Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany. johanna.preuss@ukb.uni-bonn.de
Several morphological alterations of the pancreatic tissue have been described as common findings in hypothermia (e.g. bleedings, pancreatitis, vacuoles). The frequency of these findings varies a lot. It was the aim of this study to clarify the kind and frequency of pancreatic changes in cases of death due to hypothermia. The autopsy reports of 143 cases of fatal hypothermia were, retrospectively, evaluated with regard to describe macroscopic findings in the pancreas. Additionally, microscopic investigations of tissue samples of the pancreas were carried out in 62 cases. As a control group, pancreatic samples of 25 autopsy cases without hypothermia and without alcoholism were collected. Additionally, pancreatic samples of 25 further autopsy cases with an alcoholic disease in the case history were investigated. In only 5 out of 143 cases of the study group, macroscopic bleedings in the pancreas were described. One case of acute and one of chronic pancreatitis was found in the autopsy reports. In 11 (17.7%) out of 62 cases, microscopic investigations yielded bleedings in the pancreatic tissue and in 24 (38.7%) out of 62 cases, optically empty vacuoles in the adenoid cells were found. In 15 out of 62 cases (24.2%), autolysis was too pronounced to gain utilisable results. In the control group without alcoholism, 12 out of 25 cases (48%) were diagnosed without pathological findings, five cases showed bleedings, one case an acute pancreatitis, one case a chronic pancreatitis and in six cases, the pancreatic tissue was autolytic. Vacuoles in the adenoid cells were not found. In the additional collective with alcoholism in the case history, 13 cases presented signs of an acute or a chronic pancreatitis. In 3 out of these 13 cases, vacuoles in the adenoid cells were found, but no case with vacuoles and without signs of a chronic pancreatitis was observed. The high frequency of pancreatic bleedings in cases of fatal hypothermia as described in the literature cannot be confirmed by our investigations. Only the vacuoles in the adenoid cells of the pancreas seem to be an additional sign of death due to hypothermia or associated with hypothermia.
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Institut für Rechtsmedizin, Universität des Saarlandes, Gebäude 42, 66421, Homburg/Saar, Germany, Elisabeth.tuerk@uks.eu.
Hypothermia refers to a situation where there is a drop in body core temperature below 35 degrees C. It is a potentially fatal condition. In forensic medicine and pathology, cases of hypothermia often pose a special challenge to experts because of their complex nature, and the often absent or nonspecific nature of morphological findings. The scene of the incident may raise suspicions of a crime initially, due to phenomena such as terminal burrowing behavior and paradoxical undressing. An element of hypothermia often contributes to the cause of death in drug- and alcohol-related fatalities, in the homeless, in immersion deaths, in accidents and in cases of abuse or neglect, making the condition extremely relevant to forensic medical specialists. The aim of this review is to give an overview of the pathophysiological aspects of hypothermia and to illustrate different aspects relevant to forensic medical casework.
Marija Jakubeniene,
Algimantas Irnius,
Gregoire Abi Chaker,
Jonas Mindaugas Paliulis,
Antanas Bechelis
Institute of Forensic Medicine of Mykolas Romeris University, Didlaukio str. 86E, Vilnius LT-08303, Lithuania. marija.jakubeniene@gmail.com
The identification of hypothermia as cause of the death was always quite problematic in the field of forensic medicine. The aim of the present study was to verify the determination of calcium content in post-mortem liver, heart, and skeletal muscle samples as the biochemical marker defining hypothermia as the cause of death. The study involved 43 autopsy cases in which the circumstances of death indicated the effects of overcooling. The control group consisted of material collected from the corpses of 30 persons who were not exposed to low temperatures but died due to technical injuries (n=5), asphyxia (n=6), intoxication with ethanol and other substances (n=8), and acute myocardial infarction/ischemia (n=11). The concentration of calcium in autopsy samples was determined applying flame atomic absorption spectroscopy. Our study showed no significant differences of calcium content in tissues of persons who died due to hypothermia, over those who died in normothermic conditions.
