Skip to main content
Erschienen in: Virchows Archiv 1/2004

01.07.2004 | Review Article

Fibrosis of the pancreas: the initial tissue damage and the resulting pattern

verfasst von: Günter Klöppel, Sönke Detlefsen, Bernd Feyerabend

Erschienen in: Virchows Archiv | Ausgabe 1/2004

Einloggen, um Zugang zu erhalten

Abstract

Fibrosis in the pancreas is caused by such processes as necrosis/apoptosis, inflammation or duct obstruction. The initial event that induces fibrogenesis in the pancreas is an injury that may involve the interstitial mesenchymal cells, the duct cells and/or the acinar cells. Damage to any one of these tissue compartments of the pancreas is associated with cytokine-triggered transformation of resident fibroblasts/pancreatic stellate cells into myofibroblasts and the subsequent production and deposition of extracellular matrix. Depending on the site of injury in the pancreas and the involved tissue compartment, predominantly inter(peri)lobular fibrosis (as in alcoholic chronic pancreatitis), periductal fibrosis (as in hereditary pancreatitis), periductal and interlobular fibrosis (as in autoimmune pancreatitis) or diffuse inter- and intralobular fibrosis (as in obstructive chronic pancreatitis) develops.
Literatur
1.
Zurück zum Zitat Abraham SC, Leach S, Yeo CJ, Cameron JL, Murakata LA, Boitnott JK, Albores-Saavedra J, Hruban RH (2003) Eosinophilic pancreatitis and increased eosinophils in the pancreas. Am J Surg Pathol 27:334–342CrossRefPubMed Abraham SC, Leach S, Yeo CJ, Cameron JL, Murakata LA, Boitnott JK, Albores-Saavedra J, Hruban RH (2003) Eosinophilic pancreatitis and increased eosinophils in the pancreas. Am J Surg Pathol 27:334–342CrossRefPubMed
2.
Zurück zum Zitat Ammann RW, Heitz PU, Klöppel G (1996) Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology 111:224–231PubMed Ammann RW, Heitz PU, Klöppel G (1996) Course of alcoholic chronic pancreatitis: a prospective clinicomorphological long-term study. Gastroenterology 111:224–231PubMed
3.
Zurück zum Zitat Andoh A, Takaya H, Saotome T, Shimada M, Hata K, Araki Y, Nakamura F, Shintani Y, Fujiyama Y, Bamba T (2000) Cytokine regulation of chemokine (IL-8, MCP-1, and RANTES) gene expression in human pancreatic periacinar myofibroblasts. Gastroenterology 119:211–219PubMed Andoh A, Takaya H, Saotome T, Shimada M, Hata K, Araki Y, Nakamura F, Shintani Y, Fujiyama Y, Bamba T (2000) Cytokine regulation of chemokine (IL-8, MCP-1, and RANTES) gene expression in human pancreatic periacinar myofibroblasts. Gastroenterology 119:211–219PubMed
4.
Zurück zum Zitat Apte MV, Haber PS, Applegate TL, Norton ID, McCaughan GW, Korsten MA, Pirola RC, Wilson JS (1998) Periacinar stellate-shaped cells in rat pancreas: identification, isolation, and culture. Gut 43:128–133PubMed Apte MV, Haber PS, Applegate TL, Norton ID, McCaughan GW, Korsten MA, Pirola RC, Wilson JS (1998) Periacinar stellate-shaped cells in rat pancreas: identification, isolation, and culture. Gut 43:128–133PubMed
5.
Zurück zum Zitat Apte MV, Haber PS, Darby SJ, Rodgers SC, McCaughan GW, Korsten MA, Pirola RC, Wilson JS (1999) Pancreatic stellate cells are activated by proinflammatory cytokines: implications for pancreatic fibrogenesis. Gut 44:534–541PubMed Apte MV, Haber PS, Darby SJ, Rodgers SC, McCaughan GW, Korsten MA, Pirola RC, Wilson JS (1999) Pancreatic stellate cells are activated by proinflammatory cytokines: implications for pancreatic fibrogenesis. Gut 44:534–541PubMed
6.
