Martella E M, Ferraro G, Azzoni C, Marignani M, Bordi C
Department of Anatomic Pathology, University of Parma, Italy.
Hum Pathol. 1997 Feb;28(2):149-53. doi: 10.1016/s0046-8177(97)90098-8.
An immunohistochemical investigation of pancreatic-polypeptide (PP) cells in the PP-rich region of the pancreas, of ventral embryological origin, was performed in three female patients affected by or previously operated on for functioning duodenal or pancreatic gastrinomas not associated with multiple endocrine neoplasia syndrome. A pronounced PP-cell hyperplasia showing histological patterns of endocrine cell dysplasia and focal adenomatosis as defined by Jaffe et al was found in all cases. Morphometric analysis showed that in these patients the fraction of ventral-type pancreatic lobules occupied by PP-immunoreactive cells was 14.77 +/- 5.73%, 8.94 +/- 2.92%, and 10.83 +/- 5.64%, respectively. These values were three to five times higher than the upper values found in controls (mean, 2.20%; range, 1.54 to 2.93%; P < .0001). PP-cell hyperplasia may contribute for the increased circulating levels of PP found in gastrinoma patients. In this regard, elevation of fasting blood PP was found in one of four determinations done in one patient, indicating that PP-cell hyperplasia may be responsible for, at least, transient PP hypersecretion. In one of our patients, PP-cell hyperplasia was found 15 years after normalization of gastrin levels by removal of a single pancreatic gastrinoma. This finding is against a trophic role for hypergastrinemia in the development of PP-cell hyperplasia. In one of two patients in whom the pancreatic regions of dorsal embryological origin (ie, body and tail of the gland) were examined, ventral-type, PP-rich islets were frequently encountered, a finding at variance with their exceptional detection in control cases. This finding suggests that PP cell hyperplasia of the PP-rich pancreatic region may be a feature of a more diffuse disorder of PP cell development in the pancreas of gastrinoma patients.
对三名女性患者进行了免疫组织化学研究，这些患者患有功能性十二指肠或胰腺胃泌素瘤且未伴有多发性内分泌肿瘤综合征，或曾接受过相关手术。研究对象为胰腺中富含胰多肽（PP）细胞的区域，该区域起源于胚胎腹侧。所有病例均发现明显的PP细胞增生，呈现出Jaffe等人所定义的内分泌细胞发育异常和局灶性腺瘤病的组织学模式。形态计量分析表明，在这些患者中，PP免疫反应性细胞占据的腹侧型胰腺小叶比例分别为14.77±5.73%、8.94±2.92%和10.83±5.64%。这些值比对照组的上限值高出三到五倍（平均值为2.20%；范围为1.54%至2.93%；P<.0001）。PP细胞增生可能导致胃泌素瘤患者循环中PP水平升高。在这方面，一名患者的四次测定中有一次发现空腹血PP升高，这表明PP细胞增生可能至少导致了短暂的PP分泌过多。在我们的一名患者中，切除单个胰腺胃泌素瘤使胃泌素水平恢复正常15年后，仍发现PP细胞增生。这一发现与高胃泌素血症在PP细胞增生发展中的营养作用相悖。在两名检查了胚胎背侧起源的胰腺区域（即腺体的体部和尾部）的患者中，有一名患者经常遇到腹侧型、富含PP的胰岛，这一发现与在对照病例中极少检测到的情况不同。这一发现表明，富含PP的胰腺区域的PP细胞增生可能是胃泌素瘤患者胰腺中更弥漫性PP细胞发育障碍的一个特征。