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Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany. dr.j.preuss@gmx.de
BACKGROUND There exist only a few "typical" morphological signs of death due to hypothermia. For forensic practice, the identification of other reliable markers to determine hypothermia as cause of death is important. In the literature hypothermia is discussed as a stress factor for cells. It was the aim of this study to clarify wether an increased HSP 70 expression in the kidneys of fatal hypothermia victims can be observed. MATERIAL AND METHODS Kidney tissue samples of 100 fatal cases of hypothermia and 50 control cases without hypothermia and burning were investigated. The expression of HSP 70 in both study and control group was graded after immunohistochemical staining using a 4 degrees scale from 0 up to +3. RESULTS Altogether, in the study group 89.0% in the tubule epithelium cells and 80.0% in the glomerula presented a HSP 70 expression of different grades. In the control group, 33 out of 50 cases were diagnosed completely without any HSP 70 expression in renal tubules, 17 cases showed a slight (+1) HSP 70 expression in the tubuli. In the glomeruli 42 cases of the control group were completely negative for HSP 70 expression, 8 cases showed a slight (+1) expression in the glomeruli. CONCLUSION Our results show, that hypothermia is a stress factor inducing HSP 70 expression in the renal tubular epithelial cells and in the glomerular podocytes. Although HSP 70 expression was increased in the kidneys in cases of hypothermia, there was no strong correlation to Wischnewski's spots.
Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany. johanna.preuss@ukb.uni-bonn.de
Lipid-deposits in internal organs, e.g. nephrons, are discussed as reliable marker to determine hypothermia as cause of death. While investigations concerning lipid vacuoles in the epithelium of the renal tubules are already published, there is no systematic information available about hypothermia and lipid deposits in cardiomyocytes. Therefore, this retrospective study presents the first results of lipid-stainings of myocardial samples taken by autopsies in hypothermia-cases in comparison to samples from a control group. It was the aim of the study to clarify the conceivable causal relationship between death due to hypothermia and lipid-deposits apart from lipofuscin and fatty degeneration, respectively, in cardiomyocytes.
Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany. jpreuss@uni-bonn.de
The diagnosis "death due to hypothermia" is mainly based on circumstances and gross autopsy findings like frost erythema and gastric erosions. Up to now, there are no reliable histologic criteria available to confirm the diagnosis "death due to hypothermia." However, fatty changes of organs have been reported already in the literature as a histological finding contributing to the diagnosis "death due to hypothermia." To evaluate these reports, cases with well-documented hypothermia (study-group; n=83), cases with other causes of death (control-group; n=25) and additionally also seven cases with a past medical history of diabetes mellitus were investigated. Renal tissue autopsy samples were taken from both the left and the right kidney and investigated for signs of fatty degeneration within the renal tubule epithelium. The results were compared with regard to macroscopic signs of hypothermia (Wischnewski-ulcers, erythema), as reported in the autopsy protocols. The results lead to the conclusion, that fatty degeneration is a very reliable histologic diagnostic criterium in cases of hypothermia, comparable to the significance of Wischnewski-ulcers.
Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany. jpreuss@uni-bonn.de
Downstairs falls frequently occur within domestic environments and are mainly associated with elderly and intoxicated individuals, often feature multiple injuries on various parts of the body. In most cases it is not possible to determine the cause of the fall and/or death solely by means of external examination. In this retrospective study, which covers a period of 11 years, all cases of death which included a fall downstairs in their case history, were collected from the Forensic Institutes of the Universities of Bonn and Greifswald, Germany. Falls downstairs made up to 2%(166 cases) of all postmortem examinations carried out within this period. Interestingly, almost double of the amount of such falls applied to males as to females. The primary cause of death was cranio-cerebral trauma and the vast majority of skull injuries associated with falls downstairs were found above 'the hat brim line'. Injuries were also often found on several other parts of the body at once. Nineteen of the 116 examined individuals exhibited agonal injuries. In these cases, postmortem examination revealed pre-existing disease or intoxication to be the cause of death and thus, cause of the fall. The injury pattern only allows a tendency towards vital or agonal incident as a conclusion.
Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, 53111 Bonn, Germany. f.musshoff@uni-bonn.de
In a suicide committed using aluminium phosphide (AlP) the liberated toxic phosphine gas was detected in post-mortem specimens using a headspace gas chromatographic procedure with a nitrogen-phosphorous detector (HS-GC/NPD). At autopsy a direct sampling into airtight headspace vials for a later analysis is recommended. AlP has to be considered a potent pesticide and its use and availability should be restricted as much as possible.
Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, 53111 Bonn, Germany. thierauf@uni-bonn.de
Aneurysms of the visceral arteries are a rather common feature appearing in 0.1-2% of the population. The clinical relevance of those anomalies varies a lot. The wide range of descriptions reaches from asymptomatic cases to fatalities in particular due to haemorrhages. The latter will be discussed in a case report concerning a 60-year-old man who collapsed at his work place and died 4 h after admission to the intensive care unit of a hospital nearby. The ruptured aneurysm remained undiagnosed in hospital and was found by autopsy. The case is presented and discussed in view of medico-legal questions.
