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By Eugene C Toy

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Patients with HNPCC are also at risk for extra–gastrointestinal tract tumors. CLINICAL CASES 43 There are also less-well-defined familial cancer syndromes involving glandular elements (adenocarcinomas) that are associated with a family history or personal history of breast, ovarian, endometrial, or colon cancer. The development of colon cancer is a multifactorial process involving not only predisposition genes but also factors such as diet (low-fiber foods, red meat, and refined carbohydrates are nonfavorable), obesity, and inactivity.

Thus, patients with autoimmune gastritis may initially present with peripheral neuropathy symptoms from B12 deficiency in addition to their abdominal symptoms. Patients may also have other autoimmune disorders, such as Hashimoto thyroiditis or Addison disease. Peptic Ulcer Disease Peptic ulcers are usually solitary, arising from exposure of the mucosal epithelium to acid-peptic secretions. Peptic ulcer disease (PUD) occurs most often in middle-aged to older adults. The most common anatomic sites are the duodenum and the stomach, in a ratio of 4:1 (see Table 2-3).

DISCUSSION Normal Pancreatic Histology The pancreas is a small, spongy gland that lies just under the curvature of the stomach and deep within the abdomen. The majority of the pancreas is composed of exocrine glands, which produce enzymes necessary for food digestion. The secretions from acinar cells, the structural unit throughout the pancreas, containing salts and enzymes, are called pancreatic fluid, which eventually drains into the pancreatic duct. The pancreatic duct usually joins the bile duct and empties its combined digestive contents into the duodenum.

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