RESUMEN
BACKGROUND/PURPOSE: The role of the ampullary mucosa, especially its distended glands at the papilla of Vater, has not been fully explored. METHODS: Twenty-nine pancreatoduodenectomized specimens from pancreatobiliary diseases and 44 autopsied cases, as controls, were studied histopathologically and immunohistochemically. RESULTS: In 12 out of the 29 pancreatoduodenectomized cases the ampullary mucosa was in contact with the duodenal mucosa just at the outlet of the ampulla. In the remaining 17 cases, the ampullary mucosa overgrew beyond the ostium, replacing a portion of the surrounding duodenal mucosa, termed "distended glands," which measured an average of 1532 microm in length. The muscularis mucosae of the duodenum and the Oddi's sphincter muscle merged in an "end-to-end, sharp-angled" manner at the ostium in the former, whereas this occurred in an "end-to-side, less sharp, rather right-angled" manner in the latter. Immunohistochemically, the distended glands in some cases showed negative/weakly positive staining for anti-carbohydrate antigen (CA) 19-9 and a high proliferation index evaluated using Ki67. In the autopsied materials, distended glands were found in 24 out of the 44 cases. CONCLUSIONS: Distended glands of the ampullary mucosa were frequently found and only grew on the Oddi's sphincter muscle extension. They may represent not only malignant change but also an adaptive phenomenon for bile and pancreatic juice flow.
Asunto(s)
Ampolla Hepatopancreática/patología , Membrana Mucosa/patología , Neoplasias Pancreáticas/patología , Adulto , Anciano , Anciano de 80 o más Años , Ampolla Hepatopancreática/metabolismo , Ampolla Hepatopancreática/fisiopatología , Biopsia , Antígeno CA-19-9/metabolismo , Proliferación Celular , Enfermedad Crónica , Neoplasias del Conducto Colédoco/patología , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Membrana Mucosa/metabolismo , Pancreatitis/patologíaRESUMEN
Pancreatic fibrosis in patients with congenital biliary dilatation (CBD) or choledochal cyst was studied to determine why biliary pancreatitis seldom progresses to chronic pancreatitis/more progressive state. Pancreatic collagenization in eight patients (three adults with pancreatoduodenectomy and five children with biopsy of the pancreas performed when excising the cyst) with CBD was evaluated histopathologically and immunohistochemically. Interlobular and periductal fibrosis with both collagen Type I and Type III immunoreactivities was found in six out of eight cases and in all four cases in which the pancreatic duct was included, respectively. The interlobular area was seldom immunoreactive for alpha-smooth muscle actin (alpha-SMA), a marker for myofibroblasts, but was usually positive for CD34, a human progenitor cell antigen. In contrast, the periductal area was usually immunoreactive for alpha-SMA, but usually negative for CD34 and immunopositive for bcl-2, indicating a continuously progressive state of fibrosis, in which 'pre-existing'alpha-SMA immunoreactivity in the interlobular area may change in nature and lead to CD34-positive fibrosis or apoptosis. In conclusion, biliary pancreatitis is not likely to evolve into chronic pancreatitis/more progressive state because 'pre-existing'alpha-SMA immunoreactivity in the interlobular area may change in nature.