Institut für Rechtsmedizin der Universität Bonn. b.madea@uni-bonn.de
BACKGROUND AND OBJECTIVE: There are no reliable data in Germany on the incidence of medical malpractice, preliminary proceedings against medical practitioners and the results of such proceedings. Preliminary proceedings are especially felt by medical practioners to be a significant burden on them. MATERIAL AND METHODS: A retrospective study was carried out of all criminal proceedings involving accusations of medical malpractice, dealt with at the Institute of Forensic Medicine of the University of Bonn between 1989 and 2003. RESULTS: The analysis comprised 210 preliminary proceedings. The accusations mainly concerned offences against the patient's life or health (negligent bodily injury, section sign 229 StGB; negligent manslaughter,[section sign] 222 StGB). Most of the preliminary proceedings were started without the services of a lawyer representing the injured/bereaved. Many accused medical practitioners also had not engaged a lawyer, probably because they did not even know of the preliminary proceeding. 87% of the proceedings were closed according to [section sign] 170 Abs. 2 StPO or the verdict was acquittal. 7.6% of the cases were completed according to [section sign] 153a Abs. 1 StPO or the result was a conviction. CONCLUSION: Preliminary proceedings against medical practitioners due to medical malpractice are predominantly closed according to [section sign] 170 Abs. 2 StPO. The study reveals that, especially in cases ending in death, autopsy findings often exonerate medical practitioners from accusations of medical malpractice. Medical practitioners themselves should for this reasons officially report the manner of death as of undetermined in order to prepare a basis for later objective explanation of the cause of death by legal autopsy.
Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany. johanna.preuss@ukb.uni-bonn.de
Wischnewsky's spots in the mucosa of the stomach have been a well-known sign of death due to hypothermia for many years. Furthermore it is reported that those spots can rarely be found in the esophagus as well. We now report on a case concerning a 93-year-old woman who presented an ectopic stomach with erosions of the mucosa in the intrathoracic part of the stomach that were assessed as Wischnewsky's spots. When she was found dead in her flat, she was completely undressed and showed an injury to the head. The autopsy findings are presented and discussed in view of a possible genesis and pathophysiology of Wischnewsky's spots.
Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany. rdettmey@uni-bonn.de
Medicolegal malpractice assessments have been an important part of the work of forensic pathologists. Not only botchers are concerned but also physicians of all clinical subjects, especially malpractice charges claiming a malpractice leading to death. Single long articles and book chapters have been published about malpractice assessments since the end of the 17th century by forensic pathologists. After World War II systematic studies of malpractice charges first were published in the 1960s. Meanwhile the attention focuses more and more on the role of forensic pathologists to help in prevention of malpractice.
Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany. reinhard.dettmeyer@forens.med.uni-giessen.de
Well-known complications related to drug abuse are myocardial insufficiency, myocardial infarction, endocarditis, myocarditis, aortic dissection, neurologic damages, ischemic colitis, thrombotic phenomenons, renal infarction and acute liver failure. Furthermore, microfocal fibrosis of the myocardium is found in stimulant abuse. The origin of myocardial fibrosis associated with opiate abuse (endocarditis, myocarditis, embolism) is still unclear. This question shall be investigated using immunohistochemical staining for early diagnosis of myocarditis. A quantification of myocardial interstitial leucocytic infiltrates was accomplished in 21 chronic drug abusers who died of heroin/morphine intoxication and compared to 15 normal subjects who died suddenly due to non-cardiac causes of death without intoxication (e.g. traffic accidents, head trauma). Toxicological investigations were performed and in addition, blood samples were checked to clarify the status of HIV, hepatitis A, B and C in both groups. To verify signs of inflammation, myocardial specimen from different locations were investigated with conventional histological stainings and immunohistochemical techniques for characterization and quantification of interstitial myocardial leucocytes, T-lymphocytes and macrophages. The number of cells were found up to fivefold increased in heroin addicts compared to the control group without reaching the cut-off values for immunohistochemically based diagnosis of myocarditis.
