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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.


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Fibrin masses noted around Langerhans islet in the zone of necrosis. Masson staining (×100).
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fig10: Fibrin masses noted around Langerhans islet in the zone of necrosis. Masson staining (×100).

Mentions: It is well known that in follow-up studies of ANP patients, only about 10–26% develop pancreatogenic diabetes after recovery [5, 6]. Diabetes is not necessarily present in patients with total exocrine pancreatic insufficiency. Microscopically, the structure of the islets of Langerhans is intact among masses of detritus (Figure 9). When stained with Masson, the islets of Langerhans are frequently surrounded by a gracile net of fibrin (Figure 10) which shows a deep claret color. Hence we may assume that this formation of a fibrin net around the islet of Langerhans contributes to its resistance and preservation of its structure in the aggressive microenvironment in patients with ANP.


Patterns of pathomorphological changes in acute necrotizing pancreatitis.

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

Fibrin masses noted around Langerhans islet in the zone of necrosis. Masson staining (×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig10: Fibrin masses noted around Langerhans islet in the zone of necrosis. Masson staining (×100).
Mentions: It is well known that in follow-up studies of ANP patients, only about 10–26% develop pancreatogenic diabetes after recovery [5, 6]. Diabetes is not necessarily present in patients with total exocrine pancreatic insufficiency. Microscopically, the structure of the islets of Langerhans is intact among masses of detritus (Figure 9). When stained with Masson, the islets of Langerhans are frequently surrounded by a gracile net of fibrin (Figure 10) which shows a deep claret color. Hence we may assume that this formation of a fibrin net around the islet of Langerhans contributes to its resistance and preservation of its structure in the aggressive microenvironment in patients with 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