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Casillas Javier - Multidisciplinary teaching atlas of the pancreas: radiological, surgical, and pathological correlations

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Casillas Javier Multidisciplinary teaching atlas of the pancreas: radiological, surgical, and pathological correlations

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This innovative teaching atlas provides the reader with a practical approach to the diagnosis and management of the common and uncommon diseases that may involve the pancreatic gland. Its perspective is multidisciplinary, the authors being radiologists, surgeons, pathologists, and gastroenterologists who have worked together for the past 25 years. Very concise descriptions of clinical presentation, pathology, imaging, and management are provided for a great variety of pathologic conditions, and a wealth of illustrative material displays intraoperative appearances, gross specimens, histology, and radiological findings. Pancreatic surgery, including transplantation, is also discussed, and the final chapter presents a gallery of challenging and diverse cases. Specialists and residents in a range of specialties will find this atlas to be an invaluable aid, and it will also serve as an excellent reference for medical students.;General: Embryology of the pancreas -- Anatomy of the pancreas -- Histology of the pancreas -- Physiology of the pancreas.- Imagenology of the pancreas -- Cystic Masses of the Pancreas: Serous Cystadenomas -- Mucinous Cystoadenomas -- Intraductal Papillary Mucinous Neoplasm. Solid Masses of the Pancreas: Neuroendocrine Tumors -- Pancreatic adenocarcinoma -- Acinar tumor of the pancreas -- Pancreatic Lymphoma -- Unusual tumor of the pancreas -- Pancreatic metastases -- Inflammatory Conditions of the Pancreas: Acute pancreatitis -- Chronic pancreatitis -- Pancreatic pseudocyst -- Autoimmune pancreatitis -- Trauma of the Pancreas: Pancreatic Trauma -- Pancreatic Surgery: Pancreas transplant -- Surgical Procedures of the Pancreas -- Gallery of Cases.