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Vnitr Lek. 2009 Jan ;55 (1):18-21
19227951
Interní hepatogastroenterologická klinika Lékarské fakulty MU a FN Brno, pracovistĕ Bohunice. pdite@med.muni.cz
INTRODUCTION Pancreatic carcinoma is one of the diseases which mostly fail to be diagnosed on a timely basis, and there is no way to effectively screen patients for pancreatic carcinoma either. An option for the diagnosis of the "early glandular carcinoma" therefore resides in identification and systematic screening of patients with risk of pancreatic carcinoma. METHOD We monitored 223 patients with chronic pancreatitis on a systematic basis from 1992 to 2005. During this 14-year period, we monitored the number of cigarettes smoked per year in addition to standard parametres measured by biochemical methods, endosonography, CT and ERCP exams, and assigned the alcoholic form of chronic pancreatitis to patients consuming more than 80g of alcohol per day on a systematic basis for more than 5 years in the case of men, and 50 g of alcohol per day in the case of women, and classed the patients according the TIGARO classification. RESULTS Alcoholic etiology was proven in 73.1% of the examined patients, chronic obstructive form of pancreatitis was diagnosed in 21.5% of patients, and only 5.4% of patients were classified into the idiopathic pancreatitis group. Pancreatic carcinoma in the region of chronic pancreatitis was found in 13 patients (5.8%); stomach carcinoma was diagnosed in 3 patients with chronic pancreatitis, and oesophageal carcinoma in 1 patient of the total of patients monitored. Malignant pancreatic disease was diagnosed primarily in patients with alcoholic pancreatitis (4.5%). During the period of 14 years, 11 patients died, 8 of the deaths being associated with pancreatic carcinoma. CONCLUSION Both pancreatic and extrapancreatic carcinoma in gastrointestinal location is a serious complication of protracted chronic, non-hereditary pancreatitis. Systematic identification and treatment of patients with chronic pancreatitis is therefore necessary for timely diagnosis ofgastrointestinal and pancreatic malignancies.
Department of Neurology, Martin Wing, Leeds General Infirmary, Leeds LS1 3EX, UK. altyjane@doctors.org.uk
A 61-year-old woman with secondary progressive multiple sclerosis presented on six occasions over a 2-year period with severe hypothermia (31-33.5 degrees C). This resulted in numerous multi-system complications comprising acute pancreatitis, hepatitis, gastrointestinal haemorrhage, psychiatric disturbance, bradycardia, paradoxical sweating, thrombocytopenia, anaemia and raised inflammatory markers. Septic screens were consistently normal. On each occasion she was successfully treated with passive external rewarming and made a complete recovery. This is the first reported case of such extensive sequelae in a single patient with recurrent hypothermic episodes. This unusual patient provides an invaluable insight into the natural history and pathophysiology of hypothermia. The case report is followed by a review of dysfunctional thermoregulation and pathophysiology of hypothermia-induced multi-system complications. A key learning point is to recognise that the clinical manifestations of hypothermia may be widespread and serious but are nonetheless reversible. In addition, one should consider the differential diagnosis of covert hypothermia in those patients with episodic confusion, as hypothermia is under-recognised, particularly in older people, who are prone to accidental hypothermia, and in those with common neurological conditions, such as stroke, head injury and multiple sclerosis, that may have suboptimal thermoregulation.
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7510, USA.
PURPOSE To determine the accuracy of MRI including T1-weighted gadolinium (Gd)-enhanced three-dimensional-gradient-echo (3D-GE) sequences to distinguish pancreatic cancer from chronic pancreatitis in patients with pancreatic mass or focal enlargement. MATERIALS AND METHODS The study included 22 patients (15 males and seven females; mean age +/- SD, 56.2 +/- 11.5 years) with pancreatic mass or focal enlargement. Fourteen had pancreatic carcinoma and eight had chronic pancreatitis based on the histopathological and clinical findings. MRI examinations of all patients were retrospectively evaluated by two independent reviewers for the predetermined imaging findings of carcinoma and chronic pancreatitis. The accuracy of MRI for differentiating pancreatic carcinoma from chronic pancreatitis was determined. MRI findings of both entities were compared using t-tests, chi-squared tests, and logistic regression analyses for the differentiation of these two entities. The extent of agreement between two reviewers was determined with Kappa statistics. RESULTS The sensitivity and specificity of MRI including T1-weighted 3D-GE sequences for differentiating pancreatic carcinoma from chronic pancreatitis were 93%(13/14) and 75%(6/8), respectively. The most discriminative finding for pancreatic carcinoma was relative demarcation of the mass compared to background pancreas in contrast to chronic pancreatitis on post-Gd 3D-GRE sequences (P < 0.05). CONCLUSION MRI including Gd-enhanced T1-weighted 3D-GE sequences can differentiate pancreatic carcinoma from chronic pancreatitis successfully in most cases.
