The Adult Pancreas in Trauma and Disease

Abstract

The spectrum of traumatic and natural disease that can affect the adult pancreas is multiple and varied. Some entities are more commonly encountered in routine forensic pathology practice and the forensic pathologist needs to be very familiar with their pathological features and development from a pathophysiological perspective. However, many of the conditions are extremely rare and may never be encountered in the professional lifetimes of an individual pathologist. Still, forensic pathologists need to be aware of them in case they are one day faced with these entities as possible diagnoses to be established at postmortem examination. This can be the result of clinical concerns raised in life, potential natural disease explanations for unexpected biochemical results, and sudden, unexpected or otherwise unexplained deaths where criminal concern about the exogenous administration of a substance must be considered. Acad Forensic Pathol. 2018 8(2): 192-218.

Keywords: Alcoholic and obstructive pancreatitis; Chronic pancreatitis; Forensic pathology; Pancreatic injury; Pancreatic trauma; Pancreatitis.

Figure 1:

Diagrammatic representation of the pancreas and its relation to neighboring structures (anterior view). Created under contract by professional medical illustrator Diana Kryski.

Figure 2:

Diagrammatic representation of the pancreas and its relation to neighboring structures (posterior view). Created under contract by professional medical illustrator Diana Kryski.

Image 1:

A) Patterned footwear mark on the lateral aspect of the abdomen of a decomposed male decedent who died from blunt force head injury with a large acute subdural hematoma. B) A large contusion of the mesentery was evident on internal examination. (Images courtesy of Dr. Matt Lyall, Home Office Pathologist, United Kingdom).

Image 2:

Inflammation of the peritoneum with fat necrosis (saponification) (arrows) of the mesentery.

Image 3:

Mesenteric bruise (yellow arrow) and fat necrosis (saponification) (white arrows) of the mesentery.

Image 4:

Sutured laceration of the liver.

Image 5:

Abrasions on the back of the right elbow.

Image 6:

Sections of well preserved pancreas A) and B) (H&E, x50).

Image 7:

A) Mild autolysis (H&E, x20) and B) (H&E, x400).

Image 8:

Severe autolysis of the pancreas A) (H&E, x10) and B) (H&E, x400).

Image 9:

Acute pancreatitis A) (H&E, x100) and B) (H&E, x200).

Image 10:

Chalky spots of fat necrosis (saponification) (arrows) of the mesentery in a case of acute pancreatitis.

Image 11:

Chronic pancreatitis, A) Calcified luminal protein precipitation in a ductal lumen (H&E, x40), B) With marked parenchymal loss and interstitial replacement fibrosis (H&E, x50), C) Acinar atrophy with replacement fibrosis (H&E, x50), D) Cystic dilatation of ducts and interstitial replacement fibrosis with mononuclear inflammatory cell infiltration (H&E, x50), E) Marked lymphocytic chronic inflammatory cell infiltrate within fibrosis tissue (H&E, x400), F) Chronic pancreatitis – dilated duct with lumenal debris (H&E, x50), G) Chronic pancreatitis – higher power magnification of the interface of a dilated duct (H&E, x400).

Image 12:

Cytoplasmic vacuolation of pancreatic acinar cells (H&E, x400).

Image 13:

Encapsulated pancreatic endocrine tumor (H&E, x50).

Image 14:

Pancreatic endocrine tumor (H&E, x50).