PANCREATITIS 6. MUTATION IN K-RAS GENE (12 p)IS FOUND IN >90% OF CASES. P 16 CDKN 2 A(9 p) IN >95% OF CASES P 53 (17 p) IN 50 – 70 % OF CASES

MORPHOLOGY GROSSLOCATION – HEAD OF THE PANCREAS 60% OF CASES (20% OF CASES RESECTABLE) FOLLOWED IN DECREASING FREQUENCY BY THE BODY & TAIL 15% IN THE BODY 5% IN THE TAIL 20 % IS DIFFUSE

NORMAL PANCREAS

MORPHOLOGY HEAD SMALL HOMOGENOUS POORLY DEFINED GREY WHITE MASS EXTENDING INTO THE AMPULLA OF VATER, COMMON BILE DUCT & DUODENUMHENCE OBSTRUCT THE COMMON BILE DUCT AS IT COURSES THROUGH THE HEAD OF THE PANCREAS CAUSING MARKED DISTENTION OF THE BILIARY TREE MOST DEVELOP OBSTRUCTIVE JAUNDICE

CARCINOMA HEAD OF THE PANCREAS

MORPHOLOGY OBSTRUCTIVE BILIARY SYMPTOMS

MORPHOLOGY CARCINOMA OF BODY & TAILLARGE ERREGULAR MASSES , WIDELY DISSEMINATED BY THE TIME THEY ARE DISCOVERED

MORPHOLOGY CARCINOMA INFILTRATE TRANSVERSE COLON STOMACH, LIVER , SPLEEN , LYMPH NODES (PERIPANCREATIC, GASTRIC, MESENTERIC, OMENTAL AND PORTAHEPATIC ) RETROPERITONEUM ENTRAPPING ADJACENT NERVES , VERTEBRAL COLUMN.

MICROSCOPY 1. DUCTAL CARCINOMA ADENOCARCINOMANO DIFFERENCE BETWEEN CARCINOMA HEAD OF AND BODY AND TAIL OF THE PANCREAS MUCINOUS OR NONMUCINOUS

MICROSCOPY OTHER DUCTAL CARCINOMAS ARE ADENOSQUAMOUS CELL CARCINOMA UNDIFFERENTIATED WITH OSTEOCLAST LIKE GIANT CELL

MICROSCOPY 11. ACINAR CELL CARCINOMA WITH ACINAR CELL DIFFERENTIATION INCLUDING FORMATION OF ZYMOGEN GRANULES AND PRODUCTION OF EXOCRINE ENZYME LIKE TRYPSIN AND LIPASE

MICROSCOPY AND THE PRODUCTION OF EXOCRINE ENZYMES

CARCINOMA PANCREAS

CARCINOMA PANCREAS

MICROSCOPY PERINEURAL & INTRANEURAL INVASION

CLINICAL FEATURES OF CARCINOMA PANCREAS DEPEND ON SITE OF ORIGIN OF THE TUMOUR HEAD OF THE PANCREASOBSTRUCTIVE JAUNDICE EARLY PRESENTATION

CLINICAL FEATURES OF CARCINOMA PANCREAS DARK URINE, CLAY LIKE STOOLS, PRURITUS, HIGH SERUM ALKALINE PHOSPHATASE.

CLINICAL FEATURES OF CARCINOMA PANCREAS OTHER FEATURES ABDOMINAL PAIN CACHEXIA, ANOREXIA WEIGHT LOSS

CLINICAL FEATURES OF CARCINOMA PANCREAS WEAKNESS, MALAISE, NAUSEA, VOMITING MIGRATORY THROMBOPHLEBITIS ( TROUSSEAU SIGN)

PROGNOSIS DISMAL MEDIAN SURVIVAL IS 6 MONTHS FROM THE TIME OF DIAGNOSIS ONE YEAR SURVIVAL- 10% FIVE YEAR SURVIVAL- 1 – 2 %

