A 45-year-old man presents with severe epigastric pain radiating to the back. Serum lipase is markedly elevated. At laparotomy, the omentum shows chalky white deposits adjacent to areas of hemorrhagic pancreatic necrosis. Microscopy of these deposits would show:
- A Amorphous basophilic calcium soap formation ✓
- B Anucleate ghost cells with preserved outlines
- C Granular eosinophilic debris with giant cells
- D Fibrinoid necrosis of small vessels
Correct answer: A. Amorphous basophilic calcium soap formation
Explanation
Enzymatic fat necrosis in acute pancreatitis results from released lipases digesting adipocyte membranes, liberating triglycerides that are split by pancreatic lipase into fatty acids. These combine with calcium to form calcium soaps, seen grossly as chalky white areas on omentum and mesentery and microscopically as basophilic amorphous deposits. This process can lower serum calcium enough to cause hypocalcemic tetany. Ghost cells with preserved outlines define coagulative necrosis instead.
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.