Podcast
Questions and Answers
What percentage of pancreatic cystic lesions are pseudocysts?
What percentage of pancreatic cystic lesions are pseudocysts?
- 25%
- 75% (correct)
- 50%
- 90%
Which of the following is the main microscopic feature distinguishing pseudocysts from true cysts or cystic neoplasms?
Which of the following is the main microscopic feature distinguishing pseudocysts from true cysts or cystic neoplasms?
- Thick, irregular wall
- Lack of epithelial lining (correct)
- High amylase content
- Presence of hemorrhage
Which artery is the most common source of hemorrhage in pancreatic pseudocysts?
Which artery is the most common source of hemorrhage in pancreatic pseudocysts?
- Hepatic artery
- Splenic artery (correct)
- Gastroduodenal artery
- Superior mesenteric artery
Which of the following approaches is becoming the preferred method for internal drainage of pancreatic pseudocysts?
Which of the following approaches is becoming the preferred method for internal drainage of pancreatic pseudocysts?
When is external drainage preferred for pancreatic pseudocysts?
When is external drainage preferred for pancreatic pseudocysts?
Which characteristic distinguishes congenital cysts from other pancreatic cysts?
Which characteristic distinguishes congenital cysts from other pancreatic cysts?
Congenital cysts may be associated with which of the following conditions?
Congenital cysts may be associated with which of the following conditions?
What type of epithelium lines lymphoepithelial cysts?
What type of epithelium lines lymphoepithelial cysts?
Retention cysts are a result of what pathological process?
Retention cysts are a result of what pathological process?
What is the proposed origin of pancreatic lymphoepithelial cysts?
What is the proposed origin of pancreatic lymphoepithelial cysts?
Which of the following characteristics is NOT typically associated with pancreatic pseudocysts?
Which of the following characteristics is NOT typically associated with pancreatic pseudocysts?
A patient with a history of chronic alcohol abuse presents with abdominal pain and is found to have a large pancreatic cyst. Microscopic examination reveals a thick, irregular wall, no epithelial lining, and high amylase content in the fluid. Which of the following is the most likely diagnosis?
A patient with a history of chronic alcohol abuse presents with abdominal pain and is found to have a large pancreatic cyst. Microscopic examination reveals a thick, irregular wall, no epithelial lining, and high amylase content in the fluid. Which of the following is the most likely diagnosis?
A patient is diagnosed with multiple congenital cysts in the pancreas, liver, and kidneys. Which genetic condition should be suspected?
A patient is diagnosed with multiple congenital cysts in the pancreas, liver, and kidneys. Which genetic condition should be suspected?
Which type of non-neoplastic pancreatic cyst may be confused with intraductal papillary mucinous neoplasms (IPMNs) but has a different apomucin phenotype?
Which type of non-neoplastic pancreatic cyst may be confused with intraductal papillary mucinous neoplasms (IPMNs) but has a different apomucin phenotype?
A pathologist examines a pancreatic cyst and notes the presence of sebaceous appendages, hair follicles, and columnar epithelium. Which of the following is the MOST likely diagnosis?
A pathologist examines a pancreatic cyst and notes the presence of sebaceous appendages, hair follicles, and columnar epithelium. Which of the following is the MOST likely diagnosis?
Flashcards
Pseudocysts
Pseudocysts
Most common pancreatic cysts, often linked to pancreatitis or trauma. They lack an epithelial lining and can grow quite large.
Pseudocyst Gross Appearance
Pseudocyst Gross Appearance
Characterized by a thick, irregular wall, ragged inner surface, and cloudy or bloody intraluminal content. Microscopically, they lack an epithelial lining.
Pseudocyst Microscopic Features
Pseudocyst Microscopic Features
Fibrin, inflammation, hemorrhage, and fibrosis within a cyst that lacks epithelial lining. Fluid inside has high amylase content.
Pseudocyst Complications
Pseudocyst Complications
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Congenital Pancreatic Cysts
Congenital Pancreatic Cysts
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Congenital Cyst Associations
Congenital Cyst Associations
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Lymphoepithelial Cysts
Lymphoepithelial Cysts
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Retention Cysts
Retention Cysts
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Para-ampullary Duodenal Wall Cysts
Para-ampullary Duodenal Wall Cysts
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Mucinous Non-Neoplastic Cysts
Mucinous Non-Neoplastic Cysts
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Study Notes
- Pancreatic cysts include pseudocysts and congenital cysts.
Pseudocysts
- The most common pancreatic cyst type, making up about 75% of cases.
- Related to acute or chronic pancreatitis, trauma, and rarely, neoplastic obstruction of large ducts.
- Can grow very large (3-20 cm) and spread beyond the pancreas.
- Multiple in 10-20% of cases.
- Have a thick and irregular wall.
- Inner surface is ragged, and the content inside is cloudy or bloody.
- Lack an epithelial lining, which distinguishes them from cystic neoplasms.
- Prominent presence of fibrin, inflammation, hemorrhage, and fibrosis.
- Intraluminal fluid has a high amylase content.
- May or may not communicate with the ductal system.
- Complications include perforation, infection, and hemorrhage.
- Hemorrhage from the splenic artery is a major risk, potentially causing sudden death.
- Internal drainage is done via surgery like cystogastrostomy or cystojejunostomy, but endoscopic drainage is becoming more common.
- External drainage is preferred for infected or ruptured pseudocysts.
- Surgical resection is needed for pseudocysts in the tail of the pancreas or when drainage isn't feasible.
Congenital Cysts
- Located within the pancreas and do not connect with the ductal system.
- Lined with a single layer of flat, nonmucinous epithelium.
- May be linked to von Hippel-Lindau (VHL) disease, fibropolycystic liver/kidney disease, or oral-facial-digital syndrome type I -- especially if multiple are present.
- Similar cysts may also be present in other organs like the liver or kidney.
- When associated with a malformation syndrome, it is known as pancreatic cystic dysplasia/dysgenesis.
Lymphoepithelial Cysts
- A distinct type of pancreatic cyst that are similar in structure to cysts found in branchial pouch areas.
- Often have multiple compartments and are lined by squamous epithelium.
- Feature lymphocytes in the wall, often with germinal center formation.
- May develop from pancreatic ducts extending into a lymph node or an accessory spleen within the pancreas.
Other Non-Neoplastic Cysts
- Epidermoid cysts within intrapancreatic accessory spleens.
- Dermoid cysts (monodermal teratomas) may contain sebaceous appendages, hair, and columnar or respiratory epithelium, as well as squamous epithelium.
- Retention cysts are dilated segments of pancreatic ducts caused by obstruction.
- Squamoid cysts are lined by squamous epithelium but lack lymphocytes in their wall.
- Para-ampullary duodenal wall cysts may originate from the ductal part of ectopic pancreatic tissue or be related to paraduodenal pancreatitis.
- Enterogenous (enteric duplication) cysts.
- Mucinous non-neoplastic cysts can be unilocular or multilocular, and lack communication with the pancreatic ducts.
- Parasitic cysts due to hydatid disease.
- Mucinous non-neoplastic cysts may be unilocular or multilocular.
- Do not connect with the pancreatic ducts.
- Have an apomucin phenotype different from that of intraductal papillary mucinous neoplasms (IPMNs).
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