Pancreas n

Pancreas neiroendokrnie tumori (PNET)Iveta Vigupe, RSU MFIV 7.gr.

http://micro2tele.com/2011/10/22/histoquarterly-pancreas/2

Endokrn funkcija Langerhansa salias

Endokrn funkcija Langerhansa saliasLdz ~2milj. saliuDiametrs: 100-300mVisvairk to ir pancreas astes daSaliu no eksokrns daas (acniem) atdala plna saistaudu kapsulaStarp nu grupim kapilru tklojums un perikapilr telpaKrsojot ar eoznu-hematoksilnu nas viendi gaias, bez sekrta graudiiem

Langerhansa salias

Immunoperoxidase staining can help identify the nature of the cells present in the islets of Langerhans. On the right, antibody to insulin has been employed to identify the beta cells. On the left, antibody to glucagon identifies the alpha cells.

Hormoni

PNET5% no visiem pancreas audzjiemIedala funkcionjoi un nefunkcionjoiLna augana

MEN1 (Multiple Endocrine Neoplasia Type 1)entiski iedzimta (A-D)Mutcija tumorsupesorgn MEN1 (11.hromosoma)Epitlijermenu, Aizkua dziedzera neiroendokrns daas, hipofzes (visbiek) un das (angiofibromas) audzjiGastrinomas, insulinomas, prolaktinomas, karcinodi

http://emedicine.medscape.com/article/1093723-overview8

NET imnfenotips

+ Ki67 prolifercijas marieris

Nelabvlgas norises parametriAudzja izmrsLimfovaskulra invzijaMitotisk aktivitteKi-67Invzija citos orgnosMetastzesHormonu produkcija

TNM klasifikcija PNETTNM StagingPancreasTxPrimary tumour cannot be assessedT0No evidence of primary tumourT1Tumour limited to pancreas and size < 2 cmT2Tumour limited to pancreas and size 24 cmT3Tumour limited to pancreas and size > 4 cm or invading duodenum or bile ductT4Tumour invading adjacent organs (stomach, spleen, colon, adrenal gland) or the wall of large blood vessels (celiac or superior mesenteric artery)

NxRegional lymph nodes cannot be assessedN0No regional lymph node metastasisN1Regional lymph node metastasisMxDistant metastasis cannot be assessedM0No distant metastasisM1Distant metastasis

http://www.myvmc.com/diseases/pancreatic-neuroendocrine-tumour-pnet/11

NET bioloisk potencila vrtjums pc mitotisks aktivittes, proliferatvs aktivittes un nekrozes

PNET veidi

Insulinoma60% no vism PNETIzcelsme B nasVid.vec. 45-57gSiev=Vr90% labdabgi audzji90% gadjomos solitriVienldz biei viss pancreas das90% 7 U/ml), hipoglikmija (60% malignasMt: plauas, kauli, aknas90% lokalizcija Passaro trijstrisGastrna intensva sekrcija25% gad. Asoci ar MEN1 (tad ar jaunkiem pacientiem)

Smagas pakpes peptisks las, vderspes, IN asioanas, vemana, slikta da, svara zudums, GERS

Gastrinoma

Gastrinoma5 gadu dzvildzeMt: 2cmPac.vecums: 50-70 gadiLokalizcija: pancreas galviaLielk daa: maligni (90%)

Klniski- steatoreja, holelitize, diabts

VIPoma (Vernera-Morisona audzjs)Izcelsme D2 nasPaaugstinta vazointestinl peptda sekrcijaoti reti audzji90% - pacienti pusm, 10%