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Introduction Heterotopic pancreas (HP) has rarely been identified in the wall of choledochal cyst (CC). Methods Retrospectively we screened 200 excised specimens of CC received at our Institute over a period of last eight years and looked for presence of HP rests in them. All the specimens were processed in their entirety. Result HP was identified in the wall of 13 (6.5%) CCs, out of which 11 were Heinrich Type 2, and two were Heinrich Type 1. In half of the cases peribiliary mucous glands were observed intermingled with the HP rests. Features of chronic fibrosing pancreatitis were identified in these rests, with ulceration of overlying cyst lining. Conclusions HP rests in the wall of CC though rare; their coexistence with peribiliary glands may possibly indicate their common embryonic origin. As a common site of inflammation, HP rest may be one of the common causes of CC.

Chronic fibrosing pancreatitis in childhood is an uncommon condition of unknown etiology with a variety of clinical presentations, histopathologic features, and outcomes. The diagnosis is one of exclusion (of hereditary or secondary pancreatitis), which should include histological assessment. The histological features of this condition have been described, to our knowledge, in nine published cases. We report a case in a 13-year-old male, who presented, with obstructive jaundice and subsequently had evidence of endocrine and exocrine pancreatic insufficiency, despite a surgical decompression of the pancreatic-biliary duct system.

Recurrent abdominal pain in an adolescent population is a frequent complaint. However, diseases of the pancreas, and especially chronic pancreatitis, in this age group are extremely uncommon. One type of pancreatitis, fibrosing pancreatitis, has been reported in only 14 previous pediatric patients, five of whom were over 12 years of age. We report an additional 12-year-old female with this condition. This case serves to remind us that fibrosing pancreatitis needs to be considered in any adolescent patient with chronic abdominal pain, recurrent vomiting, weight loss, steatorrhea, and painless obstructive jaundice.

