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IPLab:Lab 1:Fat Necrosis: Difference between revisions

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== Clinical Summary ==
== Clinical Summary ==
This was a 37-year-old female with chronic renal failure that necessitated a renal transplant. Following transplantation, the patient developed a herpes simplex virus (HSV) infection in her nasal cavity, oral candidiasis, pneumonia, hematuria, pyuria, and gastrointestinal bleeding. Subsequently, the patient became septic and died.  
This was a 37-year-old female with chronic renal failure who underwent a cadaveric renal transplant. Following transplantation she developed oral candidiasis, pneumonia, pyuria, and gastrointestinal bleeding. Subsequently, the patient became septic and died.
Major findings at autopsy included extensive hemorrhagic bronchopneumonia and multiple ulcers affecting the stomach and esophagus. There was also evidence of disseminated intravascular coagulation (DIC) with multiple hemorrhages present. Firm, whitish foci of necrotic tissue were found in the fat around the pancreas.


== Autopsy Findings ==
== Images ==
Major findings at autopsy included extensive hemorrhagic bronchopneumonia (Pseudomonas aeruginosa) and multiple ulcers affecting the stomach and esophagus. There was also evidence of disseminated intravascular coagulation (DIC) with multiple hemorrhages present. Firm, whitish foci of necrotic tissue were found in the fat around the pancreas.  
<gallery heights="250px" widths="250px">
File:IPLab1FatNecrosis1.jpg|This gross photograph shows the intestines and omentum at autopsy. Note the small (5-15 mm in diameter) white nodules on the surface of the omental and mesenteric fat tissue (arrows).
File:IPLab1FatNecrosis2.jpg|This gross photograph of the pancreas from this case shows white nodules (arrows) in the pancreas and the adjacent mesenteric fat tissue.
File:IPLab1FatNecrosis3.jpg|This low-power photomicrograph of the pancreas from this case shows the fat tissue (1) surrounding the pancreas. Note the rim of inflammatory cells (arrows) and the blue areas that represent calcified fat adjacent to the pancreas (2).
File:IPLab1FatNecrosis5.jpg|This medium-power photomicrograph shows the blue discoloration of the fat tissue in the interlobular spaces (1) of the pancreas. This blue to purple staining represents calcium deposits that occur after enzymatic necrosis of the fat cells releases free fatty acids.
File:IPLab1FatNecrosis6.jpg|A higher-power photomicrograph of the previous slide contains a small area of fat necrosis (1) in the upper right portion of the image. The fat necrosis is within the fat tissue that is normally found adjacent to the pancreas. The appearance of the pancreatic tissue in this area is somewhat disrupted due to autolysis (the pancreas autolyzes very rapidly after death) but there is some premortem necrosis as well.
File:IPLab1FatNecrosis10.jpg|This high-power photomicrograph demonstrates fat necrosis in the interlobular spaces of the pancreas. Note the granular blue-staining calcium deposits (arrows) within the fat cells. The clear areas represent artifact caused by the "washing-out" of fat from cells during tissue processing for histology.
</gallery>


== Images ==
== Virtual Microscopy ==
{| cellpadding="10"
=== Pancreatic Fat Necrosis ===
| [[Image:IPLab1FatNecrosis1.jpg|frameless]]
<peir-vm>IPLab1FatNecrosis</peir-vm>
| This gross photograph shows the intestines and omentum at autopsy. Note the small (5-15 mm in diameter) white nodules on the surface of the omental and mesenteric fat tissue (arrows).
 
|-
=== Normal Pancreas ===
| [[Image:IPLab1FatNecrosis2.jpg|frameless]]
<peir-vm>UAB-Histology-00154</peir-vm>
| This gross photograph of the pancreas from this case shows white nodules (arrows) in the pancreas and the adjacent mesenteric fat tissue.
|-
| [[Image:IPLab1FatNecrosis3.jpg|frameless]]
| This low-power photomicrograph of the pancreas from this case shows the fat tissue (1) surrounding the pancreas. Note the rim of inflammatory cells (arrows) and the blue areas in the fat adjacent to the pancreas (2).
|-
| [[Image:IPLab1FatNecrosis4.jpg|frameless]]
| This high-power photomicrograph shows areas of inflammation (1) and fat necrosis (arrows) in the peripancreatic fat tissue (2) of the pancreas from this case.
|-
| [[Image:IPLab1FatNecrosis5.jpg|frameless]]
| Another high-power photomicrograph shows blue discoloration in the fat tissue in the interlobular spaces (1) of the pancreas.
|-
| [[Image:IPLab1FatNecrosis6.jpg|frameless]]
| A higher-power photomicrograph of the previous slide contains a small area of fat necrosis (1) in the upper right portion of the image. The fat necrosis is within the fat tissue that is normally found adjacent to the pancreas. The appearance of the pancreatic tissue in this area is somewhat disrupted due to autolysis (the pancreas autolyzes very rapidly after death) but there is some premortem necrosis as well.
|-
| [[Image:IPLab1FatNecrosis7.jpg|frameless]]
| This is a higher-power photomicrograph of the fat necrosis involving the fat cells in the interlobular spaces (arrow) of the pancreas. Note the blue to purple staining of the calcium deposits within the fat cells.
|-
| [[Image:IPLab1FatNecrosis8.jpg|frameless]]
| This high-power photomicrograph demonstrates fat necrosis in the interlobular spaces of the pancreas. Note the granular blue-staining calcium deposits (arrows) within the fat cells. The clear areas represent artifact caused by the "washing-out" of fat from cells during tissue processing for histology.
|-
| [[Image:IPLab1FatNecrosis9.jpg|frameless]]
| This is another high-power photomicrograph demonstrating the calcification (arrows) seen in fat necrosis involving the interlobular spaces of the pancreas.
|}


== Study Questions ==
== Study Questions ==
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=== Journal Articles ===
=== Journal Articles ===
* Bhatnagar A, Wig J, Vaiphei K, Majumdar S. [http://www.ncbi.nlm.nih.gov/pubmed/11560386 Intracellular cytokines in cells of necrotic tissue from patients with acute pancreatitis].  ''Eur J Surg'' 2001 Jul;167(7):510-7.
* Forsmark CE, Vege SS, Wilcox CM. [http://www.nejm.org/doi/full/10.1056/NEJMra1505202 Acute Pericarditis].  ''N Engl J Med" 2016; 375:1972-1981. November 17, 2016.
* LeWinter MM. [http://http://www.nejm.org/doi/full/10.1056/NEJMcp1404070 Acute Pericarditis].  ''NEJM'' 2014 Dec 18;371:2410-2416.


=== Images ===
=== Images ===
* [http://peir.path.uab.edu/library/index.php?/tags/333-pancreas PEIR Digital Library: Pancreas Images]
* [{{SERVER}}/library/index.php?/tags/333-pancreas PEIR Digital Library: Pancreas Images]
* [http://library.med.utah.edu/WebPath/CINJHTML/CINJIDX.html WebPath: Cellular Injury Images]
* [http://library.med.utah.edu/WebPath/CINJHTML/CINJIDX.html WebPath: Cellular Injury Images]


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