Faculty of allied medical sciences
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Histopathology and cytologyHistopathology and cytology
((MLHC-201MLHC-201))
Faculty of allied medical Faculty of allied medical sciencessciences
Pancreatic PathologyPancreatic Pathology
Inflammation of the pancreasInflammation of the pancreas
Prof. Dr. Noha RagabProf. Dr. Noha Ragab
Learning OutcomesLearning Outcomes
By the end of this lecture, the By the end of this lecture, the student will be able tostudent will be able to: :
11 - -Differentiate between acute, Differentiate between acute, and chronic pancreatitisand chronic pancreatitis..
22 - -Identify pancreatic tumoursIdentify pancreatic tumours . .
33 - -Identify gall bladder, and biliary Identify gall bladder, and biliary tract pathologytract pathology . .
Acute hemorrhagic pancreatitisAcute hemorrhagic pancreatitis
Etiology:Etiology: Gall-stonesGall-stones AlcoholsAlcohols HypercalcaemiaHypercalcaemia DrugsDrugs InfectionInfection
Pathogenesis:Pathogenesis: Pancreatic acinar cell injury results in Pancreatic acinar cell injury results in
activation of pancreatic enzymes and the activation of pancreatic enzymes and the enzymes consequently causes destruction enzymes consequently causes destruction of the pancreatic parenchyma of the pancreatic parenchyma
Clinical presentationClinical presentation Stabbing epigastric abdominal pain radiating to Stabbing epigastric abdominal pain radiating to
the backthe back ShockShock HypercalcaemiaHypercalcaemia
Laboratory investigationLaboratory investigation: elevation of : elevation of serum amylase and lipaseserum amylase and lipase
Gross pathology:Gross pathology: Focal pancreatic hemorrhage and liquefactionFocal pancreatic hemorrhage and liquefaction Chalky, white yellow fat necrosis of adjacent Chalky, white yellow fat necrosis of adjacent
adipose tissueadipose tissue
Acute hemorrhagic pancreatitisAcute hemorrhagic pancreatitis
Microscopically:Microscopically: Liquifactive necrosis of pancreatic Liquifactive necrosis of pancreatic
parenchymaparenchyma Acute inflammationAcute inflammation Enzymatic fat necrosisEnzymatic fat necrosis Necrosis of blood vessels causes Necrosis of blood vessels causes
hemorrhagehemorrhage
Complication:Complication: Acute respiratory distress syndrome Acute respiratory distress syndrome
)ARDS()ARDS( Disseminated intra-vascular coagulopathy Disseminated intra-vascular coagulopathy
)DIC()DIC( Pseudo cyst of pancreasPseudo cyst of pancreas Pancreatic calcificationPancreatic calcification
Acute hemorrhagic pancreatitisAcute hemorrhagic pancreatitis
Fat necrosis
Chronic pancreatitisChronic pancreatitis
Definition:Definition: Chronic inflammation, atrophy and fibrosis Chronic inflammation, atrophy and fibrosis
secondary to repeated attacks of secondary to repeated attacks of pancreatitispancreatitis
Grossly:Grossly: Firm white fibrotic pancreasFirm white fibrotic pancreas
Microscopic:Microscopic: Extensive fibrosis and parenchymal Extensive fibrosis and parenchymal
atrophyatrophy Chronic inflammationChronic inflammation
Chronic pancreatitisChronic pancreatitis
Clinical presentation:Clinical presentation:
1.1. Abdominal painAbdominal pain
2.2. Pancreatic insufficiencyPancreatic insufficiency
3.3. Pancreatic calcificationPancreatic calcification
4.4. PseudocystPseudocyst
5.5. Diabetes Diabetes
Pancreatic TumorsPancreatic Tumors
Pancreatic carcinomaPancreatic carcinoma
Grossly:Grossly: On gross examination, pancreatic On gross examination, pancreatic
carcinoma is a firm, gray, poorly carcinoma is a firm, gray, poorly demarcated, multi-nodular mass, demarcated, multi-nodular mass, often embedded in a dense often embedded in a dense connective tissue stroma. connective tissue stroma.
Tumors of the head of the pancreas Tumors of the head of the pancreas may invade the common bile duct may invade the common bile duct and duodenal wall.and duodenal wall.
Pancreatic carcinomaPancreatic carcinoma
Microscopic:Microscopic: Ductal adenocarcinoma arising Ductal adenocarcinoma arising
from the duct epithelium from the duct epithelium
Clinically: Clinically: Abdominal painAbdominal pain Biliary obstructionBiliary obstruction Obstructive jaundice Obstructive jaundice
Pancreatic carcinomaPancreatic carcinoma
GALL BLADDER AND GALL BLADDER AND BILIARY TRACT BILIARY TRACT
PATHOLOGYPATHOLOGY
NORMAL GALLBLADDER
NORMAL GALLBLADDER
INFLAMMATORY INFLAMMATORY CONDITIONSCONDITIONS
Acute cholecystitisAcute cholecystitis::
Definition:Definition:Acute inflammation of the gall bladder, Acute inflammation of the gall bladder,
usually causes by cystic duct usually causes by cystic duct obstruction by gall stonesobstruction by gall stones
Clinical presentation:Clinical presentation:1.1. Biliary colicBiliary colic2.2. Right upper quadrant tenderness on Right upper quadrant tenderness on
palpationpalpation3.3. Nausea and vomitingNausea and vomiting4.4. Low-grade fever and leukocytosisLow-grade fever and leukocytosis
Acute cholecystitisAcute cholecystitis
Complications:Complications:1.1. Gangrene of the gall bladderGangrene of the gall bladder
2.2. Perforation and peritonitisPerforation and peritonitis
3.3. Fistula formation and small Fistula formation and small bowel obstruction by a large gall bowel obstruction by a large gall stone(stone(
Chronic cholecystitisChronic cholecystitis::
Definition:Definition:Ongoing chronic inflammation of the Ongoing chronic inflammation of the
gallbladder usually caused by gall gallbladder usually caused by gall stonesstones
Microscopically:Microscopically:Chronic inflammationChronic inflammation
Complication:Complication:Calcification of the gall bladder Calcification of the gall bladder
)porcelain gall bladder()porcelain gall bladder(
Chronic cholecystitisChronic cholecystitis
GALL BLADDER GALL BLADDER CANCERCANCER
Gallbladder cancerGallbladder cancer
Clinical presentation:Clinical presentation:1.1. Frequently asymptomatic until late in Frequently asymptomatic until late in
the coursethe course
2.2. CholecystitisCholecystitis
3.3. Enlarged palpable gallbladderEnlarged palpable gallbladder
4.4. Biliary tract obstruction )uncommon(Biliary tract obstruction )uncommon(
Microscopically:Microscopically: Adenocarcinoma Adenocarcinoma
Gallbladder cancerGallbladder cancer
Gallbladder cancerGallbladder cancer
QuestionsQuestions
11 - -What is the clinical presentation of chronic What is the clinical presentation of chronic pancreatitispancreatitis??
22 - -What does the microscopic examination of What does the microscopic examination of pancreatic carcinoma revealpancreatic carcinoma reveal??
33 - -What is the definition of acute cholecystitisWhat is the definition of acute cholecystitis??
44 - -What is the clinical presentation of gallbladder What is the clinical presentation of gallbladder cancercancer??
THANK YOUTHANK YOU
GOOD LUCKGOOD LUCK
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