Faculty of allied medical

sciences
Histopathology and cytology
(MLHC-201)

Pancreatic Pathology
Inflammation of the pancreas
Prof. Dr. Noha Ragab

Learning Outcomes
By the end of this lecture, the
:student will be able to
Differentiate between acute,- 1
.and chronic pancreatitis
. Identify pancreatic tumours- 2
Identify gall bladder, and biliary- 3
. tract pathology

Acute hemorrhagic pancreatitis

Etiology:

Gall-stones
Alcohols
Hypercalcaemia
Drugs
Infection

Pathogenesis:
Pancreatic acinar cell injury results in
activation of pancreatic enzymes and the
enzymes consequently causes destruction
of the pancreatic parenchyma

Clinical presentation

Stabbing epigastric abdominal pain radiating to

the back
Shock
Hypercalcaemia

Laboratory investigation: elevation of

serum amylase and lipase

Gross pathology:

Focal pancreatic hemorrhage and liquefaction

Chalky, white yellow fat necrosis of adjacent
adipose tissue

Acute hemorrhagic pancreatitis

Microscopically:
Liquifactive
necrosis
parenchyma
Acute inflammation
Enzymatic fat necrosis
Necrosis
of
blood
hemorrhage

of

vessels

pancreatic

causes

Complication:
Acute respiratory distress syndrome )ARDS(
Disseminated intra-vascular coagulopathy
)DIC(
Pseudo cyst of pancreas
Pancreatic calcification

Fat necrosis

Acute hemorrhagic pancreatitis

Chronic pancreatitis
Definition:
Chronic inflammation, atrophy and fibrosis
secondary to repeated
attacks of
pancreatitis
Grossly:
Firm white fibrotic pancreas
Microscopic:
Extensive fibrosis and parenchymal atrophy
Chronic inflammation

Chronic pancreatitis

Clinical presentation:
1. Abdominal pain
2. Pancreatic insufficiency
3. Pancreatic calcification
4. Pseudocyst
5. Diabetes

Pancreatic Tumors

Pancreatic carcinoma
Grossly:
On gross examination, pancreatic
carcinoma is a firm, gray, poorly
demarcated, multi-nodular mass,
often embedded in a dense
connective tissue stroma.
Tumors of the head of the pancreas
may invade the common bile duct
and duodenal wall.

Pancreatic carcinoma

Microscopic:
Ductal adenocarcinoma arising
from the duct epithelium
Clinically:
Abdominal

pain
Biliary obstruction
Obstructive jaundice

Pancreatic carcinoma

GALL BLADDER AND

BILIARY TRACT
PATHOLOGY

NORMAL GALLBLADDER

NORMAL GALLBLADDER

INFLAMMATORY
CONDITIONS

:Acute cholecystitis
Definition:
Acute inflammation of the gall bladder,
usually causes by cystic duct
obstruction by gall stones

Clinical presentation:
1.
2.
3.
4.

Biliary colic
Right upper quadrant tenderness on
palpation
Nausea and vomiting
Low-grade fever and leukocytosis

Acute cholecystitis

Complications:
1.
2.
3.

Gangrene of the gall bladder

Perforation and peritonitis
Fistula formation and small
bowel obstruction by a large gall
stone(

:Chronic cholecystitis
Definition:
Ongoing chronic inflammation of the
gallbladder usually caused by gall
stones

Microscopically:
Chronic inflammation

Complication:
Calcification of the gall
)porcelain gall bladder(

bladder

Chronic cholecystitis

GALL BLADDER
CANCER

Gallbladder cancer

Clinical presentation:
1.

2.
3.
4.

Frequently asymptomatic until late in

the course
Cholecystitis
Enlarged palpable gallbladder
Biliary tract obstruction )uncommon(

Microscopically:

Adenocarcinoma

Gallbladder cancer

Gallbladder cancer

Questions
What is the clinical presentation of chronic - 1
?pancreatitis
What does the microscopic examination of- 2
?pancreatic carcinoma reveal
?What is the definition of acute cholecystitis - 3
What is the clinical presentation of- 4
?gallbladder cancer

THANK YOU
GOOD LUCK