Pancreatic Pathology Practice Questions

Q: Which cystic neoplasm of the pancreas is more commonly seen in females?

Mucinous cystic neoplasm. ***Mucinous cystic neoplasm*** - This **pancreatic cystic neoplasm** is almost exclusively found in **females**, with a strong predilection for the body and tail of the pancreas [1]. - They have a **malignant potential** and are characterized by cellular mucin production and an ovarian-type stroma. *Serous cystadenoma* - While more common in females, its gender predilection is not as pronounced as with mucinous cystic neoplasms [1]. - These are typically **benign** and appear as a sponge-like honeycombed lesion with a central stellate scar. *Solid pseudopapillary neoplasm* - This tumor also predominantly affects **young women**, but its characteristic presentation includes both solid and cystic components, often with papillary structures. - It is distinct from mucinous cystic neoplasm in its microscopic features and the presence of **beta-catenin mutations**. *Acinar cell cystadenocarcinoma* - **Acinar cell carcinomas** are rare pancreatic tumors, and the cystic variant is even rarer, without a clear female predominance. - They are typically characterized by features of acinar differentiation and have a more aggressive clinical course. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, pp. 895-897.

Q: CA 19-9 is a marker for which of the following:

Pancreatic carcinoma. ***Pancreatic carcinoma*** - **CA 19-9** is a widely used **tumor marker** primarily associated with **pancreatic cancer** [1]. - Its levels can be elevated in other conditions such as **cholangitis** or **gallstones**, but its most significant clinical utility is in monitoring pancreatic cancer progression and response to treatment [2], [4]. *Breast carcinoma* - The primary tumor markers for breast carcinoma are **CA 15-3** and **CA 27-29**, which are used for monitoring recurrence and treatment response. - While CA 19-9 can be slightly elevated in some breast cancer cases, it is not considered a primary or reliable marker for this type of cancer. *Lung carcinoma* - Common tumor markers for lung cancer include **CEA** (carcinoembryonic antigen) for non-small cell lung cancer and **NSE** (neuron-specific enolase) for small cell lung cancer [3]. - CA 19-9 has very limited utility in the diagnosis or monitoring of lung carcinoma. *Ovarian carcinoma* - **CA-125** is the primary tumor marker used for ovarian carcinoma, particularly for monitoring disease progression and treatment response. - Although CA 19-9 can be elevated in some gynecological malignancies, it is not the marker of choice for ovarian cancer.

Q: Term "Pseudo" used in "Pseudocyst" is due to its -

Lining. ***Lining*** - A **pseudocyst** lacks an **epithelial or endothelial lining**, which is characteristic of true cysts [1]. - Instead, its wall is formed by **fibrous tissue** and **granulation tissue** surrounding fluid collections [1]. *Site* - The term "pseudo" does not refer to the **location** of the cyst. - Pseudocysts commonly occur in specific organs like the **pancreas**, but their site is not what defines them as "pseudo" [1]. *Course* - The **clinical course** or progression of a pseudocyst, whether it resolves spontaneously or requires intervention, is not the basis for the "pseudo" designation [1]. - Its behavior, while clinically important, does not define its fundamental nature. *Contents* - The contents of a pseudocyst, which often include **necrotic debris**, **inflammatory fluid**, or **pancreatic enzymes**, do not define the "pseudo" aspect. - The fluid composition is a result of the underlying condition, not the reason for the term "pseudo." **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, p. 895.

Q: A 50-year-old chronic alcoholic presents to the emergency room with 12 hours of severe abdominal pain. The pain radiates to the back and is associated with an urge to vomit. Physical examination discloses exquisite abdominal tenderness. Laboratory studies show elevated serum amylase. Which of the following morphologic changes would be expected in the peripancreatic tissue of this patient?

Fat necrosis. ***Fat necrosis*** - The patient's presentation with **severe abdominal pain radiating to the back**, **elevated serum amylase**, and **history of chronic alcoholism** is highly suggestive of **acute pancreatitis** [2], [3]. - **Fat necrosis** is a characteristic morphologic change in **acute pancreatitis**, occurring when activated pancreatic enzymes (especially **lipases**) leak into the peripancreatic tissue and break down fat, leading to the formation of **calcium soaps** [1]. *Caseous necrosis* - This type of necrosis is typically associated with **granulomatous inflammation**, most commonly seen in **tuberculosis** [1]. - It results in a **cheese-like appearance** and is not characteristic of pancreatic injury from acute pancreatitis [1]. *Fibrinoid necrosis* - **Fibrinoid necrosis** involves damage to **blood vessel walls**, where plasma proteins (including fibrin) leak into the vessel wall, appearing amorphous and eosinophilic. - It is typically seen in **immunologic diseases** (e.g., vasculitis) or severe hypertension, not acute pancreatitis. *Coagulative necrosis* - This type of necrosis is classically caused by **ischemia** (e.g., myocardial infarction, renal infarction), where cell outlines are preserved for a period due to the denaturation of structural proteins and enzymes. - While ischemia can lead to pancreatic damage, the primary and distinctive form of necrosis in peripancreatic fat during acute pancreatitis is **fat necrosis**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death, p. 55. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 406-407. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, pp. 889-890.