Zurück zum Zitat Apte MV, Phillips PA, Fahmy RG, Darby SJ, Rodgers SC, McCaughan GW, Korsten MA, Pirola RC, Naidoo D, Wilson JS (2000) Does alcohol directly stimulate pancreatic fibrogenesis? Studies with rat pancreatic stellate cells. Gastroenterology 118:780–794PubMed Apte MV, Phillips PA, Fahmy RG, Darby SJ, Rodgers SC, McCaughan GW, Korsten MA, Pirola RC, Naidoo D, Wilson JS (2000) Does alcohol directly stimulate pancreatic fibrogenesis? Studies with rat pancreatic stellate cells. Gastroenterology 118:780–794PubMed
7.
Zurück zum Zitat Bedossa P, Paradis V (2003) Liver extracellular matrix in health and disease. J Pathol 200:504–515CrossRefPubMed Bedossa P, Paradis V (2003) Liver extracellular matrix in health and disease. J Pathol 200:504–515CrossRefPubMed
8.
Zurück zum Zitat Ebert M, Kasper HU, Hernberg S, Friess H, Büchler MW, Roessner A, Korc M, Malfertheiner P (1998) Overexpression of platelet-derived growth factor (PDGF) B chain and type β PDGF receptor in human chronic pancreatitis. Dig Dis Sci 43:567–574CrossRefPubMed Ebert M, Kasper HU, Hernberg S, Friess H, Büchler MW, Roessner A, Korc M, Malfertheiner P (1998) Overexpression of platelet-derived growth factor (PDGF) B chain and type β PDGF receptor in human chronic pancreatitis. Dig Dis Sci 43:567–574CrossRefPubMed
9.
Zurück zum Zitat Ectors N, Maillet B, Aerts R, Geboes K, Donner A, Borchard F, Lankisch P, Stolte M, Lüttges J, Kremer B, Klöppel G (1997) Non-alcoholic duct destructive chronic pancreatitis. Gut 41:263–268PubMed Ectors N, Maillet B, Aerts R, Geboes K, Donner A, Borchard F, Lankisch P, Stolte M, Lüttges J, Kremer B, Klöppel G (1997) Non-alcoholic duct destructive chronic pancreatitis. Gut 41:263–268PubMed
10.
Zurück zum Zitat Elsässer HP, Adler G, Kern HF (1989) Fibroblast structure and function during regeneration from hormone-induced acute pancreatitis in the rat. Pancreas 4:169–178PubMed Elsässer HP, Adler G, Kern HF (1989) Fibroblast structure and function during regeneration from hormone-induced acute pancreatitis in the rat. Pancreas 4:169–178PubMed
11.
Zurück zum Zitat Etemad B, Whitcomb DC (2001) Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 120:682–707PubMed Etemad B, Whitcomb DC (2001) Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 120:682–707PubMed
12.
Zurück zum Zitat Friess H, Yamanaka Y, Büchler M, Beger HG, Do DA, Kobrin MS, Korc M (1994) Increased expression of acidic and basic fibroblast growth factors in chronic pancreatitis. Am J Pathol 144:117–128PubMed Friess H, Yamanaka Y, Büchler M, Beger HG, Do DA, Kobrin MS, Korc M (1994) Increased expression of acidic and basic fibroblast growth factors in chronic pancreatitis. Am J Pathol 144:117–128PubMed
13.
Zurück zum Zitat Gabbiani G (2003) The myofibroblast in wound healing and fibrocontractive diseases. J Pathol 200:500–503CrossRefPubMed Gabbiani G (2003) The myofibroblast in wound healing and fibrocontractive diseases. J Pathol 200:500–503CrossRefPubMed
14.
Zurück zum Zitat Haber PS, Keogh GW, Apte MV, Moran CS, Stewart NL, Crawford DHG, Pirola RC, McCaughan GW, Ramm GA, Wilson JS (1999) Activation of pancreatic stellate cells in human and experimental pancreatic fibrosis. Am J Pathol 155:1087–1095PubMed Haber PS, Keogh GW, Apte MV, Moran CS, Stewart NL, Crawford DHG, Pirola RC, McCaughan GW, Ramm GA, Wilson JS (1999) Activation of pancreatic stellate cells in human and experimental pancreatic fibrosis. Am J Pathol 155:1087–1095PubMed
15.
Zurück zum Zitat Hultquist GT, Jönsson LE (1965) Ligation of the pancreatic duct in rats. Acta Soc Med Upsal 70:82–88PubMed Hultquist GT, Jönsson LE (1965) Ligation of the pancreatic duct in rats. Acta Soc Med Upsal 70:82–88PubMed
16.
