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Diffuse fibrosis of the pancreas: a peculiar pattern of pancreatitis in alcoholic cirrhosis.

In order to evaluate the effects of chronic alcohol consumption on pancreas morphology we reviewed the autopsy data of 530 patients: 148 with liver alcoholic cirrhosis (group I), 39 with non alcoholic cirrhosis (group II), 47 autopsies of chronic alcohol drinkers without liver cirrhosis (group III) and 296 non alcoholic patients with normal liver, age and sex-matched with group I (group IV). In the control group (group IV) lipomatosis and intralobular fibrosis were common (57 percent and 40 percent) and increased with age. The prevalence of five elementary lesions (protein plug, dilatation of duct, epithelial atrophy, canalicular regression and perilobular fibrosis) and of one pathologic diagnosis (diffuse fibrosing pancreatitis) were higher in group I than in group IV. Duct lesions (protein plugs, canalicular regression and epithelial atrophy) were also significantly higher in drinkers without cirrhosis (group III) than in group IV. Chronic calcifying pancreatitis was rare (2 cases in group I). Thirty-six cases were classified as diffuse fibrosing pancreatitis. This constituted an homogeneous histopathologic group, significantly more frequent in the group of alcoholic cirrhosis, and was always discovered incidentally at autopsy. Because diffuse fibrosing pancreatitis might easily be confused with the morphological changes of chronic calcifying pancreatitis, we suggest to include this histopathologic entity into the Marseille's classification of pancreatitis.