Retrograde pancreatography in autopsy specimens

Abstract

Sixty-two pancreases were dissected at autopsy. In 55 of them, the pancreatic ducts were filled with 50 per cent Hypaqje and roentgenograms were made prior to dissection. Clinical information (available in every case) was correlated with the gross and microscopic findings and findings on the pancreatograms. The anatomically and functionally predominant duct was considered the "main pancreatic duct" regardless of its embryologic development. The common bile and main pancreatic duct opened independently into the duodenum in 8 of the 62 cases (13 per cent). The accessory pancreatic duct had a patent orifice into the duodenum in 12 of 57 cases (21 per cent). The ampulla of Vater was well developed in only 4 of the 62 cases (6 per cent), but an ampullary dilatation was present twice as often at the end of the acessory pancreatic duct, in both those that ended blindly and those that opened into the duodenum. The orifices for the accessory duct were often tiny pinhole openings. There were 2 primary carcinomas of the pancreas, one in the head and one in the tail. The pancreatic duct was almost completely obstructed in each case. Both tumors were undifferentiated adenocarcinomas, and extravasation occurred into each one of them. Extravasation also occurred into a necrotic lymphoma involving the tail of the pancreas, and into two areas of abscess formation in another case. Diffuse, dense, fluffy opacification of pancreatic parenchyma, due to alteration in cell membrane permeability, was demonstrated in acute pancreatitis, infarction, autolysis, and overfilling of the ducts by vigorous injection. Three pancreases showed microscopic changes of chronic pancreatitis. The pancreatogram on one was normal, but the microscopic changes were minimal, and pancreatitis was not suspected clinically. The other 2 cases were symptomatic, and their pancreatograms showed strictures and irregularities of the main pancreatic duct as well as saccular ectasia was present in three additional pancreases, two of which showed squamous metaplasia of ductal epithelium without other microscopic stigmata of chronic pancreatitis and no clinical features to suggest pancreatitis. The possibilities exist that ectasia of secondary ducts and squamous metaplasia of ductal epithelium are manifestations of low-grade injury and that "subclinical pancreatitis" may be common in the general population.