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. 2020 Jun 22;12(6):e8777.
doi: 10.7759/cureus.8777.

Late Pathomorphological Features of the Endocrine Pancreas in Patients With Type 2 Diabetes Mellitus

Irina Tomova  1 , George S Stoyanov  2 , Deyan L Dzhenkov  2 , Lilyana Petkova  2
Affiliations

Late Pathomorphological Features of the Endocrine Pancreas in Patients With Type 2 Diabetes Mellitus

Irina Tomova et al. Cureus. .

Abstract

Introduction Islet amyloid polypeptide (IAPP) amyloidosis is a pathologic alteration of the pancreas, represented by abnormal accumulation of amylin in the interstitial tissue. Amylin is a neuroendocrine hormone, co-secreted with insulin by beta cells and participating in downstream regulation of postprandial glycemia. This report aims to examine IAPP amyloidosis as a late consequence of poor control of blood glucose levels in patients with type 2 diabetes mellitus (T2DM) who have been referred for autopsy. Materials and methods A total of 34 consecutive autopsies performed at the St. Marina University Hospital, Varna, Bulgaria, carried out by a single pathologist were included in the study. Samples from the tail of the pancreas were obtained to evaluate the state of the changes and were analyzed together with the specific organ changes associated with T2DM, as well as the medical documentation of the patients. Results Of the 34 autopsies, 10 cases (six females and four males) were included in the study, seven of whom had a medical history of T2D. The average age was 65.7 years (range 50 to 85 years). In all of the cases, morphological features of fibrosis and lipomatosis were present, with one of the patients having signs of pancreatic amyloidosis - Congo red positive deposition of pink, amorphous material in the extracellular matrix. Conclusion The described pathological alterations in all of the cases illustrate the progressing impairment of the structure of the pancreas, especially beta cells dysfunction in late stages of T2D, and highlight IAPP amyloidosis as the cause of irreversible damage of the isles of Langerhans and beta cell death.

Keywords: amyloid; amyloidosis; diabetes; pancreas.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Fibrosis and lipomatosis of the pancreas, H&E stain, original magnification x40
H&E, hematoxylin and eosin
Figure 2
Figure 2. Pancreatic Langerhans isle amyloidosis (A) and healthy age-adjusted control (B). H&E stain, original magnification x100 (A) and x200 (B)
H&E, hematoxylin and eosin
Figure 3
Figure 3. Pancreatic Langerhans isle amyloidosis, Congo red stain, original magnification x200
Figure 4
Figure 4. Pancreatic Langerhans isle amyloidosis, Congo red staining observed with fluorescent microscopy, original magnification x200
Figure 5
Figure 5. Diffuse pancreatic changes associated with diabetes – fibrosis, lipomatosis and islet amyloidosis, H&E stain, original magnification x40
H&E, hematoxylin and eosin
See this image and copyright information in PMC

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