胰腺疾病-2013PPT.ppt

Insulinoma Whipple triads: More than 90% without metastasis, multiple: 2-7% Not often associated with MEN. Pancreas, occasionally found in ectopic pancreas. 胰岛素瘤 Whipple 三联征（ Whipple triads） 90%以上发现时无转移，多发2-7% 不常与MEN有关 发生在胰腺，偶尔见于异位胰腺 Insulinoma insulinoma Gastrinoma Zollinger-Ellison syndrome About 60% are with metastasis . Often associated with MEN type I. Pancreas, duodenum and stomach. 胃泌素瘤 Zollinger-Ellison 综合征（Zollinger-Ellison syndrome） 约60%发现时已有转移 常与MEN有关 发生在胰腺、十二指肠和胃 胰母细胞瘤 胰母细胞瘤 Trypsin CgA Endocrine pancreas B cells: (insulin)-- anabolism (glucose uptake and conversion to glycogen; uptake of aa an synthesis of protein; storage of fat in fat depots and conversion of glucose to fat). A cells: (glucagon)-- promote catabolism ( glycogen to glucose and utilized by tissue; aa to glucose in liver; increased conversion of fat to glucose). D cells: (somatostatin) -- control secretion of islet hormones. PP cells: (PP) --inhibition of exocrine secretion and relaxation of gallbladder. D1 cells: (vasoactive intestinal polypeptide(VIP)-like hormone) -- vasodilative. Endocrine tumors of the pancreas Functional: Non-functional Insulinoma Gastrinoma Glucagonoma Somatostatinoma VIPoma Ppoma Carcinoid tumor 胰腺内分泌肿瘤 功能性 无功能性 胰岛素瘤 胃泌素瘤 胰高血糖素瘤 生长抑素瘤 血管活性肠肽瘤 类癌 胰腺多肽瘤？ 胰腺多肽瘤？ Grading Mitotic count Ki67 index 1 2/10HPF 2% 2 2-20/10HPF 3-20% 3 20/10HPF 20% Grade 1,2 (NET); grade 3 (NEC) 未分化癌 CK 未分化癌伴破骨巨细胞 未分化癌伴破骨巨细胞 CK Acinar cell carcinoma Usually adult, also in children Relatively well-circumscribed mass 10 cm, with extensive hemorrhage and necrosis Cellular neoplasm: solid, trabecular or glandular May produce normal acinar structure Round to oval nuclei Abundant eosinophilic granular cytoplasm EM:abundant ER and zymogen-like granules Duct changes Squamous metaplasia mucinous cell hypertrophy ( simple hyperplasia) papillary hyperplasia adenomatoid ductal hyperplasia ductal dysplasia (mild, moderate,