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EXOCRINE PANCREAS - CARCINOMA PANCREAS

EXOCRINE PANCREAS - CARCINOMA PANCREAS. EXOCRINE PANCREASE 5 TH MOST FREQUENT CAUSE OF CANCER DEATH PRECEDED BY LUNG,COLON,BREAST PROSTATE CANCER. CARCINOMA PANCREAS. 1.EPIDEMIOLOGY 2. ETIOPATHOGENESIS INCLUDING MOLECULAR LEVEL 3.PATHOLOGY GROSS MICROSCOPY 4. DIAGNOSIS

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EXOCRINE PANCREAS - CARCINOMA PANCREAS

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

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

  3. EPIDEMIOLOGY EVERY YEAR 28,000 NEW PATIENTS ARE IDENTIFIED. AGE- PEAK INCIDENCEBETWEEN 60 & 80 YEARS

  4. ETIOPATHOGENESIS OF CARCINOMA PANCREAS 1. HIGHER IN SMOKERS THAN IN NONSMOKERS

  5. ETIOPATHOGENESIS OF CARCINOMA PANCREAS 2. DIET & OBESITY- HIGH TOTAL CALORIC VALUE,CONSUMPTION OF ANIMAL PROTEINS & FATS. OBESITY ARE RISK FACTORS.

  6. ETIOPATHOGENESIS OF CARCINOMA PANCREAS 3. CHEMICAL CARCINOGENS-EXPOSURE TO BETA NAPHTHYLAMINE,BENZIDINE, NITROSAMINES

  7. ETIOLOGY OF CARCINOMA PANCREAS 4. DIABETES MELLITUS 5. CHRONIC PANCREATITIS 6. MUTATION IN K-RAS GENE (12p)IS FOUND IN >90% OF CASES. P16 CDKN2A(9p) IN >95% OF CASES P53 (17p) IN 50 – 70 % OF CASES

  8. MORPHOLOGY GROSS- LOCATION – 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

  9. NORMAL PANCREAS

  10. MORPHOLOGY HEAD SMALL HOMOGENOUS POORLY DEFINED GREY WHITE MASS EXTENDING INTO THE AMPULLA OF VATER, COMMON BILE DUCT & DUODENUM- HENCE 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

  11. CARCINOMA HEAD OF THE PANCREAS

  12. MORPHOLOGY CARCINOMA HEAD OF THE PANCREAS PRESENT WITH OBSTRUCTIVE BILIARY SYMPTOMS

  13. MORPHOLOGY CARCINOMA OF BODY & TAIL-LARGE IRREGULAR MASSES ,WIDELY DISSEMINATED BY THE TIME THEY ARE DISCOVERED

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

  15. MICROSCOPY 1. DUCTAL CARCINOMA ADENOCARCINOMA- NO DIFFERENCE BETWEEN CARCINOMA HEAD OF AND BODY AND TAIL OF THE PANCREAS. MUCINOUS OR NONMUCINOUS

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

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

  18. CARCINOMA PANCREAS

  19. ADENOCARCINOMA

  20. ADENOCARCINOMA

  21. MICROSCOPY PERINEURAL & INTRANEURAL INVASION

  22. PERINEURAL INVASION

  23. CLINICAL FEATURES OF CARCINOMA PANCREAS DEPEND ON SITE OF ORIGIN OF THE TUMOUR HEAD OF THE PANCREAS- OBSTRUCTIVE JAUNDICE EARLY PRESENTATION

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

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

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

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

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

  29. INSULINOMA

  30. INSULINOMA SYMPTOMS OF LOW BLOOD SUGAR ARE TIREDNESS,WEAKNESS,TREMOURS, HUNGER

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

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

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

  34. INSULINOMA-GROSS

  35. INSULINOMA

  36. 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 ACID-SECRETING CELLS OF THE STOMACH TO MAXIMAL ACTIVITY, WITH CONSEQUENT GASTROINTESTINAL MUCOSAL ULCERATION(PEPTIC ULCERS).

  37. 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 .

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

  39. GASTRINOMA WITH PEPTIC ULCERATION

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

  41. GASTRINOMA

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

  43. ZOLLINGER ELLISON SYNDROME GASTRINOMASMAY BE MULTIPLE WHEN ASSOCIATED WITH MEN SYNDROME1.

  44. 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,CARCINO-MAS)THAT AFFECT THE ENDOCRINE ORGANS KNOWN AS MEN SYNDROME

  45. 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 –MEN1(CHROMOSOME 11q 13)

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

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