Volume 136, Issue 2, Pages 513-522 (February 2009) Reduced Pancreatic Volume and β-Cell Area in Patients With Chronic Pancreatitis  Henning Schrader, Bjoern A. Menge, Simone Schneider, Orlin Belyaev, Andrea Tannapfel, Waldemar Uhl, Wolfgang E. Schmidt, Juris J. Meier  Gastroenterology  Volume 136, Issue 2, Pages 513-522 (February 2009) DOI: 10.1053/j.gastro.2008.10.083 Copyright © 2009 AGA Institute Terms and Conditions

Figure 1 Different stages of pancreatic fibrosis. Panel A shows mild periductal fibrosis in the healthy pancreas from a patient (69-year-old female) with a benign pancreatic adenoma. Panel B shows more advanced periductal and septal fibrosis in a 50-year-old male patient with chronic pancreatitis (CP). Panels C and D illustrate severe interlobal fibrosis surrounding small areas of residual acinar tissue in patients with CP (57-year-old female and 34-year-old male, respectively. Panel E shows the appearance of large islets on the pancreas of a 62-year-old male patient with CP. In panel F, the acinar tissue in the pancreas of a 49-year-old male patient with CP has been almost completely replaced by fibrous tissue, whereas the islets are still relatively preserved. All images were acquired at 100× magnification. Gastroenterology 2009 136, 513-522DOI: (10.1053/j.gastro.2008.10.083) Copyright © 2009 AGA Institute Terms and Conditions

Figure 2 Pancreatic sections from a 78-year-old male patient who underwent partial pancreatectomy for a papillary tumor (A) and from a 78-year-old male patient with chronic pancreatitis (B) stained for glucagon (brown) and haematoxylin showing examples of endocrine islets in normal pancreatic tissue and surrounded by fibrosis and adipocytes in chronic pancreatitis. Images were acquired at 200× magnification. Gastroenterology 2009 136, 513-522DOI: (10.1053/j.gastro.2008.10.083) Copyright © 2009 AGA Institute Terms and Conditions

Figure 3 Fractional β-cell (A) and α-cell area (B) of the pancreas in 43 patients with chronic pancreatitis and 27 control subjects. Data are presented as means ± SEM; P values were calculated using 2-tailed Student t test. Gastroenterology 2009 136, 513-522DOI: (10.1053/j.gastro.2008.10.083) Copyright © 2009 AGA Institute Terms and Conditions

Figure 4 Mean insulin-positive islet area (A) and average number of islets per pancreatic tissue area (B) in 43 patients with chronic pancreatitis and 27 control subjects. Data are presented as means ± SEM; P values were calculated using 2-tailed Student t test. Gastroenterology 2009 136, 513-522DOI: (10.1053/j.gastro.2008.10.083) Copyright © 2009 AGA Institute Terms and Conditions

Figure 5 Pancreatic section from a 38-year-old male patient with chronic pancreatitis (A); the tumor-free pancreas of a 35-year-old male patient who underwent partial pancreatectomy because of a cholecystitis leading to intraperitoneal perforation (B); a 51-year-old male patient with chronic pancreatitis (C); and a 45-year-old male patient with a benign pancreatic adenoma (D), stained for insulin (red) and Ki67 (brown; A, B) and for glucagon (red) and Ki67 (brown; C, D) showing examples of replicating islet cells and exocrine cells. Images were acquired at 630× magnification. Gastroenterology 2009 136, 513-522DOI: (10.1053/j.gastro.2008.10.083) Copyright © 2009 AGA Institute Terms and Conditions

Figure 6 Expression of Ki67 in acinar cells (Ki67-positive acinar cells per field; A), percentage of duct cells positive for Ki67 (B), and percentage of duct cells expressing insulin (C) in 29 patients with chronic pancreatitis and 14 control subjects. Data are presented as means ± SEM; P values were calculated using Student t test. Gastroenterology 2009 136, 513-522DOI: (10.1053/j.gastro.2008.10.083) Copyright © 2009 AGA Institute Terms and Conditions

Figure 7 Pancreatic sections from 2 patients with chronic pancreatitis stained for insulin (green), TUNEL (red), as well as with DAPI (blue; A) or for glucagon (red), TUNEL (green), and DAPI (blue; B), showing examples of apoptotic nuclei. Images were acquired at 400× magnification. (C–E) Extent of apoptosis in β-cells (c), in α-cells (D), and in acinar cells (E) in 29 patients with chronic pancreatitis and 14 control subjects. Data are presented as means ± SEM; P values were calculated using Student t test. Gastroenterology 2009 136, 513-522DOI: (10.1053/j.gastro.2008.10.083) Copyright © 2009 AGA Institute Terms and Conditions