The pancreas lies deep in the body. It is a calm, silent organ located behind the stomach, with much hope and possibilities for solving the physiological and pathological problems of its behavior. Because the pancreas is a complicated organ, it is important in an anatomical and embryological sense, and because of its frequent age-related lesions. It develops from two buds fused into a single organ with a ductal system, close to the biliary tract and duodenum. Both mucous-cell hyperplasia, which corresponds to PanIN-1, and cystic dilatation of the branch pancreatic duct, relevant to branch-duct-type intraductal papillary-mucinous tumors, frequently occur in elderly persons, resulting in the modification of the tissue surrounding it, i.e. atrophy. Moreover, pathological changes in the pancreas are focal or patchy in nature (i.e. normal tissue is found adjacent to the affected foci), especially in non-tumorous lesions, but not homogeneous and diffuse in the case in the liver.
Nowadays, many different imaging methods and approaches allow the form of the pancreas and its parenchyma to be seen in detail and in repetition or sequence, while the problems posed by biopsy specimens, apart from the risk involved in obtaining the sample, are of sampling error and small sample size because of unequally distributed foci or sparing neighboring areas in the whole organ, as mentioned above.
When doing a pathological study of the pancreas, my colleagues and I appreciate not only the pancreas itself, in a morphological sense, but also its relationship with its neighboring organs such as the duodenum, biliary tract (especially in the pancreatico-choledocho-ductal junction) and liver, and its developmental and anatomical characteristics.
Here, my colleagues and I describe a number of pathological changes in the behavior of the pancreas based on our experience and knowledge. Our opinions may include those which differ from established ones. They are to stimulate discussion resulting from detailed histopathological or clinicopathological observations.
I offer my deep appreciation of my fellow department members as well as my publisher Karger for their kind assistance and consideration in publishing this book.
My hope is that this book will be a useful reference source for all those who wish to investigate and practice research in pancreatology.
Koichi Suda, Tokyo
Suda K (ed): Pancreas - Pathological Practice and Research. Basel, Karger, 2007, pp 1-7
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