Pathological Findings

Macroscopic recognition of pancreatic ischemia depends on the severity or size of ischemia, and the presence of complicated lesions, such as hemorrhages or fat necrosis. Some authors have described that the pancreatic necrotic area can be pale and yellowish with red congested margins 2 . In our experienced case, examination by the naked eye was not able to reveal significant changes in pancreatic ischemia caused by cholesterol, but on histological examination geographic or lobular ischemic...

From Benign IPMN Hyperplasia Adenoma and IDA

Benign IPMN (hyperplasia adenoma) is papillary-sheet-palisading and cohesive (fig. 1a). Noninvasive IPMC shows small papillary-cohesive clusters that are often accompanied by outer protrusions of cells (fig. 1b). IDA is in sheet-tubular-solid form and loose (fig. 1c). As for arrangement of noninvasive Fig. 2. Nuclei of benign IPMN (hyperplasia), noninvasive IPMC and IDA. a Benign IPMN has small nuclei but no hyperchromatin. Pancreatic ductal brushing, Papanicolaou stain. X400. b Noninvasive...

Paired Ventral Pancreatic Anlage and Annular Pancreas

Annular Infantile

An annular pancreas is a rare malformation and its pathogenesis is still controversial. In the normal course of development between the 8- and 12-mm stages (sixth week), the common duct and the right portion of the ventral prim-ordium are carried dorsally around the circumference of the duodenum to lie adjacent to the dorsal pancreas. This rotation is the result of duodenal growth, during which all enlargement is from the ventral side only. The duct of the longer, dorsal pancreas anastomoses...

Distribution after Fusion of Ventral and Dorsal Anlagen Branch Duct Fusion of the Pancreatic Duct and Annular Pancreas

Accessory Duct Pancreas

Identification of the Originating Primordium After fusion, the 'ventral' and 'dorsal' pancreata can be distinguished 16 by the distribution of the PP islets 17, 18 , which are distributed selectively in Fig. 5. Schematic drawing of various junctions sites between the terminal bile duct and ventral pancreatic duct system in patients with PBM. From 15 with permission. Fig. 5. Schematic drawing of various junctions sites between the terminal bile duct and ventral pancreatic duct system in patients...

Experimental Pancreatic Regeneration

Sixty young male Wistar rats were divided into two groups. Ten rats were fed a synthetic control diet (ND group), and fifty rats were fed an experimental diet, containing 0.5 DL-ethionine (ED group). On day 14, five rats from each group and on day 21, five rats of group ED were sacrificed. After affirmation of necrosis and destruction of the pancreas, the remaining rats of group ED were changed to the normal diet (END group). On days 24, 28, 50 and 70, i.e. 3, 7, 29 and 49 days after cessation...

Mechanism of Interlobular Fibrosis of the Pancreas

The most commonly cited theory for the cause of chronic alcoholic pancreatitis is the deposition of protein plugs which later calcify, leading to duct obstruction with subsequent fibrotic replacement of the acinar tissue upstream from the occlusion 12 . However, duct obstruction is considered to be an essential mechanism for fibrosis in chronic obstructive pancreatitis distal to a stricture of the pancreatic duct. Chronic obstructive pancreatitis is observed secondary to slow-growing pancreatic...

Acinar Cells

Abnormalities Related to Alcohol Intake At the initial stage of periacinar collagenization, abnormalities related to alcohol intake were found in zymogen granules, lysosomes, lipid droplets and the endoplasmic reticulum. A decreased number of zymogen granules and electron-dense zymogen granules were found in patients with chronic alcoholism. Decreased electron-dense zymogen granules were sometimes seen with peripheral halos and centric or eccentric cores (fig. 3). An increased number of...

Serous Microcystic Adenomas

Normal Pancreas Cut Surface

In 1978, Compagno et al. described microcystic adenomas as composed of innumerable tiny cysts 2 . Serous microcystic adenoma is the most common subtype of SCT, accounting for more than 70 of SCTs 19, 20 . Synonyms include microcystic adenoma, glycogen-rich adenoma, and simply serous cystadenoma 1, 2, 10 . Females are more commonly affected (70 ). Tumors usually affect elderly individuals in their 6th and 7th decades (34-91 years). The patients may present with a palpable mass or vague abdominal...

Conclusion and Summary

DL-Ethionine is the antagonist of methionine, which is one of the essential amino acids, and is known to cause pancreatic acinar cell necrosis in rats and other experimental animals by either intraperitoneal injection or oral administration. The mechanism of pancreatic damage is presumed to be abnormal metabolism in protein synthesis. There are also other chemical agents, such as 1-aminocyclopentane carboxylic acid (ACPC) and puromycin, which can cause pancreatic acinar cell necrosis and...