Zurück zum Zitat Isaksson G, Ihse I, Lundquist I (1983) Influence of pancreatic duct ligation on endocrine and exocrine rat pancreas. Acta Physiol Scand 117:281–286PubMed Isaksson G, Ihse I, Lundquist I (1983) Influence of pancreatic duct ligation on endocrine and exocrine rat pancreas. Acta Physiol Scand 117:281–286PubMed
17.
Zurück zum Zitat Izumi M, Suda K, Torii A, Inadama E (2001) Pancreatic ductal myofibroblasts. Proliferative patterns in various pathologic situations. Virchows Arch 438:442–450PubMed Izumi M, Suda K, Torii A, Inadama E (2001) Pancreatic ductal myofibroblasts. Proliferative patterns in various pathologic situations. Virchows Arch 438:442–450PubMed
18.
Zurück zum Zitat Kawaguchi K, Koike M, Tsuruta K, Okamoto A, Tabata I, Fujita N (1991) Lymphoplasmacytic sclerosing pancreatitis with cholangitis: variant of primary sclerosing cholangitis extensively involving pancreas. Hum Pathol 22:387–395CrossRefPubMed Kawaguchi K, Koike M, Tsuruta K, Okamoto A, Tabata I, Fujita N (1991) Lymphoplasmacytic sclerosing pancreatitis with cholangitis: variant of primary sclerosing cholangitis extensively involving pancreas. Hum Pathol 22:387–395CrossRefPubMed
19.
Zurück zum Zitat Klöppel G (1997) Morphology of acute pancreatitis in relation to etiology and pathogenesis. In: Malfertheiner P, Domínguez-Muńoz JE, Schulz HU, Lippert H (eds) Diagnostic procedures in pancreatic disease. Springer, Berlin Heidelberg New York, pp 13–20 Klöppel G (1997) Morphology of acute pancreatitis in relation to etiology and pathogenesis. In: Malfertheiner P, Domínguez-Muńoz JE, Schulz HU, Lippert H (eds) Diagnostic procedures in pancreatic disease. Springer, Berlin Heidelberg New York, pp 13–20
20.
Zurück zum Zitat Klöppel G (1998) Chronic pancreatitis. Etiology, pathophysiology, and pathology. In: Howard J , Idezuki Y, Ihse I, Prinz R (eds) Surgical diseases of the pancreas, 3rd edn. Williams & Wilkins, Baltimore, pp 321–328 Klöppel G (1998) Chronic pancreatitis. Etiology, pathophysiology, and pathology. In: Howard J , Idezuki Y, Ihse I, Prinz R (eds) Surgical diseases of the pancreas, 3rd edn. Williams & Wilkins, Baltimore, pp 321–328
21.
Zurück zum Zitat Klöppel G (1999) Progression from acute to chronic pancreatitis. A pathologist’s view. Surg Clin North Am 79:801–814PubMed Klöppel G (1999) Progression from acute to chronic pancreatitis. A pathologist’s view. Surg Clin North Am 79:801–814PubMed
22.
Zurück zum Zitat Klöppel G, Lüttges J, Löhr M, Zamboni G, Longnecker D (2003) Autoimmune pancreatitis: pathological, clinical, and immunological features. Pancreas 27:14–19CrossRefPubMed Klöppel G, Lüttges J, Löhr M, Zamboni G, Longnecker D (2003) Autoimmune pancreatitis: pathological, clinical, and immunological features. Pancreas 27:14–19CrossRefPubMed
23.
Zurück zum Zitat Klöppel G, Maillet B (1991) Chronic pancreatitis: evolution of the disease. Hepatogastroenterology 38:408–412PubMed Klöppel G, Maillet B (1991) Chronic pancreatitis: evolution of the disease. Hepatogastroenterology 38:408–412PubMed
24.
Zurück zum Zitat Klöppel G, Maillet B (1992) The morphological basis for the evolution of acute pancreatitis into chronic pancreatitis. Virchows Arch [A] Pathol Anat 420:1–4 Klöppel G, Maillet B (1992) The morphological basis for the evolution of acute pancreatitis into chronic pancreatitis. Virchows Arch [A] Pathol Anat 420:1–4
25.
Zurück zum Zitat Konishi K, Izumi T, Kato O, Yamaguchi A, Miyazaki I (1981) Experimental pancreatolithiasis in the dog. Surgery 89:687–691PubMed Konishi K, Izumi T, Kato O, Yamaguchi A, Miyazaki I (1981) Experimental pancreatolithiasis in the dog. Surgery 89:687–691PubMed
26.
