Scanning electron microscopic analysis of pancreatic tissue in alcoholic and tropical chronic pancreatitis

Chronic Pancreatitis (CP) is a heterogenous disease with alcoholic chronic pancreatitis (ACP) dominating in the West, and idiopathic or tropical chronic pancreatitis (TCP) in the tropics. The aim of this study is to assess the feasibility of using a scanning electron microscope (SEM) to analyze the ultra-structural changes in alcoholic and tropical subtypes of CP.

Chronic pancreatitis tissue samples were taken from the biopsy samples of 16 patients (seven ACP and nine TCP) who underwent drainage procedures for CP. These samples were subjected to SEM analysis and findings of normal pancreas were compared with those of CP for appreciating differences in their architectural changes.

Normal architecture of pancreas could be observed as lobules of parenchyma, ductal system and definite loci of Islets of Langerhans (IOL). CP samples showed loss of architecture in the form of severe fibrosis and calcifications. In ACP, the fibrosis was predominantly seen towards the periphery of the gland sparing the periductal areas. These fibres were strangulating and damaging the parenchyma. Crystals were seen over these fibres. In TCP, fibrosis was moderate and uniform throughout the parenchyma. Moreover the crystals were larger and intraluminal. Total fatty replacement of parenchyma was a striking feature in TCP, seen exclusively in diabetics with gross atrophy of IOL.

SEM gives the real-life pictures of fibrosis, fatty change, ductal changes, calcifications and thus the actual extent of damage in CP better than the ordinary light microscopy.