Enlargement of Islets of Langerhans in Patients with Cirrhosis of the Liver

In patients with cirrhosis of the liver (LC), it is known that glucose intolerance 29, 30 and pancreatic change related to portal hypertension 31 occur clinically. Pathologically, there are pancreatic fibrosis 32 and enlargements of islets 33, 34 (fig. 3). However, the relationship between glucose intolerance and the enlarged islets is not known. In 17 LC patients including any types causes, an area of the islets was statistically enlarged in 14, compared with that of controls as shown in table...

Cells from IDAType Cells

Small papillary-cohesive and compact clusters are the most consistent features of PanIN-3 (upper portion of figs. 11a, b and 13a, b) 5, 41, 46-49 . Small papillary-cohesive clusters appeared to result from excessive proliferation and strong cohesion of well-preserved epithelial cells within strong uninfiltrated ducts. These reflect low papillary projections palisades that are a histologic characteristic of PanIN-3 (right portion of fig. 12 and upper portion of fig. 14) 1, 5, 7, 23, 31, 32, 41,...

Hemosiderin Deposition in the Islets of Langerhans

Hemosiderin deposition has been well investigated by many authors, such as in cases of diabetes mellitus, which is usually related to a deposition of hemosiderin in the B cells of the islets of Langerhans 35 . Hemosiderin deposition occurs predominantly in the acinar tissue in cases of primary hemochromatosis (fig. 4) and in the periinsular acinar tissue in patients who receive a large volume of blood through transfusions 36, 37 . In the latter, the distribution and amount of hemosiderin...

Abstract

The potential for regeneration of pancreatic tissue in the adult human has generally been regarded as minimal. However, in chronic pancreatitis, isolated lobuli are frequently seen in fibrosis. These isolated lobuli have nodular architecture and bear resemblance to regenerative nodules of the cirrhotic liver. In experimental animals, regeneration of the acinar cells has been shown in the literature since Fitzgerald et al., followed by other experimental studies for pancreas exocrine and or...

Chronic Alcoholic Pancreatitis

In chronic alcoholic pancreatitis (CAP), pancreatic damage is observed in a patchy pattern throughout the pancreas. Parenchymal loss and fibrosis occur mainly interlobularly, leaving remaining lobules with a nodular appearance 3, 4 . Histopathological View of CAP and Progression CAP is a progressive disease and the pathological characteristics differ depending on the stage of the disease and the area being investigated 5, 6 . Fig. 1. Chronic alcoholic pancreatitis (CAP) by disease stages. a...

Embryological Development

In order to understand the anatomical variations and congenital anomalies of the pancreas, many of which have practical surgical implications, it is important to realize that this organ originates from two separate embryonic anlagen a ventral and a dorsal primordium. On or about the 24th day of gestation, the diverticulum begins to bud from the ventral surface of that part of the primitive digestive tube which is destined to later become the duodenum. This hepatic anlage invades the ventral...

Invasive IPMC with Two Cell Types Noninvasive and Invasive Components

Invasive IPMC with a Mucinous Noncystic Carcinoma Invasive Component Among invasive IPMC, noninvasive component cells have papillary-cohesive clusters, suspicious of malignancy, and polyclonal-like cytoplasm (fig. 7a), while invasive component cells (mucinous noncystic carcinoma) have Fig. 5. Noninvasive IPMC with special type goblet cells. a Periodic acid-sodium boro-hydride-potassium hydroxide-periodic acid Schiff (a special marker of goblet cells of the large intestine) stains pink (arrows)....

Age Related Pathological Findings in the Pancreas

Metaplasia Hyperplasia of Pancreatic Ductal Epithelium There are two types of epithelial metaplasia of the pancreatic duct mucous cell metaplasia, or goblet cell metaplasia, and squamous cell metaplasia, including basal cell metaplasia. The former is composed of a tall columnar mucinous epithelium, non-papillary or flat in a layer, often arranged in papillary protrusion, compatible with mucous cell hyperplasia and found in all sizes and levels of the pancreatic ducts, but predominantly in the...

Serous Oligocystic Adenoma

Although SCTs have been classified as microcystic adenomas, recent advances in imaging techniques have revealed more cases of serous oligocystic adenoma 25 . Serous oligocystic adenoma is the second common subtype of SCT, accounting for 7-30 of all SCTs 14, 19, 20, 27, 30, 31 . Synonyms include macrocystic serous cystadenoma, and serous oligocystic and ill-demarcated adenoma 1, 8, 30-33 . Serous oligocystic adenoma occurs equally in both sexes. Tumors usually affect individuals with a mean age...

References

1 Isse K, Harada K, Suzuki Y, et al Retroperitoneal mucinous cystadenoma report of two cases and review of the literature. Pathol Int 2004 54 132-138. 2 Wheeler DA, Edmondson HA Cystadenoma with mesenchymal stroma (CMS) in the liver and bile ducts. Cancer 1985 56 1434-1445. 3 Nobukawa B, Suda K Pathology of pancreatic cystic tumors differential diagnosis between Intraductal papillary-mucinous tumor and mucinous cystic tumor (in Japanese). Syokakinaishikyo 2002 14 20-26. 4 Wouters K, Ectors N,...

