The pathogenesis of chronic pancreatitis relates to

• (1) ductal obstruction by concretions

• (2) decreased secretion of lithostathine,

• (3) oxidative stress, and

• (4) interstitial fat necrosis and haemorrhage with secondary fibrosis.

Cystic fibrosis (fibrocytic disease of the pancreas) in a boy aged 13 years. See duodenum (red arrows). The pancreas is not greatly reduced in size. Most of the parenchyma however has been lost and replaced by fibrofatty tissue (blue arrows).

Bronchiectasis (black arrows), widespread suppurative pneumonia, patchy carnification, and hyperplasia of peribronchial lymph nodes (blue arrows) in a female aged 4½ years with cystic fibrosis.

Focal biliary fibrosis in a boy aged 13 years with fibrocystic disease of the pancreas. Histological examination shows that small bile ducts are obstructed by eosinophilic material.

Note that while this superficially resembles cirrhosis, you cannot see rounded nodules each surrounded by fibrous tissue. The scarring here is far more irregular.

Meconium ileus and focal intestinal atresia (arrows) in a male aged 8 days with cystic fibrosis.

Large benign cystadenoma of the pancreas causing obstruction of the duct and atrophy of the exocrine elements in the pancreatic tail (red arrows).

Histology: Benign cystadenoma. Note the flat inconspicuous lining cells (arrows)

Carinoma (blue arrows) of the head of the pancreas with obstruction of ducts and atrophy of the body (red arrow) and the tail (black arrow).The dilated pancreatic duct can be seen for the whole length of the pancreas.

presented with duodenal ulceration, and then stomal ulceration following gastrojejunostomy. Blood gastrin level was raised.

Gastrin-secreting islet cell tumour of the body of the pancreas in a man aged 45.

Haemochromatosis of the pancreas. The organ has become a uniform brown colour due to the deposition of iron