Endocrine Pancreas Pathology Part 1

• 1. Normal pancreas
• 2. Lobular architecture

• 1. Normal pancreas
• 2. pancreatic duct lined by low columnar epithelium
• 3. Acini of exocrine pancreas
• 4. Langerhans islets

• Left: exocrine pancreas
• Right: endocrine pancreas

Immunostain for beta cells of pancreas (insulin-producing)

• 1. Insulinitis in man
• 2. Insulinitis in mouse
• 3. Lymphocytic infiltrates

Amyloidosis of the Langerhans islets in DM type 2

Amyloidosis of the Langerhans islets in DM type 2

• 1. "Normal" aorta
• 2. Atherosclerotic aorta

• Left: Acute transmural MI with rupture of the free wall of the left venturicle.
• Right: Acute MI 3 days old
• This is a common result of the atherosclerotic effects of DM

Diabetic foot ulcers caused by plantar pressure at the second metatarsal head. The unerlying cause is a combination of peripheral vascular disease and peripheral diabetic neuropathy.

Pad with dry gangrene. Resulting from DM II.

Pad with wet gangrene resluting from DM II

Brain, organizing infarct – Gross, coronal section. The large necrotic area appears yellow and starts to liquefy. The surrounding brain exhibits gliosis, which is better appreciated under a microscope. There are also several small lacunar infarcts of varying ages and stages of liquefaction. Hypertension and diabetes are predisposing factors for lacunar infarcts, which, if multiple, can lead to subcortical vascular dementia (Binswanger disease)

• 1. DIABETIC NEPHROPATHY WITH AN END-STAGE KIDNEY
• 2. Granular surface
• 3. Thinned cortex
• 4. Atherosclerosis

• Diagnosis: Nodular glomerulosclerosis (diabetic nephropathy).
• Description: The outer surface (right) is finely granular as indicated by the broken light reflexes. The cut surface (left) shows yellowish-red nodules.
• Comment: The diabetic kidney is usually enlarged in the beginning with granular surface and firm consistency. As the DM-induced atherosclerosis becomes worse, the kidneys begin to shrink. Thus the diabetic kidney can be enlarged,
• normal or small in size depending on the stage of the disease..

• Granular surface
• Cortico-medullary junction not well defined

• Diagnosis: Diabetic nephropathy.
• Description: Most glomeruli display nodular glomerulosclerosis and several glomeruli are completely hyalinized. There is hyaline arteriolosclerosis and interstitial fibrosis, and some tubuli appear dilated.
• Comment: The capsule was adherent to the cortex and stripped off with difficulty, which caused the apparent surface damage

• Diagnosis: Diabetic kidney.
• Description: The kidney arterioli are tortuous and thick-walled (hyaline arteriolosclerosis).
• Comment: The hyaline material is composed of plasma proteins that have leaked into the arteriolar wall under pressure.

• 1. Mesangial nodules
• 2. Hyaline aretriolo-sclerosis
• 3. Completely hyalinized glomerulus

• Diabetic nodular glomerulosclerosis and arteriosclerosis.
• Description: Partly and completely hyalinized glomeruli and thickened capillary and tubular basement membranes. Intimal thickening in a medium sized artery. Interstitial fibrosis