Pancreas - Minor abnormalities

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Pancreas

General

Minor abnormalities

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 10 December 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Acinar dilation
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● Associated with uremia, chronic pancreatitis (J Clin Pathol 1996;49:913), dehydration, severe bacterial infections (Hum Pathol 1984;15:677), bone marrow transplant

Altered acinar cells
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● Associated with chronic pancreatitis, alcohol, chemotherapy, pancreatic endocrine excess, tobacco

3 patterns:
● (a) Small groups of cells with reduced cytoplasm, less basophilia, more vacuolation, condensed nuclei, resemble islets
● (b) Normal sized cells without basophilia with basal nuclei
● (c) Cells with variable size and occasional large irregular nuclei

Ductal hyperplasia / ductal papillary hyperplasia
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Ductal hyperplasia: also mucinous cell hypertrophy and mild to moderate dysplasia; note the focal nuclear crowding within small papillae

Ductal papillary hyperplasia: marked papillary hyperplasia due to duct obstruction from tumor; papillae of various sizes, lined with columnar mucinous cells, project into lumen of main duct, which contains inspissated material; a few areas of flat epithelium are present between papillae

Ductal papillary hyperplasia: this interlobular duct from a patient with chronic pancreatitis shows mucous cell hypertrophy and ductular hyperplasia; epithelium exhibits slight cellular atypia

Adenomatoid ductal hyperplasia: accumulation of medium-sized pancreatic ducts, ductules, or both embedded in moderately cellular fibrous tissue

Focal fibrosis
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● Associated with older age or diabetes mellitus

Hemosiderin deposition
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● May be due to primary hemochromatosis or chronic blood transfusions (Arch Pathol Lab Med 1985;109:996)

Lipomatosis
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● Associated with older age

Marked fatty atrophy
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● Associated with type II diabetes, obesity, pancreatitis, duct obstruction, cystic fibrosis and severe generalized atherosclerosis
● Results in malabsorption

Mucinous cell hypertrophy
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Nonpapillary epithelial hypertrophy characterized by replacement of normal epithelium of large and medium-sized ducts by tall mucin-producing columnar cells

Lining columnar epithelium shows mild cellular atypia characterized by some crowding of slightly enlarged nuclei; most nuclei are polarized; apical portion of cytoplasm is filled with mucin

With pyloric gland metaplasia: an area of parenchymal atrophy, chronic pancreatitis and fatty replacement of parenchyma in patient with pancreatic carcinoma; there is marked hypertrophy and hyperplasia of mucous glands of duct epithelium; a diagnosis of pyloric gland metaplasia has to be made histochemically and is suggested by PAS+ and Alcian blue (pH 2.8) negative

Electron micrograph of papillary hyperplasia in patient with cancer of head of pancreas; mucin granules have an electron-opaque matrix and a darker eccentric core

Mucinous (goblet cell) metaplasia
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● Associated with older age, chronic pancreatitis, carcinoma
● Differential diagnosis: PanIN-1A

Oncocytic change
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● Associated with chemotherapy

Proliferation of centroacinar or intercalated duct cells
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● Associated with recent ductal obstruction, acute alcohol abuse, chronic pancreatitis, hyperinsulinemia or hypergastrinemia

Pseudolipomatous hypertrophy
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Pancreatic parenchyma consists of mature fatty tissue separated by thin fibrous septa containing isolated clusters of normal islets

Squamous metaplasia
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● Common, associated with chronic pancreatitis, normal pancreas, bone marrow transplant with chemotherapy (Hum Pathol 1993;24:152)
● Micro images:

Squamous metaplasia: mucinous epithelial duct cells are partly replaced by squamous epithelium

End of Pancreas > General > Minor abnormalities

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