Kovalenko I. Morphogenesis and gradation of pancreas fibrosis progression in chronic pancreatitis

Pathohistopathological, histochemical and immunohistochemical studies of biopsy-surgical and sectional material in 117 patients revealed peculiarities of morphogenesis of pancreatic fibrosis and its progression to pancreatic cirrhosis. It was found that new generation alfa-SMA+, vimentin+, desmin+ activated pancreatic stellate cells synthesized of significant amount of collagen I, III, IV types plays the main role in morphogenesis of pancreatic fibrosis. It was established histological, immunohistochemical morphometric differences F1 mild fibrosis, F2 moderate fibrosis, F3 severe fibrosis and F4 subtotal pancreatic fibrosis/cirrhosis according to clinical-laboratory manifestations of exocrine and endocrine pancreatic insufficiency. It was determined that the transition from F1 fibrosis to F2, F3 fibrosis and F4 cirrhosis of the pancreas was authentically increased area of occupation of activated alfa-SMA + pancreatic stellate cells and collagen I and III types. At patients with severe F3-F4 pancreatic fibrosis according to its location and distribution was identified: circular-periductal fibrosis involving the large ducts of the pancreas, laminar fibrosis in extensive fibrous fields between large ducts and acinar tissue, as well as tape-like interlobular and septal-periacinar intralobular pancreatic fibrosis. It was described pathomorphological peculiarities of the restructuring of the ductal system and acinar-endocrine structures according tolevels expression Кі-67, Ki-67, caspase-3, СА 19-9, the activity of MMP-9, TIMP-1 and accumulation of collagens I, III and IV types.