Relationship between glucose tolerance and quantitative changes of islet cells in chronic obstructive pancreatitis due to pancreatoduodenal cancer.

Abstract

This study was conducted to clarify the relationship between indicators of preoperative glucose tolerance and quantitative changes of endocrine cells in the islet of Langerhans in patients with chronic obstructive pancreatitis due to pancreatoduodenal cancer. Twenty-one specimens of pancreatic tissue obtained from patients who underwent pancreatoduodenectomy or total pancreatectomy for pancreatoduodenal cancer were divided into four groups according to the degree of fibrosis (Grades 0-III). Islet cells in serial sections were stained immunohistochemically to determine the proportions of B-, A-, D-, and PP-cells in the islets of Langerhans. In patients with pancreatic tissue with the most severe fibrosis, of several preoperative glucose metabolism indices measured, it was found that the ratio of integrated value of change in serum insulin to that of serum glucose (sigma delta IRI:sigma delta BS) was significantly decreased. There was a significant positive correlation between proportion of B-cells, and both the ratio of change in insulin to that of glucose (delta IRI:delta BS) and sigma delta IRI:sigma delta BS. On the other hand, there was a significant negative correlation between proportion of A-cells and sigma delta IRI:sigma delta BS. The present data strongly suggest that it is possible to estimate the degree of fibrosis and to quantify changes of the islet cells prior to surgery in patients with obstructive pancreatitis due to pancreatoduodenal cancer by calculating these glucose metabolism indices, and that sigma delta IRI:sigma delta BS is a particularly useful index.