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Pathology of Pancreatic Diseases: with special reference to acute pancreatitis K. Hayashi 1 11st Department of the Pathology, Nagoya City University, Medical School pp.1407-1420
Published Date 1974/11/25
DOI https://doi.org/10.11477/mf.1403112131
  • Abstract
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 A histopathological study has been made of the so-called acute pancreatitis with the following results:

 1. The so-called acute pancreatitis can be divided into three fundamental types: (1) hemorrhagic and/or hemorrhagico-erosive type; (2) punched-out necrosis type and (3) inflammatory type = phlegmon of the pancreas.

 2. Hemorrhagic and/or hemorrhagico-erosive type manifests itself as bleeding into the periacinar space in the lobulus, followed by degeneration and necrosis of acinar cells and then by secondary massiv hemorrhage due to interlobular vascular disorders caused by liberated pancreatic enzymes. Substantially it is bleeding and not inflammation. The greater majority of this type is fatal in its outcome.

 3. Punched-out necrosis takes place through accumulation of the pancreatic juice due to narrowing or obstruction of the pancreatic ducts, through reflux phenomenon of the pancreatic juice leaking around acinar cells caused by sustained secretion of the exocrine glands and through autolysis due to activation of oozed-out pancreatic juice. Cancer of the papillary region or of the head of the pancreas and calculus can account for the narrowing or obstruction of the pancreatic ducts, but papillary proliferation of the ductal epithelium accompanied by goblet cell metaplasia must also be taken in due consideration. The true nature of this type is not inflammation but regressive changes. The course of healing never takes the form of scarring. Necrosis usually absorbed and replaced by fatty tissue. At times, however, pseudocyst may be formed.

 4. Inflammatory type=phlegmon of the pancreas does really represent inflammation. When the outflow of the pancreatic juice is disturbed, inflammation occurs through infection (mostly Escherichia coli) either ductally from the duodenum or via lymphatic vessels. The obstructed outflow of the juice can well be caused by cancer or calculi, but we attach as great importance to papillary proliferation of the ductal epithelium in association with goblet cell metaplasia. This is the type in which the so-called acute pancreatitis changes into chronic one. It seems hardly possible that other types are responsible for the transition from acute to chronic pancreatitis.


Copyright © 1974, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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