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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

PAS-positive substance accumulation (A) in zones of fibrinoid necrosis. PAS reaction for neutral mucopolysaccharides (×100).
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fig5: PAS-positive substance accumulation (A) in zones of fibrinoid necrosis. PAS reaction for neutral mucopolysaccharides (×100).

Mentions: Mucoid changes of the stromal carcass which at first are reversible, progress and become visible with routine hematoxylin-eosin staining. Most often mucoid swelling is located in perivascular spaces, but it may also extend and change into fibrinoid imbibition. Fibrin and fibrinoids are easily detected by Masson staining wherein fibrinoids are seen as a bright red and fibrin as a dark red or claret color that shows a fasciculated structure. Intact connective tissue appears as blue or cyan fibers. Foci with fibrinoid changes progress into necrosis and assume PAS-positive features. When stained by Shiff reagent they turn into deep crimson color (Figure 5). Later these foci may accumulate calcium and that is why calcinosis found in pancreatic parenchyma may indicate earlier ANP.


Patterns of pathomorphological changes in acute necrotizing pancreatitis.

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

PAS-positive substance accumulation (A) in zones of fibrinoid necrosis. PAS reaction for neutral mucopolysaccharides (×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: PAS-positive substance accumulation (A) in zones of fibrinoid necrosis. PAS reaction for neutral mucopolysaccharides (×100).
Mentions: Mucoid changes of the stromal carcass which at first are reversible, progress and become visible with routine hematoxylin-eosin staining. Most often mucoid swelling is located in perivascular spaces, but it may also extend and change into fibrinoid imbibition. Fibrin and fibrinoids are easily detected by Masson staining wherein fibrinoids are seen as a bright red and fibrin as a dark red or claret color that shows a fasciculated structure. Intact connective tissue appears as blue or cyan fibers. Foci with fibrinoid changes progress into necrosis and assume PAS-positive features. When stained by Shiff reagent they turn into deep crimson color (Figure 5). Later these foci may accumulate calcium and that is why calcinosis found in pancreatic parenchyma may indicate earlier ANP.

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