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Chapter 12: Pathology of the Pancreas

Which of the following statements is true?

A. Pancreatic hormones are secreted into acinar lumens.

B. If left untreated, dysplasia commonly develops in pancreatic pseudocysts.

C. Liver metastases are often the initial presentation of insulinomas.

D. The prognosis of invasive ductal adenocarcinoma is poor.

E. Pancreatic biopsy is an important part of the work up of diabetes mellitus.

Answer: D

Explanation: As of 2014, the 5-year survival rate for pancreatic cancer is 8.5% (National Institutes of Health, SEER Program). Islet-produced hormones are secreted into the bloodstream. Pancreatic pseudocysts lack an epithelial lining, thus dysplasia is not a possible outcome. Insulinomas usually present with hypoglycemia. Pancreatic biopsy does not play a role in the diagnosis of diabetes mellitus.

An 18-year-old man is involved in an automobile accident and dies from his injuries. During a review of the medical history, the pathologist notes that the decedent had a history of Type I diabetes mellitus. Which of the following histologic finding(s) is most likely to be found in a representative section of the pancreas?

A. Profound loss of acinar tissue and severe fibrosis

B. Pancreatic duct dilation and calcifications

C. Islet amyloid deposition and islet fibrosis

D. Lymphocytic infiltrates within Islets of Langerhans

Answer: D

Explanation: The characteristic histologic finding of Type I diabetes mellitus is insulitis, which is a lymphocytic infiltration of Islets of Langerhans. These lymphocytes represent an autoimmune attack against insulin-producing beta cells.

Which of the following functional well-differentiated pancreatic neuroendocrine tumor IS NOT paired with its correct paraneoplastic syndrome?

A. Insulinoma: severe hypoglycemia

B. Glucagonoma: mild diabetes, migratory skin rash, venous thrombosis, and infections

C. Somatostatinoma: severe intractable watery diarrhea

D. Gastrinoma: severe peptic ulcer disease

Answer: C

Explanation: Severe intractable watery diarrhea is seen in VIPomas (vasoactive intestinal peptide). Somatostatinomas are associated with mild diabetes, gallstones, steatorrhea, and hypochlorhydria.

A 72-year-old woman presents to her primary care physician with yellowing of her eyes and skin. Upon further questioning, she states that she has lost 15 pounds in the prior few months. An abdominal CT is performed and demonstrates a 2.2 cm ...

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