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. 1997 Aug;41(2):263–268. doi: 10.1136/gut.41.2.263

Non-alcoholic duct destructive chronic pancreatitis

N Ectors 1, B Maillet 1, R Aerts 1, K Geboes 1, A Donner 1, F Borchard 1, P Lankisch 1, M Stolte 1, J Luttges 1, B Kremer 1, G Kloppel 1
PMCID: PMC1891454  PMID: 9301509

Abstract

Background—The pathology of non-alcoholic chronic pancreatitis has not yet been sufficiently studied. 
Aims—To identify the major changes of pancreatic tissue in patients surgically treated for non-alcoholic chronic pancreatitis. 
Patients—Pancreatectomy specimens from 12 patients with non-alcoholic chronic pancreatitis, including four patients with autoimmune or related diseases (Sjögren's syndrome, primary sclerosing cholangitis, ulcerative colitis, and Crohn's disease), were reviewed. 
Methods—Morphological changes were studied histologically and immunohistochemically (to type inflammatory cells) and compared with the pancreatic alterations found in 12 patients with alcoholic chronic pancreatitis. 
Results—In patients with non-alcoholic chronic pancreatitis, with or without associated autoimmune or related diseases, pancreatic inflammation particularly involved the ducts, commonly resulting in duct obstruction and occasionally duct destruction. None of these features was seen in alcoholic chronic pancreatitis which, however, showed pseudocysts and calcifications. 
Conclusion—The pancreatic changes in patients with non-alcoholic chronic pancreatitis clearly differ from those with alcoholic chronic pancreatitis. The term chronic duct destructive pancreatitis is suggested for this type of pancreatic disease. 



Keywords: non-alcoholic chronic pancreatitis; duct destructive pancreatitis

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Figure 1 .

Figure 1

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: Gross appearance of non-alcoholic chronic pancreatitis mimicking pancreatic carcinoma (duodeno-hemipancreatectomy specimen from patient 8). On sectioning the head of the pancreas appears indurated and pale. The intrapancreatic segment of the distal bile duct is narrowed (arrows). 


Figure 2 .

Figure 2

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: Non-alcoholic duct destructive chronic pancreatitis: large interlobular duct surrounded by a dense inflammatory infiltrate composed of mononuclear cells. Haematoxylin and eosin; original magnification ×60. 


Figure 3 .

Figure 3

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: Non-alcoholic duct destructive chronic pancreatitis: inflammatory process destroying the epithelium (arrows) of some interlobular ducts. Haematoxylin and eosin; original magnification ×120. 


Figure 4 .

Figure 4

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: Non-alcoholic duct destructive chronic pancreatitis: a small interlobular duct embedded in a dense inflammatory infiltrate. The epithelium has been invaded by lymphocytes and granulocytes. Haematoxylin and eosin; original magnification ×240. 


Figure 5 .

Figure 5

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: Non-alcoholic duct destructive chronic pancreatitis: advanced changes in the pancreas, characterised by fibrotic replacement of acinar tissue and severe duct obliteration. Haematoxylin and eosin; original magnification ×120. 


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