Structures by Inflammation

Involvement of Inflammation of the Splenic Vein Involvement of the splenic vein 4 often occurs. The clinical manifestation of splenic vein obstruction is splenomegaly and varicose veins in the stomach (many in the gastric fundus) and esophagus, generally called localized (or left-sided) portal hypertension. In our histopathological study of surgical and autopsy specimens from 12 patients with chronic alcoholic pancreatitis, fibrosis in the pancreatic parenchyma continuously extended to the wall...

Role of Fibrin Thrombi in Fat Necrosis

With regard to the pathogenesis of pancreatitis, Schmitz-Moormann 11 reported that acute pancreatitis begins with fat necrosis around and within the pancreas. In the second step, acinar cell necrosis, as well as vascular destruction and thrombosis, arises in the immediate vicinity of the fat necrosis. Kl ppel et al. 12 also noted that the earliest autodigestive lesions are found in the peri-pancreatic fatty tissue. If the initial fat necrosis is extensive and effusion of Fig. 7. Fat necrosis...

Noninvasive IPMC

Analysis of PanIN-3 and IPMC (with Dense Cytoplasms and Both PanIN-3 and IPMC tumors are similar in terms of small papillary-cohesive clusters, small nuclei (about 10 xm at the shortest diameter) without prominent anisonucleosis (fig. 15a-e). As for nuclear crowding overlapping, the nuclei of both tumors tend to exist in the well-preserved cytoplasm and to be separated from each other the cytoplasmic borders between the nuclei can be clearly defined by focusing the microscope up and down (fig....

Structure and Shape of the Papilla of Vater

The papilla of Vater, also called the major papilla, which is usually situated medially at the midportion of the second part of the duodenum, is a cylindrical protuberance that houses a common channel or the terminations of the common bile duct (CBD) and main pancreatic duct (MPD) (fig. 1). In most cases, especially among Japanese, both ducts join within the duodenal wall 1 and have a short common chamber, named an ampulla or the common channel (fig. 2). Fig. 1. Longitudinal section of the PV...

Pancreaticobiliary Maljunction

Pancreaticobiliary Maljunction and Variations of the Pancreatico-Choledocho-Ductal Junction Pancreaticobiliary maljunction PBM is a form of congenital anomaly in which the junction of the pancreatic and biliary ducts is located outside the duodenal wall. The configuration of the junction varies and is occasionally complex. This type of anomaly is almost always seen in patients with choledochal cyst or congenital biliary dilatation 1 , and is also sometimes found in patients with congenital...

Distribution of Pancreatic Fibrosis

The distribution of fibrosis mostly corresponds to or is based on individual causes, as shown in table 1. Pancreatic fibrosis or chronic pancreatitis due to pancreatic duct obstruction is known as chronic obstructive pancreatitis COP , which is characterized by both inter- and intralobular fibrosis and lobular acinar atrophy. Autoimmune pancreatitis AIP , recently a focus of attention, shows a similar fibrosis pattern to COP, except that it is accompanied by marked lymphoplasmacytic...

Distribution in Pathologic States

Cases categorized as focal pancreatitis FP showed localized stenosis of the main pancreatic duct on endoscopic retrograde pancreatography and histological findings of localized acinar atrophy with massive fibrosis with scanty inflammatory cell infiltration. All cases with FP showed fibrous thickening of the wall of the main pancreatic duct without atypical epithelium at the stenotic portion. In 6 cases with FP, a-SMA-positive and desmin-negative cells, i.e. myofibroblasts, proliferated between...

The Blood Supply of the Pancreas

Smv Sma Anatomy

The pancreas, in particular its head, has an abundant blood supply basically derived from the celiac axis and the superior mesenteric artery SMA . In fact, the collateral pathways between these two arteries are so efficient that the cut surface of the pancreas removed en bloc using the Whipple procedure will often continue to bleed until the very last jejunal branch and the proximal jejunal artery itself has been divided. The general pattern of the arterial blood supply and anatomy of the...

Progression of Pancreatic Fibrosis

There are no precise morphological tools or studies of fibrosis patterns to distinguish between more progressive and steady states in chronic pancreatitis cases. In the end stage, chronic pancreatitis is represented by massive or extensive interlobular fibrosis and total permanent loss of the exocrine pancreatic Fig. 8. Collagen fibrils between a myofibroblast and an acinar cell in a 73-year-old male with chronic alcoholism. Note the presence of many fine filaments arrows , 8-15 nm in diameter,...

Tigaro Theory and the New Hypotheses

The most common etiology of chronic pancreatitis involves alcohol. Possible mechanisms of alcohol-related injury include exocrine dysfunction, changes in lipid metabolism, and induction of oxidative stress 2 . However, because pancreatic acinar cells are capable of metabolizing alcohol, it is not proven that alcohol can initiate chronic pancreatitis and or fibrosis. Oxidative stress may exacerbate chronic inflammation. Some patients with chronic pancreatitis have no clear risk factors. However,...