Zurück zum Zitat Kuroda J, Suda K, Hosokawa Y (1998) Periacinar collagenization in patients with chronic alcoholism. Pathol Int 48:857–868PubMed Kuroda J, Suda K, Hosokawa Y (1998) Periacinar collagenization in patients with chronic alcoholism. Pathol Int 48:857–868PubMed
27.
Zurück zum Zitat Lack EE (2003) Cystic fibrosis and selected disorders with pancreatic insufficiency. In: Lack EE (ed) Pathology of the pancreas, gallbladder, extrahepatic biliary tract, and ampullary region. Oxford University Press, Oxford, pp 63–80 Lack EE (2003) Cystic fibrosis and selected disorders with pancreatic insufficiency. In: Lack EE (ed) Pathology of the pancreas, gallbladder, extrahepatic biliary tract, and ampullary region. Oxford University Press, Oxford, pp 63–80
28.
Zurück zum Zitat Luttenberger T, Schmid-Kotsas A, Menke A, Siech M, Beger H, Adler G, Grünert A, Bachem MG (2000) Platelet-derived growth factors stimulate proliferation and extracellular matrix synthesis of pancreatic stellate cells: implication in pathogenesis of pancreas fibrosis. Lab Invest 80:47–55PubMed Luttenberger T, Schmid-Kotsas A, Menke A, Siech M, Beger H, Adler G, Grünert A, Bachem MG (2000) Platelet-derived growth factors stimulate proliferation and extracellular matrix synthesis of pancreatic stellate cells: implication in pathogenesis of pancreas fibrosis. Lab Invest 80:47–55PubMed
29.
Zurück zum Zitat Martin ED (1984) Different pathomorphological aspects of pancreatic fibrosis, correlated with etiology: anatomical study of 300 cases. In: Gyr KE, Singer MV, Sarles H (eds) Pancreatitis: concepts and classification. Elsevier, Amsterdam, pp 77–82 Martin ED (1984) Different pathomorphological aspects of pancreatic fibrosis, correlated with etiology: anatomical study of 300 cases. In: Gyr KE, Singer MV, Sarles H (eds) Pancreatitis: concepts and classification. Elsevier, Amsterdam, pp 77–82
30.
Zurück zum Zitat Masi L, Malentacchi C, Campanacci D, Franchi A (2002) Transforming growth factor-beta isoform and receptor expression in chondrosarcoma of bone. Virchows Arch 440:491–497CrossRefPubMed Masi L, Malentacchi C, Campanacci D, Franchi A (2002) Transforming growth factor-beta isoform and receptor expression in chondrosarcoma of bone. Virchows Arch 440:491–497CrossRefPubMed
31.
Zurück zum Zitat Notohara K, Burgart LJ, Yadav D, Chari S, Smyrk TC (2003) Idiopathic chronic pancreatitis with periductal lymphoplasmacytic infiltration: clinicopathologic features of 35 cases. Am J Surg Pathol 27:1119–1127CrossRefPubMed Notohara K, Burgart LJ, Yadav D, Chari S, Smyrk TC (2003) Idiopathic chronic pancreatitis with periductal lymphoplasmacytic infiltration: clinicopathologic features of 35 cases. Am J Surg Pathol 27:1119–1127CrossRefPubMed
32.
Zurück zum Zitat Saurer L, Reber P, Schaffner T, Büchler MW, Buri C, Kappeler A, Walz A, Friess H, Mueller C (2000) Differential expression of chemokines in normal pancreas and in chronic pancreatitis. Gastroenterology 118:356–367PubMed Saurer L, Reber P, Schaffner T, Büchler MW, Buri C, Kappeler A, Walz A, Friess H, Mueller C (2000) Differential expression of chemokines in normal pancreas and in chronic pancreatitis. Gastroenterology 118:356–367PubMed
33.
Zurück zum Zitat Seifert G (1984) Cystic fibrosis and haemochromatosis. In: Klöppel G, Heitz PU (eds) Pancreatic pathology. Churchill Livingstone, Edinburgh, pp 32–43 Seifert G (1984) Cystic fibrosis and haemochromatosis. In: Klöppel G, Heitz PU (eds) Pancreatic pathology. Churchill Livingstone, Edinburgh, pp 32–43
34.
