Pancreas Pathology Lab, Case 2 47-year-old alcoholic man with severe epigastric pain radiating to the back.

Identify the organ Identify the structures Diagnosis?

Acute Pancreatitis The pancreas is bisected along its longitudinal axis. Many foci of yellow-white necrosis are scattered throughout the head, body, and tail. A – Fat necrosis B- Splenic vein and thrombus

Identify the organ Describe the histologic findings

A – acinus B – Islet of Langerhans C – adipose cell Normal Pancreas

Describe the histologic findings in sections A and B

Section (A) reveals Acute Pancreatitis. The section shows amorphous debris (arrow) that formed after necrosis of acini. The few remaining acini (*) are separated by infiltrating neutrophils. Section B reveals normal pancreas for comparison

Amorphous debris acini Acini Acute inflammation Acute pancreatitis

Describe the histologic findings

A low power view of peripancreatic fat shows necrosis Fat necrosis Pancreas

Identify the organs Describe the gross morphologic changes Diagnosis?

Acute Pancreatitis An autopsy specimen consisting of the stomach, spleen, pancreas, and adjacent fat reveals acute inflammation. The pancreas is swollen and hyperemic. Focal areas of green necrosis are present. Small foci of bright yellow, fat necrosis are present. The stomach is folded back so as to reveal its posterior wall and the pancreas. A – Stomach B – Spleen C – Fat D - Pancreas

An intraoperative photograph reveals an acute hemorrhagic pancreatitis. The fat of the pancreas, colon, and greater omentum is necrotic and hemorrhagic

Acute Hemorrhagic Pancreatitis A surgical specimen of the body and tail of the pancreas reveals acute, hemorrhagic necrosis. Describe the gross findings

Acute Pancreatitis A surgical specimen of the transverse colon and greater omentum shows extensive fat necrosis (Note the bright yellow foci). The mesenteric fat has been completely digested away so as to reveal the isolated blood vessels. Describe the findings of this surgical specimen