Tomova Irina, Stoyanov George S, Dzhenkov Deyan L, Petkova Lilyana
Medicine, Medical University of Varna, Varna, BGR.
General and Clinical Pathology/Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR.
Cureus. 2020 Jun 22;12(6):e8777. doi: 10.7759/cureus.8777.
Introduction Islet amyloid polypeptide (IAPP) amyloidosis is a pathologic alteration of the pancreas, represented by abnormal accumulation of amylin in the interstitial tissue. Amylin is a neuroendocrine hormone, co-secreted with insulin by beta cells and participating in downstream regulation of postprandial glycemia. This report aims to examine IAPP amyloidosis as a late consequence of poor control of blood glucose levels in patients with type 2 diabetes mellitus (T2DM) who have been referred for autopsy. Materials and methods A total of 34 consecutive autopsies performed at the St. Marina University Hospital, Varna, Bulgaria, carried out by a single pathologist were included in the study. Samples from the tail of the pancreas were obtained to evaluate the state of the changes and were analyzed together with the specific organ changes associated with T2DM, as well as the medical documentation of the patients. Results Of the 34 autopsies, 10 cases (six females and four males) were included in the study, seven of whom had a medical history of T2D. The average age was 65.7 years (range 50 to 85 years). In all of the cases, morphological features of fibrosis and lipomatosis were present, with one of the patients having signs of pancreatic amyloidosis - Congo red positive deposition of pink, amorphous material in the extracellular matrix. Conclusion The described pathological alterations in all of the cases illustrate the progressing impairment of the structure of the pancreas, especially beta cells dysfunction in late stages of T2D, and highlight IAPP amyloidosis as the cause of irreversible damage of the isles of Langerhans and beta cell death.
引言 胰岛淀粉样多肽（IAPP）淀粉样变性是胰腺的一种病理改变，表现为胰岛间质组织中胰淀素异常蓄积。胰淀素是一种神经内分泌激素，由β细胞与胰岛素共同分泌，参与餐后血糖的下游调节。本报告旨在研究IAPP淀粉样变性作为2型糖尿病（T2DM）患者血糖控制不佳的晚期后果，这些患者已被转诊进行尸检。
材料与方法 本研究纳入了保加利亚瓦尔纳圣玛丽娜大学医院由一名病理学家连续进行的34例尸检。获取胰腺尾部样本以评估病变状态，并与T2DM相关的特定器官病变以及患者的医疗记录一起进行分析。
结果 在34例尸检中，10例（6名女性和4名男性）纳入研究，其中7例有T2D病史。平均年龄为65.7岁（范围50至85岁）。所有病例均存在纤维化和脂肪化生的形态学特征，其中1例患者有胰腺淀粉样变性的迹象——细胞外基质中粉红色无定形物质的刚果红阳性沉积。
结论 所有病例中描述的病理改变说明了胰腺结构的进行性损害，尤其是T2D晚期的β细胞功能障碍，并突出了IAPP淀粉样变性是朗格汉斯岛不可逆损伤和β细胞死亡的原因。
