Ultrastructural studies of human acute pancreatitis

Microvasculature of the pancreas. Relation to pancreatitis

Local or generalized alteration of microcirculation may be expected in diseases of the pancreas. Changes may range from increased permeability of capillaries to hemorrhage. Tissue necrosis may result from prolonged ischemia owing to intravascular coagulation and severely impaired blood flow. It is possible to observe early microvascular changes by intravital microscopy. Klar and coworkers have demonstrated by this method that isovolemic hemodilution improves blood flow under conditions that would otherwise lead to tissue damage. This paper presents the basic microcirculation of the pancreas and the changes that accompany pancreatic disease. It emphasizes that concentration on the changes in microcirculation that accompany the early manifestations of pancreatic diseases, particularly pancreatitis, may reveal important clues to their pathogenesis.

Immunocytochemical and morphometric analysis of acinar zymogen granules in human acute pancreatitis

In the present study fine structural changes of acinar zymogen granules were investigated in human acute pancreatitis. Pancreatic tissue was obtained at surgery from 6 patients, prepared for ultrastructural analysis, and stained immunocytochemically for trypsinogen. Stereological parameters of zymogen granules were evaluated. The density of the immunocytochemical labelling for trypsinogen was estimated over zymogen granules, the rough endoplasmic reticulum, Golgi apparatus and the acinar lumina. In acute pancreatitis the number of zymogen granules was diminished and their size reduced. The density of the labelling for trypsinogen was unchanged over zymogen granules but showed a significant reduction over the rough endoplasmic reticulum, Golgi apparatus, and the acinar lumina. In general the integrity of zymogen granules was well preserved. Focally degenerative changes of zymogen granules and large autophagosomes were observed. From the immunogold labelling a disturbance of enzyme synthesis and secretion was suggested. Evidence is given that a disruption of the zymogen granule membranes and a fusion with lysosomal bodies might contribute to the pathogenesis of human acute pancreatitis.

Ultrastructure of human acute pancreatitis

Few studies have been published on the ultrastructural changes which accompany human acute pancreatitis, and these have concentrated primarily on parenchyma. The present study concentrates on extraparenchymal changes, compares acute pancreatitis occurring alone with that on a background of chronic pancreatitis, and tests for similarity with observations made previously in an experimental model. Pancreatic tissue came from 16 patients undergoing surgery for pancreatic disease and five subjects without pancreatic disease. Regressive changes in parenchymal cells were consistent with ischemia, and with previously described studies. Polymorphonuclear leukocytes infiltrated into stroma and parenchyma. Platelets accumulated intra- and extravascularly. Fibrin deposits were common in the connective tissue, and could be observed in intercellular spaces at the base of acini, mingled with degenerating acinar cells and secretion product. Microthrombi occurred in blood vessels. These alterations were consistent with those in experimental acute pancreatitis. Similar changes were observed whether or not acute pancreatitis occurred on a background of chronic pancreatitis. The vascular component is important in acute pancreatitis, and altered epithelial barriers allow interaction between blood-borne material and pancreatic exocrine secretions.

Early histological changes in acute necrotizing hemorrhagic pancreatitis. A retrospective pathological study of 20 total pancreatectomy specimens

Settled lesions of acute necrotizing hemorrhagic pancreatitis have been commonly reported. Early alterations remained unknown. In a retrospective pathological study of 20 total pancreatectomy specimens, early changes have been evidenced in "grossly unmodified" areas of pancreas: acinar cells homogenization, ductal dilatation with epithelial degeneration, diffuse interstitial edema and fibroblastic reaction, necrotic angeitis . These alterations were identical to the changes described in experimental studies.

