Gradient inflammation in the pancreatic stump after pancreaticoduodenectomy: Two case reports and review of literature

Figure 1 Pathology in the pancreatic stump with postoperative pancreatic fistula after pancreaticoduodenectomy. A: Subserosal hematoma; B: Infiltration of inflammatory cells in glandular lobes and interlobular structures; C: Necrotic foci; D: Concentration of inflammatory cells and red blood cells in the main pancreatic duct; E: Destruction of inflammatory cells in the interlobular duct; F: Decomposition of inflammatory cells in the acinar duct metaplasia (ADM)-formed ducts; G: Transmigration of a neutrophil through the ADM-formed duct; H: Weakening or disappearance of apoptosis in the pancreatic stump after pancreaticoduodenectomy (transferase dUTP nick-end labeling); I: Normal level of apoptosis in control tissue of the pancreatic head before the postoperative pancreatic fistula (transferase dUTP nick-end labeling); J: Normal level of cytokeratin 19 (CK19) expression in the pancreas; K: Strong expression of CK19 in the pancreatic stump after pancreaticoduodenectomy; L: Malformation of the ADM-formed duct; M: Dilatation of the ADM-formed ducts.