Abstract

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Histological characteristics of alcoholic, bile, autoimmune, and obstructive pancreatitis are reviewed and summarized. Chronic alcoholic pancreatitis has characteristics such as interlobular fibrosis, nodular appearance of remaining lobules, and formation of protein plugs or stones in the pancreatic ducts. The difference in the distribution of fibrosis between alcoholic pancreatitis and chronic alcoholism is noted briefly. The histopathological changes of bile pancreatitis are degeneration/disappearance of the pancreatic ductal epithelium, and less progressive interlobular/periductal fibrosis. In autoimmune pancreatitis, narrowing of pancreatic ducts due to dense lymphoplasmacytic infiltration is the main remarkable feature. A significant number of these inflammatory cells are IgG4-positive plasma cells. Characteristics of obstructive pancreatitis are both inter- and intralobular fibrosis with duct dilatation especially in the progressive stage. Recognizing these characteristics helps not only to elucidate causes of pancreatic damage whose etiologies remain clinically unknown, but also to investigate the pathogenic mechanisms of chronic pancreatitis.

Copyright © 2007 S. Karger AG, Basel

Chronic pancreatitis is an irreversible and progressive disease, and its pathological hallmarks are inflammation, glandular atrophy, ductal changes, and fibrosis [1]. Although excess alcohol consumption is the most common cause of chronic pancreatitis in developed countries, several other etiologies are known and there are many cases whose etiologies remain unclarified. Also, the exact pathogenic mechanism of chronic pancreatitis has so far remained elusive, in spite of a great deal of cellular, genetic and molecular research.

Over the past twenty years, we have observed and reported that there are several specific and characteristic pathological changes connected to some etiologies. To recognize these histological characteristics is not only helpful in

Table 1. Etiology of chronic pancreatitis

Male

Female

Sex uncertain

Total

Alcoholic

525 (78.6%)

43 (29.7%)

14

582 (69.7%)

Idiopathic

98 (l4.7%)

73 (50.3%)

8

179 (21.4%)

Bile

19 (2.8%)

10 (6.9%)

29 (3.5%)

Pancreas divism

6 (0.9%)

8 (5.5%)

14 (1.7%)

Hyperlipidemia

4 (0.6%)

4 (2.8%)

8 (1.0%)

Obstructive

5 (0.7%)

2 (1.4%)

7 (0.8%)

Chronic renal failure

5 (0.7%)

0 (0.0%)

5 (0.6%)

Hereditary

4 (0.6%)

1 (0.7%)

5 (0.6%)

Abnormal pancreatic

1 (0.1%)

1 (0.7%)

2 (0.2%)

choledochoductal

junctions

Stenosis of papilla

0 (0.0%)

2 (1.4%)

2 (0.2%)

Injury

1 (0.1%)

0 (0.0%)

1 (0.1%)

Drug

0 (0.0%)

1 (0.7%)

1 (0.1%)

Total

668 (80.0%)

17.4%

835

trying to elucidate the causes of pancreatic damage in cases whose etiologies remain clinically unknown, but also necessary to investigate the pathogenic mechanism of chronic pancreatitis.

The etiologies of chronic pancreatitis in Japanese patients are categorized in table 1 [2]. Autoimmune pancreatitis, whose disease concept has been recently established, is excluded from this table. Among these etiologies, this chapter focuses on histological characteristics of alcoholic, bile, and autoimmune pancreatitis. The histopathology of obstructive pancreatitis, whose mechanism of tissue damage has been well elucidated, is also described here.

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Alcohol No More

Alcohol No More

Do you love a drink from time to time? A lot of us do, often when socializing with acquaintances and loved ones. Drinking may be beneficial or harmful, depending upon your age and health status, and, naturally, how much you drink.

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