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Patterns of pathomorphological changes in acute necrotizing pancreatitis.

Kovalska I, Dronov O, Zemskov S, Deneka E, Zemskova M - Int J Inflam (2012)

Bottom Line: Initially, parietal circular intravascular microthrombosis accompanied by endothelial desquamation as early as stromal swelling occurs with no detectable necrosis.Residual stroma appears between areas of necrosis and intact pancreatic tissue.Reticulin argyrophilic backbone surrounding the pancreatic acini and small ducts decompose.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery No. 1, Bogomolets National Medical University, Kyiv 03039, Ukraine.

ABSTRACT
Acinar necrosis is the basic microscopic sign of acute necrotizing pancreatitis (ANP). Microcirculation disorder is one of the major factors in the pathogenesis and morphogenesis of ANP besides free radicals and damage of enzymatic origin. This study is dedicated to the description of microscopic changes in the pancreatic stroma in ANP, which leads to destruction of the exocrine pancreas with a putative mechanism of endocrine function preservation. This study has been carried out on histological samples of pancreas from 224 patients with ANP. Histological staining was performed with hematoxylin-eosin (H&E), Masson, Gomori methods, and PAS. Microscopy was performed with magnifications of 40×, 100×, and 400×. Vascular endothelial desquamation, stasis, and sludge are typical changes in microcirculation observed in early stages of ANP. Initially, parietal circular intravascular microthrombosis accompanied by endothelial desquamation as early as stromal swelling occurs with no detectable necrosis. Residual stroma appears between areas of necrosis and intact pancreatic tissue. Mucoid swelling is first seen in the perivascular spaces extending to the parenchyma and changing into fibrinoid imbibition causing further necrosis. Reticulin argyrophilic backbone surrounding the pancreatic acini and small ducts decompose. Pancreatic structures, which may be preserved in necrotic tissue, include nerves, major ducts, and Langerhans islets.

No MeSH data available.


Related in: MedlinePlus

Focal necrosis of pancreatic parenchyma associated with massive thrombosis in venules. H&E (×40).
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fig2: Focal necrosis of pancreatic parenchyma associated with massive thrombosis in venules. H&E (×40).

Mentions: Vascular endothelial desquamation, stasis, and sludge are typical changes that are seen in the microcirculation that occurs in early stages of ANP and which subsequently evolves into thrombosis. We believe that thrombosis of the pancreatic microcirculation is one of the leading factors in the course of ANP. This hypothesis correlates with recent data of other investigators [1–4]. Initially, intravascular microthrombosis are seen as parietal circular changes (Figure 1) accompanied by endothelial desquamation. These changes are detected in the early stages when stromal swelling appears and there is no necrosis as yet. Apparently parietal circular thrombosis does not cause complete arrest of the circulation. That is why the first minimal signs of necrosis appear after thrombosis progresses into total obstruction of the vessels (Figure 2).


Patterns of pathomorphological changes in acute necrotizing pancreatitis.

Kovalska I, Dronov O, Zemskov S, Deneka E, Zemskova M - Int J Inflam (2012)

Focal necrosis of pancreatic parenchyma associated with massive thrombosis in venules. H&E (×40).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3350850&req=5

fig2: Focal necrosis of pancreatic parenchyma associated with massive thrombosis in venules. H&E (×40).
Mentions: Vascular endothelial desquamation, stasis, and sludge are typical changes that are seen in the microcirculation that occurs in early stages of ANP and which subsequently evolves into thrombosis. We believe that thrombosis of the pancreatic microcirculation is one of the leading factors in the course of ANP. This hypothesis correlates with recent data of other investigators [1–4]. Initially, intravascular microthrombosis are seen as parietal circular changes (Figure 1) accompanied by endothelial desquamation. These changes are detected in the early stages when stromal swelling appears and there is no necrosis as yet. Apparently parietal circular thrombosis does not cause complete arrest of the circulation. That is why the first minimal signs of necrosis appear after thrombosis progresses into total obstruction of the vessels (Figure 2).

Bottom Line: Initially, parietal circular intravascular microthrombosis accompanied by endothelial desquamation as early as stromal swelling occurs with no detectable necrosis.Residual stroma appears between areas of necrosis and intact pancreatic tissue.Reticulin argyrophilic backbone surrounding the pancreatic acini and small ducts decompose.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery No. 1, Bogomolets National Medical University, Kyiv 03039, Ukraine.

ABSTRACT
Acinar necrosis is the basic microscopic sign of acute necrotizing pancreatitis (ANP). Microcirculation disorder is one of the major factors in the pathogenesis and morphogenesis of ANP besides free radicals and damage of enzymatic origin. This study is dedicated to the description of microscopic changes in the pancreatic stroma in ANP, which leads to destruction of the exocrine pancreas with a putative mechanism of endocrine function preservation. This study has been carried out on histological samples of pancreas from 224 patients with ANP. Histological staining was performed with hematoxylin-eosin (H&E), Masson, Gomori methods, and PAS. Microscopy was performed with magnifications of 40×, 100×, and 400×. Vascular endothelial desquamation, stasis, and sludge are typical changes in microcirculation observed in early stages of ANP. Initially, parietal circular intravascular microthrombosis accompanied by endothelial desquamation as early as stromal swelling occurs with no detectable necrosis. Residual stroma appears between areas of necrosis and intact pancreatic tissue. Mucoid swelling is first seen in the perivascular spaces extending to the parenchyma and changing into fibrinoid imbibition causing further necrosis. Reticulin argyrophilic backbone surrounding the pancreatic acini and small ducts decompose. Pancreatic structures, which may be preserved in necrotic tissue, include nerves, major ducts, and Langerhans islets.

No MeSH data available.


Related in: MedlinePlus