Q: Marker for pancreatic non-functional neuro-endocrine tumor is

Chromogranin-A. ***Chromogranin-A*** - **Chromogranin-A** is a glycoprotein found in the neurosecretory granules of various neuroendocrine cells, making it a reliable **general neuroendocrine tumor marker** [1]. - Elevated levels are particularly useful for detecting and monitoring **pancreatic non-functional neuroendocrine tumors**, which often lack specific hormonal symptoms. *CEA* - **Carcinoembryonic antigen (CEA)** is primarily used as a tumor marker for **colorectal cancer**, and less commonly for other adenocarcinomas like pancreatic adenocarcinoma. - It is generally **not a specific marker** for neuroendocrine tumors. *PSA* - **Prostate-specific antigen (PSA)** is a specific marker for **prostate cancer**, used for screening, diagnosis, and monitoring of this particular malignancy. - It has **no relevance** in the diagnosis or monitoring of pancreatic neuroendocrine tumors. *CD100* - **CD100** (also known as semaphorin-4D) is a membrane glycoprotein involved in immune cell regulation and has been implicated in certain cancers, such as those of **hematopoietic origin**. - It is **not used as a marker** for pancreatic non-functional neuroendocrine tumors. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 780-781.

Q: Destruction of fat in acute pancreatitis is due to ?

Lipase. ***Lipase*** - **Lipase** is the primary enzyme responsible for **fat necrosis** in acute pancreatitis. - It hydrolyzes triglycerides into **fatty acids and glycerol**. - The released fatty acids combine with calcium to form **soap (saponification)**, visible as chalky white areas of fat necrosis. - This is a characteristic pathological finding in acute pancreatitis. *Trypsin* - **Trypsin** is a proteolytic enzyme that breaks down **proteins**, not fats. - While trypsin activation is central to the pathogenesis of pancreatitis (it activates other pancreatic enzymes), **it does not directly destroy fat**. - Its primary role is in the autodigestion of pancreatic tissue and activation of the enzymatic cascade. *Secretin* - **Secretin** is a hormone that regulates pancreatic bicarbonate secretion and gastric acid secretion. - It plays **no role** in the enzymatic destruction of fat in acute pancreatitis. *Elastase* - **Elastase** is a protease that digests elastin in blood vessel walls and other proteins. - It contributes to vascular damage and hemorrhage in pancreatitis but **does not directly destroy fat**. - Fat necrosis is specifically caused by lipolytic enzymes, not proteases.

Q: What is the most specific marker for pancreatic acinar cell carcinoma?

Trypsin. ***Trypsin*** - **Trypsin**, along with other pancreatic enzymes like lipase and alpha-1-antitrypsin, is a specific marker for **pancreatic acinar cell carcinoma** due to the tumor's characteristic differentiation towards acinar cells. - The detection of these enzymes in tumor tissue or serum can aid in the diagnosis and differentiation of this rare pancreatic malignancy. *Chromogranin* - **Chromogranin** is a marker for **neuroendocrine tumors**, not specifically acinar cell carcinoma. - While some pancreatic tumors can have neuroendocrine features, chromogranin is not the most specific marker for a pure acinar cell differentiation. *Synaptophysin* - **Synaptophysin** is another marker primarily associated with **neuroendocrine differentiation**. - Its presence indicates a neuroendocrine tumor rather than an acinar cell carcinoma, which derives from exocrine acinar cells. *CK7* - **CK7** (Cytokeratin 7) is a broad-spectrum **cytokeratin** often expressed in adenocarcinomas of various origins, including pancreatic ductal adenocarcinoma. - While pancreatic tumors can express CK7, it is not specific for acinar cell carcinoma and is more commonly associated with ductal differentiation.

Q: A 68-year-old man with jaundice. CT reveals a pancreatic mass. Biopsy shows glandular cells with desmoplastic stroma. What is the most likely diagnosis?

