Pancreatic Pathology Online

Pathology of Herpes Simplex Pancreatitis

Dr Sampurna Roy MD                July 2016

 

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.

Visit: Herpes Simplex Virus Infection  ; Herpes Virus (Herpesviridae); Herpes Zoster Virus (Shingles)

The gross and histopathologic changes seen in Herpes Simplex Virus pancreatitis are fairly characteristic and clearly distinguishable from those of the usual acute hemorrhagic pancreatitis (or acute pancreatic necrosis).

Visit: Acute Pancreatitis ; Pancreatitis ; Chronic Pancreatitis ; Autoimmune Pancreatitis

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.

Herpes simplex virus 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.

 

 

Further reading

Herpes simplex pancreatitis.

Acute pancreatitis associated with herpes simplex virus .

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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