Patients with Acute Pancreatitis

Reparative changes in frank parenchymal necrosis in patients with acute pancreatitis are divided into granulation tissue, mixed or fibro-granulation tissue, and fibrosis (fig. 1). According to our previous study on 24 patients with various durations of acute pancreatitis [2], the appearance and increase in reparative changes correlates with the duration of disease as follows: (1) no reparative changes with disease of less than 6 days' duration (fig. 2); (2) granulation tissue mostly between 7 and 25 days; (3) fibro-granulation tissue between 28 and 42 days, and (4) fibrosis mainly after 8 weeks or longer, as shown in table 1.

Reparative changes in parenchymal and fat necroses are not present in the early stage of acute pancreatitis, as only necrosis is seen, and granulation tissue develops later. Based on the description of the marginal reaction against frank parenchymal necrosis by Baggenstoss [1], in patients with illness of less than

Fig. 2. No reparative change. Parenchymal necrosis directly adjacent to the exocrine tissue in a patient with an illness of 2 days. HE. X200.
Table 1. Relationship between reparative changes in frank parenchymal necrosis and duration of illness in patients with acute pancreatitis [2]

Duration of illness, days

Cases

Reparative change

2

4

none

7-10

8

granulation tissue

13

l

granulation tissue

25

l

granulation tissue

28

l

granulation tissue/fibro-granulation

42

2

granulation tissue

42

2

fibro-granulation tissue

>60

3

fibro-granulation tissue/fibrosis

>60

2

fibrosis

one week's duration, zonal reaction features can be roughly identified after staining with hematoxylin and eosin. These are (1) an acidophilic structureless zone of necrosis; (2) a narrow basophilic zone of karyolysis and karyorrhexis; (3) an acidophilic zone containing coagulation necrosis of the cytoplasm and pyknotic nuclei, and (4) a zone of interacinar edema and a mild leukocytic reaction. From our observations, fat necrosis in the agonal stage is either accompanied by foamy histiocytes or shows no reparative reaction. Hence, reparative changes are related to the duration and severity of the illness.

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