Pancreas Pathology Lab, Case 2

• 47-year-old alcoholic man with severe epigastric pain radiating to the back.

Identify the organIdentify the structuresDiagnosis?

Acute PancreatitisThe pancreas is bisected along its longitudinal axis.

Many foci of yellow-white necrosis are scattered throughout the head, body, and tail.

A – Fat necrosisB- Splenic vein andthrombus

Identify the organDescribe the histologic findings

A – acinusB – Islet of LangerhansC – adipose cell

Normal Pancreas

Describe the histologic findings in sections A and B

Section (A) reveals Acute Pancreatitis. The section shows amorphous debris (arrow) that formed after necrosis of acini. The few remaining acini (*) are separated by infiltrating neutrophils.

Section B reveals normal pancreas for comparison

Amorphous debris

aciniAcini

Acute inflammation

Acute pancreatitis

Describe the histologic findings

A low power view of peripancreatic fat shows necrosis

Fat necrosis

Pancreas

Identify the organsDescribe the gross morphologic changesDiagnosis?

Acute PancreatitisAn autopsy specimen consisting of the stomach, spleen, pancreas, and adjacent fat reveals acute inflammation. The pancreas is swollen and hyperemic. Focal areas of green necrosis are present. Small foci of bright yellow, fat necrosis are present. The stomach is folded back so as to reveal its posterior wall and the pancreas.

A – StomachB – SpleenC – FatD - Pancreas

An intraoperative photograph reveals an acute hemorrhagic pancreatitis. The fat of the pancreas, colon, and greater omentum is necrotic and hemorrhagic

Acute Hemorrhagic PancreatitisA surgical specimen of the body and tail of the pancreas reveals acute, hemorrhagic necrosis.

Describe the gross findings

Acute PancreatitisA surgical specimen of the transverse colon and greater omentum shows extensive fat necrosis (Note the bright yellow foci).The mesenteric fat has been completely digested away so as to reveal the isolated blood vessels.

Describe the findings of this surgical specimen