Zurück zum Zitat Shek FWT, Benyon RC, Walker FM, McCrudden PR, Pender SLF, Williams EJ, Johnson PA, Johnson CD, Bateman AC, Fine DR, Iredale JP (2002) Expression of transforming growth factor-β1 by pancreatic stellate cells and its implications for matrix secretion and turnover in chronic pancreatitis. Am J Pathol 160:1787–1798PubMed Shek FWT, Benyon RC, Walker FM, McCrudden PR, Pender SLF, Williams EJ, Johnson PA, Johnson CD, Bateman AC, Fine DR, Iredale JP (2002) Expression of transforming growth factor-β1 by pancreatic stellate cells and its implications for matrix secretion and turnover in chronic pancreatitis. Am J Pathol 160:1787–1798PubMed
35.
Zurück zum Zitat Stamenkovic I (2003) Extracellular matrix remodelling: the role of matrix metalloproteinases. J Pathol 200:448–464CrossRefPubMed Stamenkovic I (2003) Extracellular matrix remodelling: the role of matrix metalloproteinases. J Pathol 200:448–464CrossRefPubMed
36.
Zurück zum Zitat Suda K, Takase M, Takei K, Kumasaka T, Suzuki F (2000) Histopathologic and immunohistochemical studies on the mechanism of interlobular fibrosis of the pancreas. Arch Pathol Lab Med 124:1302–1305PubMed Suda K, Takase M, Takei K, Kumasaka T, Suzuki F (2000) Histopathologic and immunohistochemical studies on the mechanism of interlobular fibrosis of the pancreas. Arch Pathol Lab Med 124:1302–1305PubMed
37.
Zurück zum Zitat Weber SM, Cubukcu-Dimopulo O, Palesty JA, Suriawinata A, Klimstra D, Brennan MF, Conlon K (2003) Lymphoplasmacytic sclerosing pancreatitis: inflammatory mimic of pancreatic carcinoma. J Gastrointest Surg 7:129–139CrossRefPubMed Weber SM, Cubukcu-Dimopulo O, Palesty JA, Suriawinata A, Klimstra D, Brennan MF, Conlon K (2003) Lymphoplasmacytic sclerosing pancreatitis: inflammatory mimic of pancreatic carcinoma. J Gastrointest Surg 7:129–139CrossRefPubMed
38.
Zurück zum Zitat Whitcomb DC, Gorry MC, Preston RA, Furey W, Sossenheimer MJ, Ulrich CD, Martin SP, Gates LK Jr, Amann ST, Toskes PP, Liddle R, McGrath K, Uomo G, Post JC, Ehrlich GD (1996) Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet 14:141–145PubMed Whitcomb DC, Gorry MC, Preston RA, Furey W, Sossenheimer MJ, Ulrich CD, Martin SP, Gates LK Jr, Amann ST, Toskes PP, Liddle R, McGrath K, Uomo G, Post JC, Ehrlich GD (1996) Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet 14:141–145PubMed
39.
Zurück zum Zitat Witt H, Becker M (2002) Genetics of chronic pancreatitis. J Pediatr Gastroenterol Nutr 34:125–136CrossRefPubMed Witt H, Becker M (2002) Genetics of chronic pancreatitis. J Pediatr Gastroenterol Nutr 34:125–136CrossRefPubMed
40.
Zurück zum Zitat Witt H, Luck W, Hennies HC, Classen M, Kage A, Lass U, Landt O, Becker M (2000) Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis. Nat Genet 25:213–216CrossRefPubMed Witt H, Luck W, Hennies HC, Classen M, Kage A, Lass U, Landt O, Becker M (2000) Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis. Nat Genet 25:213–216CrossRefPubMed
41.
Zurück zum Zitat Wreesmann V, van Eijck CHJ, Naus DCWH, van Velthuysen MLF, Jeekel J, Mooi WJ (2001) Inflammatory pseudotumour (inflammatory myofibroblastic tumour) of the pancreas: a report of six cases associated with obliterative phlebitis. Histopathology 38:105–110CrossRefPubMed Wreesmann V, van Eijck CHJ, Naus DCWH, van Velthuysen MLF, Jeekel J, Mooi WJ (2001) Inflammatory pseudotumour (inflammatory myofibroblastic tumour) of the pancreas: a report of six cases associated with obliterative phlebitis. Histopathology 38:105–110CrossRefPubMed
Metadaten
Titel
Fibrosis of the pancreas: the initial tissue damage and the resulting pattern
verfasst von
Günter Klöppel
Sönke Detlefsen
Bernd Feyerabend
Publikationsdatum
01.07.2004
Verlag
Springer-Verlag
Erschienen in
Virchows Archiv / Ausgabe 1/2004
Print ISSN: 0945-6317
Elektronische ISSN: 1432-2307
DOI
https://doi.org/10.1007/s00428-004-1021-5