Pancreatic adenocarcinoma. ***Pancreatic adenocarcinoma*** - The combination of **jaundice**, a **pancreatic mass** on CT, and a biopsy showing **glandular cells with desmoplastic stroma** is highly characteristic of pancreatic adenocarcinoma [1], [2]. - **Desmoplastic stroma** (dense fibrous tissue reaction) is a hallmark feature of pancreatic adenocarcinoma, supporting its diagnosis [1], [2]. *Cholangiocarcinoma* - While it can present with **jaundice** and a mass, cholangiocarcinoma arises from the **bile ducts**, not typically presenting as a primary pancreatic mass. - The biopsy demonstrating glandular cells with desmoplastic stroma is more specific to pancreatic adenocarcinoma than cholangiocarcinoma. *Hepatocellular carcinoma* - **Hepatocellular carcinoma** arises from the **liver parenchyma** and is usually associated with underlying liver disease (e.g., cirrhosis), not a pancreatic mass. - The biopsy findings of glandular cells are inconsistent with hepatocellular carcinoma, which typically shows hepatocytes. *Neuroendocrine tumor* - **Pancreatic neuroendocrine tumors** can present as a pancreatic mass but often have distinct histological features, including uniform cells with salt-and-pepper chromatin and less prominent desmoplastic stroma. - While some can secrete hormones, making them functional, the descriptive histology of "glandular cells with desmoplastic stroma" points away from a typical neuroendocrine tumor. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 408-409. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, pp. 898-900.

Question 1

A 55-year-old man with a history of heavy alcohol use presents with severe epigastric pain radiating to the back. His lipase is 1,200 U/L (normal <60), and CT shows pancreatic inflammation with peripancreatic fluid collection. On day 3, he develops hypocalcemia (Ca 7.8 mg/dL) and his lactate dehydrogenase is 400 U/L. What is the most likely explanation for these laboratory changes?

Accepted Answer

Fat necrosis and enzymatic calcium consumption

Answer

Acute kidney injury from dehydration

Answer

Liver dysfunction from alcohol use

Answer

Sepsis from pancreatic infection

Question 2

Which cystic neoplasm of the pancreas is more commonly seen in females?

Accepted Answer

Mucinous cystic neoplasm

Answer

Serous cystadenoma

Answer

Solid pseudopapillary neoplasm

Answer

Acinar cell cystadenocarcinoma

Question 3

CA 19-9 is a marker for which of the following:

Accepted Answer

Pancreatic carcinoma

Answer

Breast carcinoma

Answer

Lung carcinoma

Answer

Ovarian carcinoma

Question 4

Term "Pseudo" used in "Pseudocyst" is due to its -

Accepted Answer

Lining

Answer

Site

Answer

Course

Answer

Contents

Question 5

An 80-year-old man has increasing jaundice with abdominal pain for the past 2 weeks. He has lost 4 kg over the past 5 months. On physical examination, there is tenderness with palpable gallbladder in the right upper quadrant. An abdominal CT scan shows gallbladder and common bile duct dilation, along with a 3-cm mass in the head of the pancreas. Which of the following lesions is the most likely precursor to this mass?

Accepted Answer

Pancreatic intraepithelial neoplasia

Answer

Duodenal adenocarcinoma

Answer

Colonic neuroendocrine carcinoma

Answer

Neuroendocrine tumor

Question 6

A 50-year-old chronic alcoholic presents to the emergency room with 12 hours of severe abdominal pain. The pain radiates to the back and is associated with an urge to vomit. Physical examination discloses exquisite abdominal tenderness. Laboratory studies show elevated serum amylase. Which of the following morphologic changes would be expected in the peripancreatic tissue of this patient?

Accepted Answer

Fat necrosis

Answer

Caseous necrosis

Answer

Fibrinoid necrosis

Answer

Coagulative necrosis

Question 7

Marker for pancreatic non-functional neuro-endocrine tumor is

Accepted Answer

Chromogranin-A

Answer

CEA

Answer

PSA

Answer

CD100

Question 8

Destruction of fat in acute pancreatitis is due to ?

Accepted Answer

Lipase

Answer

Trypsin

Answer

Secretin

Answer

Elastase

Question 9

What is the most specific marker for pancreatic acinar cell carcinoma?

Accepted Answer

Trypsin

Answer

Chromogranin

Answer

Synaptophysin

Answer

CK7

Question 10

A 68-year-old man with jaundice. CT reveals a pancreatic mass. Biopsy shows glandular cells with desmoplastic stroma. What is the most likely diagnosis?

Accepted Answer

Pancreatic adenocarcinoma

Answer

Cholangiocarcinoma

Answer

Hepatocellular carcinoma

Answer

Neuroendocrine tumor

Pancreatic Pathology — MCQs

Pancreatic Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?