Ultrastructure of early development of acute pancreatitis in the rat

This study was undertaken to define the earliest ultrastructural changes appearing in the exocrine pancreas and its vasculature during the development of experimental acute pancreatitis induced by the closed duodenal loop technique. Experimental and sham-operated rats were killed at hourly intervals up to 4 hr and at 6 hr postoperatively. Focal acinar cell response included appearance of vacuoles containing uncondensed or partially condensed secretory product, and some rearrangement and dilatation of the rough endoplasmic reticulum within 1 hr. Mild edema was observed and damage to the vascular endothelium developed by 2 hr. At 4 hr focal hemorrhage and a slight inflammatory cell infiltrate was noted which was more prominent at 6 hr. The lack of a correspondence between areas of acinar cell and of vascular abnormalities suggests that factors other than increased secretory back-pressure are involved in the early development of this model of acute pancreatitis.

Experimental pancreatitis in the rat. Light and electron microscopical observations on early pancreatic lesions induced by intraductal injection of trypsin, phospholipase A2, lysolecithin and non-ionic detergent

Trypsin, phospholipase A2, lysolecithin or non-ionic detergent polyoxyethylene p-t-octyl phenol solutions were injected into the rat biliopancreatic duct. Histological and ultrastructural changes in the gland were studied 15 min and 3 h after the injections. The rough surfaced endoplasmic reticulum disintegrated in two ways: (1) the endoplasmic reticulum in the cell periphery was vesiculated but ribosomes were well preserved at 15 min, and (2) large, round membranous structures appeared in apical cytoplasm at 3 h. Zymogen granules disintegrated in the second type, which possibly represents autodigestion. Both types of injury lead ultimately to structureless necrosis. Lesions induced by phospholipase A2 and lysolecithin were identical. Trypsin-induced damage developed slowly and the two phases of endoplasmic reticulum disintegration were not sharply separable. Lesions caused by polyoxyethylene p-t-octyl phenol were variable at 15 min, but at 3 h the type 2 injury described above was observed. It was concluded that although the initial damage in pancreatic acinar cells may vary, necrotic changes are similar despite the injected material at the later time interval. During acute pancreatitis, the acinar cell necrosis is most probably due to the action of lysolecithin produced by the activation of phospholipase A2.

Pancreatic acinar ultrastructure in human acute pancreatitis

Ultrastructural alterations in pancreatic acini from six patients operated for acute necrotizing pancreatitis are described. One of the patients suffered from biliary tract disease, the rest had excessive alcohol intake as the presumed aetiology. Areas of the pancreatic parenchyma showing oedematous inflammation in light microscopy were studied in the electron microscope. Findings in acinar cells included changes in zymogen granules and an increased autophagocytosis in addition to unspecific organelle alterations. Zymogen granules showed increase in size and number, loss or variation of electron-density and peripheral dissolution. Increased autophagic activity was indicated by several autophagic vacuoles and residual bodies. Acinar lumina were dilated showing effacement of microvilli and invaginations in the luminal plasma membrane of the acinar cells. In acinar lumina and in the interstitium fibrillar material was observed, with an increasing frequency in those areas showing severe cellular disintegration. These findings suggest: 1) an increased activity of zymogen granules, 2) an increased autophagocytosis, and 3) penetration of acinar luminal contents into the interstitium.

Ultrastructural studies of experimental acute pancreatitis

Acute pancreatitis was studied by electron microscopy after retrograde infusion of either trypsin, and/or beta-glucuronidase into the canine pancreatic duct. Marked changes were induced by the mixture of trypsin and beta-glucuronidase. (1) The acinar cells were initially excavated from the acinar lumen and formed cystic bodies in themselves. The cystic bodies were then disrupted at their marginal membranes, and the acinar cells were filled with a large amount of fibrillar materials which originated from the contents of the cystic bodies. At this time, the luminal margin of the acinar cells completely disappeared. (2) The cellular organellas and the intracellular fibrillar materials in the acinar cells were discharged into the interstitial space through the disrupted basal lamina. Infection in the pancreatic ductal system was considered to play an important role in the pathogenesis of acute hemorrhagic pancreatitis.