Die angiographischen Befunde von 16 operativ verifizierten Pankreaskarzinomen werden dargestellt und diskutiert. Bei 13 Patienten konnte die Diagnose praoperativ und bei einem Patienten erst retrospektiv gestellt werden. In 2 Fallen waren die Angiogramme auch mit Kenntnis des positiven Operationsbefundes unauffallig. Eine falsche positive Diagnose wurde bei 2 Patienten gestellt, wobei bei der Operation in dem einen Fall eine chronisch fibrosierende Pankreatitis, in dem anderen Fall ein normaler Befund am Pankreas gefunden wurde. An Hand von 178 aus der Literatur zusammengestellten verifizierten Pankreaskarzinomen wird auf die praoperative Genauigkeit der selektiven, viszeralen Angiographie bei der Diagnose des Pankreaskarzinoms eingegangen. Dabei fand sich, das in 76,4% die praoperative Diagnose aufgrund pathologischer Gefasveranderungen moglich war. In 23,6% waren die Angio-gramme auch bei retrospektiver Auswertung unauffallig. Die Ausdehnung eines Karzinoms ist angiographisch schwer zu bestimmen, da auch der alleinige Befall von organeigenen Gefasen eine Inoperabilitat nicht ausschliest. 5 von 13 inoperablen Tumoren liesen angiographisch kein Uberschreiten der Organgrenzen erkennen. The angiographic findings in 16 patients with carcinoma of the pancreas confirmed at operation are described and discussed. In 13 patients the diagnosis was made before operation, and in another it could be made retrospectively. In 2 patients the angiograms were normal, even after the diagnosis had been made at operation. A false positive diagnosis was made in two patients; in one patient a chronic fibrosing pancreatitis was found at operation, in the other the findings were normal. 178 cases of pancreatic carcinoma described in the literature are summerised; the accuracy of preoperative selective visceral angiography is then discussed. It was found that a preoperative diagnosis was possible in 76,4% on the basis of pathological vascular changes. In 23,6% the angiograms were normal even retrospectively. It is difficult to determine the extent of a carcinoma by angiography, since the tumour may prove inoperable even if the vessels of one organ only appear to be involved. Five out of 13 inoperable tumours showed no angiographic evidence of extension into other organs. Presentation et discussion des angiographies de 16 cas de cancer du pancreas confirmes a l'operation. Chez 13 malades, le diagnostic put etre pose avant l'intervention et chez un malade il ne s'est pose qu'apres l'operation. Dans deux cas les cliches de l'angiographie presentaient une image normale meme apres avoir pris connaissance du status operatoire. Un diagnostic positif errone fut pose chez deux malades. Dans un cas il s'agissait a l'operation d'une pancreatite chronique avec fibrose et dans l'autre cas d'un pancreas normal sans lesion. Les auteurs etudient dans 178 cas de cancer du pancreas confirme a l'intervention et provenant de la litterature la precision de l'angiographie selective viscerale pre-operatoire pour le diagnostic du cancer du pancreas. lis constaterent ainsi que dans le 76,4% des cas le diagnostic pre-operatoire etait possible sur la base des modifications pathologiques des lesions. Dans le 23,6% des cas les cliches de l'angiographie ne presentaient pas de lesion meme au cours de Fexamen post-operatoire retrospectif. L'extension d'un cancer est difficile a determiner par l'angiographie car meme si les seuls vaisseaux du pancreas sont atteints il peut exister une inoperabilite. Dans cinq cas de 13 tumeurs inoperables, l'angiographie montrait que les vaisseaux pathologiques ne depas-saient pas les limites de l'organe. Se presentan y se discuten los hallazgos angiograficos de 16 carcinomas del pancreas verificados operatoriamente. En 13 pacientes pudo presentarse el diagnostico preoperatoriamente y en un paciente solo retrospectivamente. En dos casos los angiogramas fueron confusos incluso conociendo el hallazgo operatorio positivo. En dos pacientes se fijo un falso diagnostico positivo, con lo que en la operacion en un caso se encontro una pancreatitis cronica fibrosa y en el otro caso un hallazgo normal en el pancreas. A base de 178 carcinomas pancreaticos verificados, agrupados en la bibliografia, se entra en el diagnostico del carcinoma del pancreas sobre la exactitud preoperatoria de la angiografia selectiva visceral. Con ello se encontro que en 76,4% fue posible el diagnostico preoperatorio partiendo de alteraciones patologicas de los vasos. En el 23,6%, los angiogramas fueron confusos incluso con un analisis retrospectivo. La extension de un carcinoma es angiograficamente dificil de determinar, ya que incluso la afeccion sola de vasos propiamente organicos no excluye una in-operabilidad. Cinco de trece tumores inoperables no dejaron reconocer angiograficamente ninguna preponderancia de los limites organicos.

Summary The light microscopic and ultrastructural changes seen in a canine model of chronic fibrosing pancreatitis are described. The distribution of the experimental lesion is similar to that of human chronic obstructive pancreatitis. The canine lesion is also compared to that of human chronic calcifying pancreatitis. It is suggested that the common denominator in all these conditions is an increased pressure in the terminal intercalated ducts which produces pressure atrophy of the acinar cells in the periphery of the obstructed lobules.

Summary The pancreases of 77 uremic rats of a Wistar strain were investigated light-microscopically ingroups of 5 animals at 11 different times between one day and ten weeks after 5/6-nephrectomy. The serum concentration of urea reached a maximum mean value of 375 mg% after three days; during the stage of chronic uremia the mean value was found to be 175 mg%. The blood pressure increased in the third week after 5/6-nephrectomy and reached in the course of the experiment values of up to 200 mm Hg and more. Histologically, after an initial acute interstitial pancreatitis with focal dystrophies of the exocrineparenchyma which was virtually cured by the 14th day of the experiment, an increasing proliferative-exudative and granulomatous vasculopathy appeared at the end of the third week. This was followed by a perivascular transmitted chronic-fibrosing pancreatitis which may be regarded as a model of vascularly induced pancreatitis. Early damage by uremia and initial pancreatitis, the rapidly developing hypertension and allergicaland autoallergical reactions are discussed as aetiological complex for the vascular alterations. The typical findings of the uremic pancreatopathy, well-known in human pathology, are not reproducible.