Chronic pancreatitis

From Libre Pathology
Jump to: navigation, search

Chronic pancreatitis is a relatively common pathology of the pancreas that can be confused for a pancreatic cancer.

General

Complications:[1]

Autoimmune pancreatitis

Histologic subtypes of autoimmune pancreatitis:[2]

  1. Lymphoplasmacytic sclerosing pancreatitis (LPSP).
  2. Idiopathic duct-centric chronic pancreatitis (IDCP).
    • Typically IgG4 negative.
    • Approximately 20% of cases.

Lymphoplasmacytic sclerosing pancreatitis

General:

  • Serum IgG4 +ve.[5]

Microscopic:

  • Lymphoplasmacytic infiltrate.

IHC:

  • Plasma cells IgG4 +ve.

Radiology

Plain film findings:

  • Calcifications.

Microscopic

Features of chronic pancreatitis:[6]

  • Preservation of lobular architecture - evenly spaced ductal units.
  • Uniformly sized ductal elements.
  • Smooth ductal contours.
  • Ducts surrounded by acini or islets.
    • Islets usu. preserved better than acini.[7]
  • Intraluminal mucoprotein plugs.

Images:

Adenocarcinoma versus pancreatitis

This contrasts with the features of adenocarcinoma:[6]

  • Ductal architecture:
    • Random distribution of ductal structures.
    • Irregular ductal contours.
    • "Naked ducts in fat"; ducts without surrounding pancreatic elements or fibrous tissue.
    • Ducts adjacent to arterioles.
  • Nuclear atypia:
    • Enlargement (>3 times the size of a lymphocyte).
    • Pleomorphism.
    • Distinct nucleoli.
    • Hyperchromatic raisinoid nucleoli.
  • Generally assoc. with malignancy:

Notes:

  • Memory device: give 'em a fair chance at a benign diagnosis. Features suggestive of malignant:
    • Fat, adjacent to.
    • Arteriole, adjacent to.
    • Irregular ducts.
    • Random distribution of ducts/non-lobular arrangement.

IHC

Positive in pancreatic carcinoma:[8]

  • p53.
  • Mesothelin.

See also

References

  1. Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 469. ISBN 978-1416054542.
  2. URL: http://path.upmc.edu/cases/case651/dx.html. Accessed on: 28 January 2012.
  3. 3.0 3.1 Kamisawa, T.; Takuma, K.; Tabata, T.; Inaba, Y.; Egawa, N.; Tsuruta, K.; Hishima, T.; Sasaki, T. et al. (Jan 2011). "Serum IgG4-negative autoimmune pancreatitis.". J Gastroenterol 46 (1): 108-16. doi:10.1007/s00535-010-0317-2. PMID 20824290.
  4. Ikeura, T.; Takaoka, M.; Uchida, K.; Shimatani, M.; Miyoshi, H.; Kusuda, T.; Kurishima, A.; Fukui, Y. et al. (2012). "Autoimmune pancreatitis with histologically proven lymphoplasmacytic sclerosing pancreatitis with granulocytic epithelial lesions.". Intern Med 51 (7): 733-7. PMID 22466829.
  5. Krasinskas, AM.; Raina, A.; Khalid, A.; Tublin, M.; Yadav, D. (Jun 2007). "Autoimmune pancreatitis.". Gastroenterol Clin North Am 36 (2): 239-57, vii. doi:10.1016/j.gtc.2007.03.015. PMID 17533077.
  6. 6.0 6.1 Adsay, NV.; Bandyopadhyay, S.; Basturk, O.; Othman, M.; Cheng, JD.; Klöppel, G.; Klimstra, DS. (Nov 2004). "Chronic pancreatitis or pancreatic ductal adenocarcinoma?". Semin Diagn Pathol 21 (4): 268-76. PMID 16273946.
  7. Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 225. ISBN 978-1416002741.
  8. Hornick, JL.; Lauwers, GY.; Odze, RD. (Mar 2005). "Immunohistochemistry can help distinguish metastatic pancreatic adenocarcinomas from bile duct adenomas and hamartomas of the liver.". Am J Surg Pathol 29 (3): 381-9. PMID 15725808.