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Minor abnormalities

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 12 December 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Acinar dilation

● Associated with uremia, chronic pancreatitis (J Clin Pathol 1996;49:913), dehydration, severe bacterial infections (Hum Pathol 1984;15:677), bone marrow transplant

Altered acinar cells

● Associated with chronic pancreatitis, alcohol, chemotherapy, pancreatic endocrine excess, tobacco

3 patterns:
● (a) Small groups of cells with reduced cytoplasm, less basophilia, more vacuolation, condensed nuclei, resemble islets
● (b) Normal sized cells without basophilia with basal nuclei
● (c) Cells with variable size and occasional large irregular nuclei

Ductal hyperplasia / ductal papillary hyperplasia

Ductal hyperplasia: also mucinous cell hypertrophy and mild to moderate dysplasia; note the focal nuclear crowding within small papillae

Ductal papillary hyperplasia: marked papillary hyperplasia due to duct obstruction from tumor; papillae of various sizes, lined with columnar mucinous cells, project into lumen of main duct, which contains inspissated material; a few areas of flat epithelium are present between papillae

Ductal papillary hyperplasia: this interlobular duct from a patient with chronic pancreatitis shows mucous cell hypertrophy and ductular hyperplasia; epithelium exhibits slight cellular atypia

Adenomatoid ductal hyperplasia: accumulation of medium-sized pancreatic ducts, ductules, or both embedded in moderately cellular fibrous tissue

Focal fibrosis

● Associated with older age or diabetes mellitus

Hemosiderin deposition

● May be due to primary hemochromatosis or chronic blood transfusions (Arch Pathol Lab Med 1985;109:996)


● Associated with older age

Marked fatty atrophy

● Associated with type II diabetes, obesity, pancreatitis, duct obstruction, cystic fibrosis and severe generalized atherosclerosis
● Results in malabsorption

Mucinous cell hypertrophy

Nonpapillary epithelial hypertrophy characterized by replacement of normal epithelium of large and medium-sized ducts by tall mucin-producing columnar cells

Lining columnar epithelium shows mild cellular atypia characterized by some crowding of slightly enlarged nuclei; most nuclei are polarized; apical portion of cytoplasm is filled with mucin

With pyloric gland metaplasia: an area of parenchymal atrophy, chronic pancreatitis and fatty replacement of parenchyma in patient with pancreatic carcinoma; there is marked hypertrophy and hyperplasia of mucous glands of duct epithelium; a diagnosis of pyloric gland metaplasia has to be made histochemically and is suggested by PAS+ and Alcian blue (pH 2.8) negative

Electron micrograph of papillary hyperplasia in patient with cancer of head of pancreas; mucin granules have an electron-opaque matrix and a darker eccentric core

Mucinous (goblet cell) metaplasia

● Associated with older age, chronic pancreatitis, carcinoma
● Differential diagnosis: PanIN-1A

Oncocytic change

● Associated with chemotherapy

Proliferation of centroacinar or intercalated duct cells

● Associated with recent ductal obstruction, acute alcohol abuse, chronic pancreatitis, hyperinsulinemia or hypergastrinemia

Pseudolipomatous hypertrophy

Pancreatic parenchyma consists of mature fatty tissue separated by thin fibrous septa containing isolated clusters of normal islets

Squamous metaplasia

● Common, associated with chronic pancreatitis, normal pancreas, bone marrow transplant with chemotherapy (Hum Pathol 1993;24:152)
● Micro images:

Squamous metaplasia: mucinous epithelial duct cells are partly replaced by squamous epithelium

End of Pancreas > General > Minor abnormalities

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