A 45-year-old woman presents with severe epigastric pain radiating to the back. At laparotomy, the pancreas shows chalky white flecks in the peripancreatic fat, and serum lipase is markedly elevated. The white deposits represent:

• A Fibrin deposited from an accompanying vasculitis
• B Calcium soaps formed by saponification of liberated fatty acids ✓
• C Collections of neutrophils forming microabscesses
• D Coagulated proteinaceous exudate from duct rupture

Explanation

In acute pancreatitis, released pancreatic lipase digests fat cell membranes, liberating fatty acids that combine with calcium to form insoluble calcium soaps. Grossly these appear as chalky white areas, a hallmark of fat necrosis, and the bound calcium can lower serum calcium levels clinically. Neutrophilic microabscesses and fibrin exudates do not produce grossly visible white deposits, and coagulative protein exudate is not a feature of enzymatic fat necrosis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.