Sindhu R S, Subhash Raveendran, Gireesan Parvathy, Raji Laila, Koshy Peter, Natesh Bonny, Rajan Ramesh, Kuruvilla A P
Department of Surgical Gastroenterology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India.
Department of Surgical Gastroenterology, Government Medical College Thiruvananthapuram, Thiruvananthapuram, Kerala, India.
Pancreatology. 2015 May-Jun;15(3):226-32. doi: 10.1016/j.pan.2015.04.002. Epub 2015 Apr 20.
Chronic Pancreatitis (CP) is a heterogenous disease with alcoholic chronic pancreatitis (ACP) dominating in the West, and idiopathic or tropical chronic pancreatitis (TCP) in the tropics. The aim of this study is to assess the feasibility of using a scanning electron microscope (SEM) to analyze the ultra-structural changes in alcoholic and tropical subtypes of CP.
Chronic pancreatitis tissue samples were taken from the biopsy samples of 16 patients (seven ACP and nine TCP) who underwent drainage procedures for CP. These samples were subjected to SEM analysis and findings of normal pancreas were compared with those of CP for appreciating differences in their architectural changes.
Normal architecture of pancreas could be observed as lobules of parenchyma, ductal system and definite loci of Islets of Langerhans (IOL). CP samples showed loss of architecture in the form of severe fibrosis and calcifications. In ACP, the fibrosis was predominantly seen towards the periphery of the gland sparing the periductal areas. These fibres were strangulating and damaging the parenchyma. Crystals were seen over these fibres. In TCP, fibrosis was moderate and uniform throughout the parenchyma. Moreover the crystals were larger and intraluminal. Total fatty replacement of parenchyma was a striking feature in TCP, seen exclusively in diabetics with gross atrophy of IOL.
SEM gives the real-life pictures of fibrosis, fatty change, ductal changes, calcifications and thus the actual extent of damage in CP better than the ordinary light microscopy.
慢性胰腺炎（CP）是一种异质性疾病，在西方以酒精性慢性胰腺炎（ACP）为主，在热带地区则以特发性或热带性慢性胰腺炎（TCP）为主。本研究的目的是评估使用扫描电子显微镜（SEM）分析CP的酒精性和热带亚型超微结构变化的可行性。
从16例因CP接受引流手术的患者（7例ACP和9例TCP）的活检样本中获取慢性胰腺炎组织样本。对这些样本进行SEM分析，并将正常胰腺的结果与CP的结果进行比较，以了解其结构变化的差异。
正常胰腺结构可观察到实质小叶、导管系统和胰岛（IOL）的特定位置。CP样本显示出以严重纤维化和钙化为形式的结构丧失。在ACP中，纤维化主要见于腺体周边，导管周围区域未受累。这些纤维挤压并损害实质。在这些纤维上可见晶体。在TCP中，纤维化程度中等且在整个实质中均匀分布。此外，晶体更大且位于管腔内。实质完全脂肪替代是TCP的一个显著特征，仅在IOL严重萎缩的糖尿病患者中可见。
与普通光学显微镜相比，SEM能更真实地呈现CP中纤维化、脂肪变化、导管变化、钙化以及实际损伤程度的情况。