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Part I
General
Springer-Verlag Berlin Heidelberg 2016
Javier Casillas , Joe U. Levi , Alexander O. Quiroz , Roberto Ruiz-Cordero , Monica T. Garcia-Buitrago and Danny Sleeman Multidisciplinary Teaching Atlas of the Pancreas 10.1007/978-3-662-46745-9_1
1. Embryology of the Pancreas and Normal Variants
Javier Casillas 1 , Chris Granville 2, Alexander Quiroz 2 and Roberto Ruiz-Cordero 3
(1)
Department of Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 NW 12 Avenue, WW-279, Miami, FL 33136, USA
(2)
Department of Radiology, Jackson Memorial Hospital, 1611 NW 12 Avenue, WW-279, Miami, FL 33136, USA
(3)
Department of Pathology, Jackson Memorial Hospital, Holz Center, 2042E, 1611 NW 12 Avenue, Miami, FL 33136, USA
Javier Casillas
Email:
1.1
1.2
1.3
1.3.1
1.3.1.1
1.3.1.2
1.3.1.3
1.3.1.4
1.3.2
1.3.3
1.3.4
1.3.5
1.3.6
1.3.7
1.3.8
1.3.9
1.4
1.4.1
1.5
1.5.1
1.5.2
1.6
1.1 Self-Assessment Questions
The uncinate process of the pancreas derives from the dorsal pancreatic bud.
a.
True
b.
False
What is the most common type of congenital anomaly of the pancreas?
a.
Ectopic pancreas
b.
Agenesis of the pancreas
c.
Congenital short pancreas
d.
Annular pancreas
e.
Pancreas divisum
Where is heterotopic pancreatic tissue most commonly found in the body?
a.
Stomach
b.
Duodenum
c.
Jejunum
d.
Meckels diverticulum
e.
Spleen
The annular pancreas may be associated with all of these, except :
a.
Esophageal atresia
b.
Imperforate anus
c.
Congenital heart disease
d.
Malrotation of the gut
e.
Omphalocele
All of these statements about pancreatic divisum are true, except:
a.
Endoscopic cholangiopancreatography (ERCP) is the current modality used to diagnose this anomaly.
b.
It is the most common congenital anomaly of the pancreas.
c.
This anomaly can be associated with pancreatitis.
d.
Magnetic resonance cholangiopancreatography (MRCP) is the best imaging modality to diagnose this anomaly.
e.
Most patients with this anomaly are asymptomatic.
Answers : 1. b , 2. e , 3. a , 4. e , 5. a .
1.2 Organogenesis of the Pancreas (Fig. )
Fig 11 Schematic illustration of the embryologic development of the pancreas - photo 1
Fig. 1.1
Schematic illustration of the embryologic development of the pancreas. ( a ) At about 4 weeks of gestation, the primitive pancreas is formed by a dorsal pancreatic and ventral pancreatic bud that arises from the endodermal lining of the duodenum. ( b ) At 6 weeks, the ventral bud and the bile duct rotate clockwise behind the duodenum ( curved arrow ). ( c ) The ventral pancreatic bud lays posteroinferior to the dorsal pancreatic bud. ( d ) By about 7 weeks, upon reaching its final destination, the dorsal pancreatic bud fuses with the ventral pancreatic bud to form the final pancreas
  • It starts during the fourth week of gestation.
  • The pancreas originates from the endodermal lining of the duodenum.
  • Two outpouchings develop at the junction of the foregut and midgut:
    • One ventral bud (caudal)
    • One dorsal bud (cranial)
  • The ventral pancreatic bud forms the posterior part of the head and the uncinate process.
  • The dorsal pancreatic bud forms the anterior part of the head, body, and tail of the pancreas.
  • The main pancreatic duct (Wirsung) is formed from the ventral duct and the distal portion of the dorsal duct.
  • The accessory duct (Santorini) may be present due to the persistence of the proximal portion of the dorsal pancreatic duct.
  • At the sixth week of gestation, as the foregut elongates, the ventral pancreas, gallbladder, and bile duct rotate clockwise posterior to the duodenum and join the dorsal pancreas.
  • At the seventh week of gestation, the ventral pancreatic bud fuses with the dorsal bud, forming a single pancreas.
  • The ventral pancreatic duct and the common bile duct (CBD) are linked by the embryonic origins, which results in the adult configuration of the common entrance into the duodenum at the major papilla.
1.3 Congenital Disorders of the Pancreas
  • Congenital anomalies of the pancreas and pancreatic duct may be clinically insignificant and may create a diagnostic dilemma.
  • These congenital anomalies may not be detected until adulthood by computed tomography or magnetic resonance as incidental findings in asymptomatic patients.
1.3.1 Agenesis of the Pancreas
1.3.1.1 Classification
  • Complete absence of the ventral and dorsal pancreas
  • Complete absence of the dorsal pancreas
  • Hypoplasia of the dorsal pancreas
1.3.1.2 Complete Agenesis of the Ventral and Dorsal Pancreas
  • Extremely rare.
  • Lethal condition.
  • Can be associated with other malformations (gallbladder aplasia, polysplenia, fetal growth retardation, heterotaxy syndrome, and intestinal malrotation).
  • This congenital anomaly has been linked with mutation in the GATAG, PDX1, and PTF1A genes.
1.3.1.3 Agenesis of the Dorsal Pancreas (Fig. )
Fig 12 Agenesis of the dorsal pancreas Illustration shows the posterior - photo 2
Fig. 1.2
Agenesis of the dorsal pancreas. Illustration shows the posterior portion of the head and the absence of the dorsal pancreas
  • Rare anomaly.
  • Results from a failure of the dorsal pancreatic bud to form the anterior head, neck, body, and tail of the pancreas.
  • Etiology of this congenital abnormality is currently not well understood.
  • Can be associated with intrauterine growth retardation, heterotaxy syndrome, and intestinal malrotation.
  • Clinical presentation
    • Most patients are asymptomatic.
    • Patients with this anomaly may present with nonspecific abdominal pain, diabetes mellitus, steatorrhea, or jaundice.
  • Imaging findings (Figs. )
    Fig 13 Agenesis of the dorsal pancreas on computed tomography CT a b - photo 3
    Fig. 1.3
    Agenesis of the dorsal pancreas on computed tomography (CT). ( a , b ) Axial view of a contrast-enhanced CT of the abdomen reveals a normal head ( arrows ) of the pancreas and the absence of the body and tail. Note the presence of mild dilatation of the distal common bile duct ( arrowhead )
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