INSULINOMA A RARE TUMOUR OF PANCREAS PRODUCE EXCESS INSULIN MORE COMMON IN FEMALES PRODUCE LOW BLOOD SUGAR

INSULINOMA

INSULINOMA SYMPTOMS OF LOW BLOOD SUGAR ARE TIREDNESS, WEAKNESS, T REMOURS, HUNGER

INSULINOMA PATIENTS HAVE TO EAT FREQUENTLY. SOME PATIENTS DEVELOP PSYCHIATRIC PROBLEMS DUE TO HYPOGLYCEMIA

INSULINOMA USUALLY SMALL LESS THAN 2 Cm 90% ARE BENIGN, ENCAPSULATED RED BROWN MOST ARE SOLITARY

INSULINOMA-MICROSCOPY THE TUMOUR LOOK LIKE GIANT ISLETS WITHOUT MUCH ANAPLASIA IN REGULAR CORD LIKE PATTERN EVEN MALIGNANT TUMOURS ARE DECEPTIVELY ENCAPSULATED

INSULINOMA-GROSS

INSULINOMA

ZOLLINGER-ELLISON SYNDROME(GASTRINOMAS) ZOLLINGER–ELLISON SYNDROME (ZES) IS CAUSED BY A NON–BETA ISLET CELL, GASTRIN-SECRETING TUMOR OF THE PANCREAS THAT STIMULATES THE ACIDSECRETING CELLS OF THE STOMACH TO MAXIMAL ACTIVITY, WITH CONSEQUENT GASTROINTESTINAL MUCOSAL ULCERATION(PEPTIC ULCERS).

ZOLLINGER-ELLISON SYNDROME(GASTRINOMAS) ZES MAY OCCUR SPORADICALLY OR AS PART OF AN AUTOSOMAL DOMINANT FAMILIAL SYNDROME CALLED MULTIPLE ENDOCRINE NEOPLASIA TYPE 1 (MEN 1). THE PRIMARY TUMOR IS USUALLY LOCATED IN THE PANCREAS, DUODENUM.

ZOLLINGER-ELLISON SYNDROME(GASTRINOMAS) HYPERSECRETION OF GASTRIC ACID SEVERE PEPTIC ULCERATION THE RATIO OF DUODENAL TO GASTRIC ULCERATION IS 6: 1.

GASTRINOMA WITH PEPTIC ULCERATION

ZOLLINGER ELLISON SYNDROME MICROSCOPIC FEATURES LIKE INSULINOMA –CORDS OF CELLS WITH BLAND FEATURES. RARELY EXHIBIT MARKED ANAPLASIA

GASTRINOMA

ZOLLINGER ELLISON SYNDROME MORE THAN HALF OF GASTRINOMAS ARE LOCALLY INVASSIVE OR ALREADY HAVE METASTASIZED AT THE TIME OF DIAGNOSIS.

ZOLLINGER ELLISON SYNDROME GASTRINOMAS MAY BE MULTIPLE WHEN ASSOCIATED WITH MEN SYNDROME 1.

MEN SYNDROME MULTIPLE ENDOCRINE NEOPLASIA TYPE 1 (MEN-1 SYNDROME) OR WERMER'S SYNDROME IS PART OF A GROUP OF GENETICALLY INHERITED DISORDERS (HYPERPLASIA, ADENOMAS, CARCINOMAS)THAT AFFECT THE ENDOCRINE ORGANS KNOWN AS MEN SYNDROME

MULTIPLE ENDOCRINE NEOPLASIA TYPE 1 (MEN-1 SYNDROME) OR WERMER'S SYNDROME COMPONENTS OF THE SYNDROME PITUITARY ADENOMAS, PARATHYROID –HYPERPLASIA+++, ADENOMAS+ PANCREATIC ISLET HYPERPLASIA++, ADENOMAS++, CARCINOMAS+++) ADRENAL CORTICAL HYPERPLASIA MUTANT GENE LOCUS –MEN 1(CHROMOSOME 11 q 13)

ZOLLINGER-ELLISON SYNDROME(GASTRINOMAS) 50% OF PATIENTS DEVELOP DIARRHEA. TREATMENT – EXCISION. TUMOURS METASTATIC TO LIVER HAVE SHORTENED LIFE EXPECTANCY