Elsevier

Human Pathology

Volume 32, Issue 11, November 2001, Pages 1174-1183
Human Pathology

Original Contributions
Mast cell distribution and activation in chronic pancreatitis*

https://doi.org/10.1053/hupa.2001.28947Get rights and content

Abstract

Chronic pancreatitis (CP) is characterized by mononuclear inflammatory cell infiltration and replacement of the destroyed parenchyma by fibrous tissue. Recently, mast cells have been implicated in chronic inflammatory processes with fibrous tissue deposition. Therefore, the number and distribution of mast cells and their state of activation were evaluated in 12 normal specimens and in 46 specimens of CP with different causes (alcoholic, tropical, and idiopathic). Furthermore, the presence of stem cell factor (SCF), the main mast cell growth factor, and of its receptor, c-kit, was also assessed. In CP tissues, mast cells were localized both in the fibrotic areas and in the residual acinar parenchyma. The total number of mast cells was significantly higher in CP than in the normal pancreas (P <.0001) and correlated positively with the extent of fibrosis and the intensity of inflammation. Immunoglobulin E (IgE)–dependent mast cell activation was higher in CP than in the normal pancreas. No differences in mast cell number or IgE positivity were found among the 3 causes of CP. SCF–and c-kit immunoreactive mast cells were mostly localized in fibrous tissue and around regenerating ducts, which were also positive for c-kit but were negative for SCF. These results suggest that mast cells, activated by an IgE-dependent mechanism and/or by an SCF–c-kit autocrine loop, are a relevant component of the inflammatory infiltrate in CP, independent of the underlying cause. Their localization near degenerating acini and regenerating ducts might indicate that they play a crucial role in tissue destruction and remodeling in CP. HUM PATHOL 32:1174-1183. Copyright © 2001 by W.B. Saunders Company

Section snippets

Patients and methods

Normal pancreatic tissue samples were obtained from 12 multiorgan donors (9 men and 3 women; median age, 42.5 years; range, 18 to 62 years). CP tissues were obtained from 46 patients (37 men and 9 women; median age, 46 years; range, 28 to 62 years) undergoing surgery for CP. In 31 patients (67%) a duodenum-preserving pancreatic head resection was performed; 7 patients (15%) underwent a pancreatic left resection; in 5 patients (11%) a pancreaticoduodenectomy was performed, and in 3 patients (7%)

Histopathologic evaluation

Normal pancreatic tissue sections did not show any histopathological alteration. In most of the CP samples, a heterogeneous pattern of fibrosis adjacent to residual acinar parenchyma was observed. In 13 patients (28%), the area occupied by fibrous tissue was <30% of the total tissue area, in 18 patients (39%) it ranged between 30% and 60%, and in 15 patients (33%) it was >60%. Inflammatory infiltrates were mild in 11 sections (24%), moderate in 17 (37%), and intense in 18 (39%). Essentially, no

Discussion

Mononuclear inflammatory cell infiltration is a constant finding in chronic pancreatitis tissues. Immunohistochemical characterization of these cell populations has shown a predominance of T lymphocytes and macrophages and a lower number of B lymphocytes and plasma cells.9 In this study, we show that mast cells are a relevant component of infiltrating inflammatory cells in CP. Several recent findings suggest that inflammatory cells are not just epiphenomena; instead, they play a true

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    *

    Address correspondence and reprint requests to Helmut Friess, MD, Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.

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