A patient with acute pancreatitis develops chalky white deposits in peripancreatic fat. Histology shows shadowy outlines of necrotic adipocytes with basophilic calcium salts. The calcium deposition here occurs despite normal serum calcium levels. What is the correct classification?

• A Metastatic calcification, because calcium-phosphate product drives it
• B Dystrophic calcification, because hypercalcemia is always present in pancreatitis
• C Metastatic calcification, because fat necrosis raises serum calcium
• D Dystrophic calcification, because it occurs in injured tissue with normal serum calcium ✓

Explanation

Fat necrosis in acute pancreatitis liberates fatty acids that combine with calcium to form calcium soaps, a process called saponification. Because the deposit forms locally in dead or injured tissue while serum calcium remains normal, this is dystrophic calcification. Metastatic calcification, by contrast, reflects deranged calcium metabolism with hypercalcemia and preferentially affects normal tissues such as gastric mucosa, kidneys, lungs, and blood vessels. Serum calcium is not raised by pancreatic fat necrosis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.