Faculty of allied medical sciences

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