Abstract
To clarify the histological status of the pancreas tail after pancreatoduodenectomy (PD), fibrosis, islets of Langerhans, and A, B, and D cells were examined histometrically in surgical cases of pancreatic cancer. The same investigations were also performed during an autopsy examination of the pancreas tail of survivors of surgery who had received either PD or total pancreatectomy with segmental autotransplantation (SAT). In the surgical cases, fibrosis and the islet percentage compared with nonpancreatic cancer cases were significantly higher while the B cell ratio was significantly lower. In addition, in pancreatic cancer patients, the fibrosis and islet ratio in the group with a blocked pancreatic duct were higher while the B cell ratio was lower than in the group with an open pancreatic duct. A direct relationship between the islet ratio and the degree of fibrosis, and an inverse relationship between the B cell ratio and the degree of fibrosis, were thus found. From the autopsy cases, the fibrosis progressed and the islet ratio increased following PD, but after SAT only the islet ratio increased compared to the time of surgery. The progression of fibrosis after PD thus suggests the presence of some problems in both the surgical method and postoperative management.
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References
Miyata M, Yamamoto T, Hamaji M, Izukura M, Nakamura M, Taketani H, Nakao K, Kawashima Y (1988) Pancreatic endocrine function in long-term survivors after pancreatoduodenectomy: special reference to reversibility of insulin and glucagon secretion. World J Surg 12:651–657.
Ishikawa O, Ohhigashi H, Wada A, Tateishi R, Ishiguro S, Okano Y, Sasaki Y, Imaoka S, Koyama H, Iwanaga T (1989) Morphologic characteristics of pancreatic carcinoma with diabetes mellitus. Cancer 64:1107–1112
Kaji H, Inoue K, Miyashita T, Uchida K, Takahashi K, Tobe T (1991) Relationship between glucose tolerance and quantitative changes of islet cells in chronic obstructive pancreatitis due to pancreaticoduodenal cancer. Am J Gastroenterol 86:1020–1026
Inoue T (1975) A histopathological study of 60 autopsied cases of the primary pancreatic carcinoma with reference to pathogenesis of the tumor in concomitant pancreatitis (in Japanese with English abstract). Juntendo Igaku (Juntendo Med J) 22:62–90
Haunz EA, Forks G, Baggenstos AH (1950) Carcinoma of the pancreas: The effect of obstruction on the ductal and acinar systems. Arch Pathol 49:367–386
Sarles H (1992) Chronic pancreatitis and diabetes. Baillieres Clin Endocrinol Metab 6:745–775
Longnecker DS (1982) Pathology and pathogenesis of disease of the pancreas. Am J Path 107:103–121
Japan Pancreas Society (1993) General rules for cancer of the pancreas, 4th edn (in Japanese). Kanehara, Tokyo
Mitsuno M, Miyata M, Okuda A, Nakashima S, Sasako Y, Yamaguchi T, Takao T (1988) Segmental autotransplantation of the pancreas after total pancreatectomy for advanced periampullary carcinoma. Jpn J Surg 18:363–368
Weibel ER, Kistler GS, Scherle WF (1966) Practical stereological methods for morphometric cytology. J Cell Biol 30:23–38
Suda K, Mogaki M, Oyama T, Matsumoto Y (1990) Histopathologic and immunohistochemical studies on alcoholic pancreatitis and chronic obstructive pancreatitis: Special emphasis on ductal obstruction and genesis of pancreatitis. Am J Gastroenterol 85:271–276
Sahel J, Cros RC, Durbec JP, Sarles H, Bank S, Marks IN, Bettarello A, Duarte I, Guarita D, Machado M, Mott C, Dani R, Nogueria C, Gullo L, Priori P (1986) Multicenter pathological study of chronic pancreatitis. Morphological regional variations and differences between chronic calcifying pancreatitis and obstructive pancreatitis. Pancreas 1:471–477
Saito K, Iwama N, Takahashi T (1978) Morphometric analysis on topographical difference in size distribution, number and volume of islets in the human pancreas. Tohoku J Exp Med 124:177–186
Malaisse-Lagae F, Stefan Y, Cox J, Perrelet A, Orci L (1979) Identification of a lobe in the adult human pancreas rich in pancreatic polypeptide. Diabetologia 17:361–365
Cubilla AL, Fitzgerald PJ (1984) Tumors of the exocrine pancreas. AFIP, Washington, D.C.
Gyr K, Feitz P, Beglinger (1984) Pancreatitis. In: Klöppel G, Heitz P (eds) Pancreatic pathology. Churchill Livingstone, Edinburgh
Inoue T, Kawano T, Shima K, Kim T, Suzuki T, Tobe T, Yajima H (1981) Relationship between development of fibrosis and hemodynamic change of pancreas in dogs. Gastroenterology 81:37–47
Koseki S, Noto N, Matuno S, Kano K (1980) Clinicopathological study on the chronic pancreatitis (in Japanese with English abstract). Jpn J Gastroenterol 77:954–962
Walker NI, Winterford GM, Kerr JF (1992) Ultrastructure of the rat pancreas after experimental duct ligation: II. Duct and stromal cell proliferation, differentiation and deletion. Pancreas 7:420–434
Yaginuma N, Takahashi T, Saito K, Kyogoku M (1985) The microvasculature of the human pancreas and its relation to Langerhans islets and lobules. Path Res Pract 181:77–84
Klöppel G, Bommer G, Commandeur G, Heitz PH (1978) The endocrine pancreas in chronic pancreatitis. Immunocytochemical and ultrastructural studies. Virchows Arch [A] Path Anat Histol 377:157–174
Laszik Z, Pap A, Farkas G, Ormos J (1989) Endocrine pancreas in chronic pancreatitis. A qualitative and quantitative study. Arch Pathol Lab Med 113:47–51
Kaiho T, Masuda T, Sasano N (1985) Three-dimensional arrangement of A, B and D cells in adult human Langerhans islets and their relationship to insular blood vessels (in Japanese). Tan to Sui (J Bil Pancr) 6:205–212
Widdison AL, Alvarez FC, Schwarz M, Reber HA (1992) The influence of ethanol on pancreatic blood flow in cats with chronic pancreatitis. Surgery 112:202–210
Ito A, Han N, Yoshida S (1976) Diagnosis and treatment of obstructive jaundice (in Japanese). Shujutsu (Operation) 15:1141–1151
Miyaishi S, Sato T, Nakamura E, Miyaishi M, Morimoto T (1992) Clinical and pathological analysis on status during 25 years after pancreaticoduodenectomy: autopsy report of an 87-year-old female case (in Japanese). Tan to Sui (J Bil Pancr) 13:307–314
Rossi R, Heiss FW, Watkins E, Soeldner JS, Shea JA, Silverman ML, Braasch JW, Nugent FW, Bolton J (1986) Segmental pancreatic autotransplantation with pancreatic ductal occlusion after near total or total pancreatic resection for chronic pancreatitis. Ann Surg 203:626–636
Tamura K, Kin S, Nogami H, Yano S, Nakagawa M, Nakase A (1992) Heterotopic autotransplantation of the distal pancreas after total pancreatectomy for cancer of the head of the pancreas. Pancreas 6:664–671
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Yamaguchi, T., Miyata, M., Kamiike, W. et al. Histometric analysis of the distal pancreas in pancreatic head cancer. Surg Today 27, 420–428 (1997). https://doi.org/10.1007/BF02385705
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DOI: https://doi.org/10.1007/BF02385705