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In Herpes
simplex virus pancreatitis the primary and also the most pronounced
lesion is intense necrosis of acinar cells due to a direct
cytopathic effect of Herpes simplex virus and although severe
hemorrhage is seen, fat necrosis remains minimal. In addition, the
alterations of the nuclei of acinar cells are easily observed and
help greatly in the pathologic diagnosis.
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The gross
and histopathologic changes seen in HSV pancreatitis are fairly
characteristic and clearly distinguishable from those of the usual
acute hemorrhagic pancreatitis (or acute pancreatic necrosis).
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Acute Pancreatitis
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Acute hemorrhagic pancreatitis
: Severe edema and acute inflammatory cell infiltration in
the interlobular stroma (interstitial pancreatitis) ; the
released pancreatic enzymes induce severe vascular injury
resulting in prominent hemorrhage and also extensive fat
necrosis with saponification. Although injury
of acinar cells occurs as the initial event in the disease
process, necrosis of acinar cells is usually not a prominent
feature, especially in its mild form .
HSV
pancreatitis :
Most pronounced lesion is intense necrosis of acinar cells due
to a direct cytopathic effect of HSV, and although severe
hemorrhage is seen, fat necrosis remains minimal. |
Gross
examination of the pancreas show scattered, small, and discrete foci
of fresh hemorrhagic necrosis, each measuring a few millimeters in
diameter.
Histopathologically, multiple foci of necrosis of the parenchyma
accompanied by intense hemorrhage are scattered throughout the
pancreas. These are present in the peripheral areas of each lobule.
Fat necrosis
with saponification is minimal.
Acinar cells
surrounding the necrotic foci show atrophy and necrobiotic changes,
and numerous eosinophilic intranuclear inclusions with clear halos (Cowdry
type A) are noted.
Many
multinucleated giant cells with hyperchromatic irregular nuclei and
eosinophilic cytoplasm are noted around these necrotic foci. |