Weitere Artikel der Ausgabe 1/2004

Virchows Archiv 1/2004 Zur Ausgabe

Announcements

July 2004

Neu im Fachgebiet Pathologie

Molekularpathologische Untersuchungen im Wandel der Zeit

Open Access Biomarker Leitthema

Um auch an kleinen Gewebeproben zuverlässige und reproduzierbare Ergebnisse zu gewährleisten ist eine strenge Qualitätskontrolle in jedem Schritt des Arbeitsablaufs erforderlich. Eine nicht ordnungsgemäße Prüfung oder Behandlung des …

Vergleichende Pathologie in der onkologischen Forschung

Pathologie Leitthema

Die vergleichende experimentelle Pathologie („comparative experimental pathology“) ist ein Fachbereich an der Schnittstelle von Human- und Veterinärmedizin. Sie widmet sich der vergleichenden Erforschung von Gemeinsamkeiten und Unterschieden von …

Gastrointestinale Stromatumoren

Open Access GIST CME-Artikel

Gastrointestinale Stromatumoren (GIST) stellen seit über 20 Jahren ein Paradigma für die zielgerichtete Therapie mit Tyrosinkinaseinhibitoren dar. Eine elementare Voraussetzung für eine mögliche neoadjuvante oder adjuvante Behandlung bei …

Personalisierte Medizin in der Onkologie

Aufgrund des erheblichen technologischen Fortschritts in der molekularen und genetischen Diagnostik sowie zunehmender Erkenntnisse über die molekulare Pathogenese von Krankheiten hat in den letzten zwei Jahrzehnten ein grundlegender …