Paraduodenal Pancreatitis: Mini-Series with Regard to Vessel Obliteration

Abstract

Context Paraduodenal pancreatitis (PP) is a form of chronic pancreatitis involving the duodenal wall close to the minor papilla within the surrounding parenchymal pancreatic tissue and common bile duct (the also called groove area). This disorder most commonly affects male patients in the 5^th decade with a history of alcohol and/or smoke abuse. It has been postulated that alcohol or smoking leads to a resistance of the pancreatic juice flow and ischemia of the paraduodenal tissue. Objective To evaluate pancreatic specimens of a series of patients suffering from PP with special emphasis on vascular changes. Patients and Methods Twelve pancreatic specimens of patients with a definitive diagnosis of PP (all males, mean age 44.4 years) were evaluated. Most of them presented with abdominal pain (n=10) and weight loss (n=8). All patients were smokers and alcohol abuse was documented in 8 patients. For histological evaluation, tissue specimens were routinely processed. Results The following histological characteristics were observed: Brunner’s gland hyperplasia, cystic changes and adenomyomatosis of the duodenal wall were also found in 11 patients. Variable numbers of a mixed inflammatory infiltrate were present in all patients analyzed. In 6 patients, we found foreign body giant cell reaction in the neighbourhood of some pseudocysts. However, most interestingly obliteration of segmental arteries was present in 7/12 cases. Conclusion This histological study confirms the common morphological changes in paraduodenal pancreatitis. Interestingly, we found vessel obliteration in several cases, which has not been described for this subtype of chronic pancreatitis so far. It remains to be investigated whether this finding is specific for PP, might reflect a particular subgroup of paraduodenal pancreatitis or might be a marker of disease progression.