Incidence and diagnostic significance of minor pathologic changes in the adult pancreas at autopsy: a systematic study of 112 autopsies in patients without known pancreatic disease.

In 112 unselected autopsies of adult patients without known pancreatic disease (except adult-onset diabetes mellitus), the pancreas was examined to establish the incidence and degree of such minor pancreatic lesions as lipomatosis, fibrosis, alterations of ducts and ductal epithelium, inflammatory infiltrates, focal necrosis, acinar dilation, and vascular changes. Each lesion was then tested for statistically significant correlations with the age of the patient and a number of clinical conditions, including cholelithiasis, adult-onset diabetes mellitus, adiposity, generalized severe atherosclerosis, chronic alcoholism, severe bacterial infection prior to death, and generalized malignant tumor. This was done in the hope of finding associated or predisposing factors for the pancreatic lesions. The results show, in addition to the unexpectedly high incidence of the various pancreatic lesions, a clear increase of lipomatosis, fibrosis, and both ductal and ductal epithelial alterations with increasing age; these conditions were accompanied by a steady decrease in the mean weight of the gland, starting at the age of about 40 years, except in cases of advanced lipomatosis. The latter condition was associated with adult-onset diabetes mellitus. Severe generalized atherosclerosis was correlated with lipomatosis and fibrosis, but the two latter conditions were found together only rarely. Acute (terminal) lesions, including focal necrosis and acinar dilation, were associated with severe bacterial disease prior to death. Other statistically significant correlations were rare, indicating the lack of specificity of these minor pancreatic lesions rather than offering a clue as to their pathogenesis. The diagnostic significance and the relations of these lesions to clinically relevant chronic pancreatitis are discussed briefly.