Saturday, 10 April 2010

Tumours of Exocrine Pancreas

Benig/Mal/Solid/Cyst
>80% Ductal Adenocarcinoma

Ductal Adenocarcinoma
From dysplastic ductal epithelium
10/100 000
*5th cancer mortality in Western Society

Cystic
<5% pancreatic tumours
Cystadenoma (Ben)
Cystadenocarcinoma (Malig)
Dx by micro

Symptoms
*Very late
Insidiously, non-specific O/S
Abdo pain
WL
Anorexia
Vomiting
>50% develop jaundice, h/e, <20% J at Pn
Migratory thrombophlebitis (Trousseau's Sign)
 - w/ appearing/disappearing Tbs in 10%
Painless distended GB (Courvoisier's Sign)

Aetiology
Unknown
A/w/ smoking with chronic pancreatitis and DM
Inconsistent a/w/ alcohol & Hlipid
Familial clustering

Pathology
Head (60%)
Body (15%)
Tail (5%)
Diffuse (20%)

Gritty/hard/pale masses
Poorly defined infiltrating edges
Invades adjacent structures

Micro
*poorly-moderately differentiated adenoCa
Infiltrating pattern of cell clusters
10% adenosquamous/giant cell/sarcomatoid type

Cx
*Very late with pain 2ry to nerve compression/invasion
Invasion = x Cure

Mets
Local
Peritoneum
Spine
Liver
Distant
Lungs
Bone

*Death w/i 18months
<15% resectable at Dx
Sx = palliative

No comments:

Post a Comment