A liver-unrelated question on chronic pancreatitis: biopsy of a pancreas from a 48-year-old alcoholic man with recurrent abdominal pain and pancreatic calcification on plain radiograph shows dense interlobular fibrosis, marked loss of acini, dilated ducts with intraductal protein plugs, and chronic inflammation. Which parenchymal component is characteristically preserved until very late in the disease course?

• A Periductal myofibroblasts
• B Pancreatic acinar cells
• C Interlobular duct epithelium
• D Islets of Langerhans ✓

Explanation

In chronic pancreatitis, fibrosis progressively destroys acinar tissue first, causing exocrine insufficiency with steatorrhea, while the endocrine islets are relatively resistant and are destroyed late. This explains why diabetes mellitus appears years after malabsorption in the natural history of the disease. Ducts are dilated and contain protein plugs that may calcify, matching the radiographic calcifications. Myofibroblast-driven fibrosis is actually a driving process, not a structure being preserved.

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.