J Surg Educ. ;64 (3):158-61
17574177
Michael Wayne,
Avram Cooperman,
Franklin Kasmin,
Seth Cohen,
Herbert Dryska,
Lawrence Ottaviano,
Chris Katcherian,
Neil Cambronero,
Jerome Siegel
Department of Surgery, Cabrini Medical Center, New York, NY 1003, USA. waynedocny@hotmail.com
HYPOTHESIS Chronic pancreatitis is a risk factor for pancreatic cancer. The association between these 2 disease processes is not well known. We present 3 unusual cases of pancreatitis associated with pancreatic cancer and review the possible mechanisms that can cause pancreatitis to degenerate into pancreatic cancer. DESIGN A case series reviewing 3 unusual cases of chronic pancreatitis associated with pancreatic cancer. The patients' charts are reviewed, and a literature search is performed looking for chronic pancreatitis associated with pancreatic cancer. SETTING The cases were performed at a small community hospital in New York City, New York. PARTICIPANTS The surgeons involved are experienced pancreatic surgeons with a large referral group. The endoscopies were performed by gastroenterologists with years of experience in biliary and pancreatic disease. RESULTS The cases and the literature review support the hypothesis that there is an association between chronic pancreatitis and pancreatic cancer. CONCLUSIONS Three unusual case of chronic pancreatitis, 2 with synchronous and 1 with metachronous malignancies, are presented. The pathway of benign to malignant change is reviewed, and the constant awareness that pancreatitis is associated with malignancy must be kept in mind.
Ist Department of General, Gastroenterological and Endcorine Surgery, Medical University of Wrocław, Poland.
BACKGROUND/AIMS Relation between cancer of the exocrine part of the pancreas and chronic pancreatitis has not been clearly defined and the problem of carcinogens based on long-lasting chronic pancreatitis is still a matter of discussion. METHODOLOGY The aim of the study was analysis of postoperative material of patients who in the years 1999-2003 underwent either drainage procedures (n=49) in the course of chronic pancreatitis or resectional procedures (n=36) for chronic pancreatitis or pancreatic cancer. RESULTS In the group of patients with drainage procedures pancreatic cancer was histologically detected in postoperative material (specimens collected from the wall of pancreatic pseudocyst or dilated main pancreatic duct) in 3 patients (6.1%). In the group of patients with long-lasting chronic pancreatitis who underwent a resectional procedure pancreatic cancer was postoperatively detected in 4 cases (30.7%). CONCLUSIONS Analysis of presented material confirms that long-lasting chronic pancreatitis predisposes to cancer of the exocrine part of the pancreas. This indicates that risk of pancreatic cancer should be taken into consideration in each patient with long lasting chronic pancreatitis.
Intern Med. 2007 ;46 (2):109-13
17220612
Cit:2
The Third Department of Internal Medicine (Gastroenterology and Metabolism), University of Occupational and Environmental Health, Japan, School of Medicine, Kitakyushu. mac-otsk@med.uoeh-u.ac.jp
In Japan, the number of patients with both chronic pancreatitis (CP) and pancreatic cancer (PC) is increasing. A nationwide survey on CP revealed that the total number of patients treated for CP in Japan in 2002 was estimated as 45,200 (95% confidence interval, 35,600-54,700), and 20,137 patients died of PC in 2002. Alcoholic pancreatitis was the most common type of pancreatitis (67.5 %). Cigarette smoking was an independent and significant risk factor for CP. The risks of pancreatic and nonpancreatic cancers increased in the course of CP. While alcohol consumption may increase the risk of PC via CP, smoking was important as a risk factor for both CP and PC. The increasing incidence of PC was closely related to the increasing intake of animal fat. Lifestyle in patients with CP appeared to be the same as that in patients with PC. Environmental factors such as lifestyle in combination with genetic factors may increase the risk for both CP and PC. Therefore, changing and improving lifestyle habits such as drinking, smoking and nutrition may reduce the risks for both CP and PC.
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
In the past year, there has been at least one important clinical paper that sheds light on the character and natural history of painful chronic pancreatitis, which has important clinical implications. In addition, several novel mutations have been described in the cationic trypsinogen gene in patients with hereditary pancreatitis. The mechanism by which these mutations cause pancreatic disease remains speculative. The diagnosis of early chronic pancreatitis is controversial. A novel noninvasive pancreatic function test (measurement of postprandial APOB-48) was reported but is unlikely to be a sensitive test of pancreatic function. Pancreatic fibrosis is frequently seen in alcoholics without chronic pancreatitis, and this makes it difficult to interpret the findings on endoscopic ultrasonogram. Recent studies highlight the difficulty in abolishing pancreatic steatorrhea. Recently fibrosing colonopathy in adult patients has been reported. Extracorporeal shockwave lithotripsy combined with endoscopic therapy failed to benefit patients with calcific chronic pancreatitis.
Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA. collinsmed@yahoo.com
A patient with severe hypothermia presented with an initial rectal temperature of 28.3 degrees C coupled with a hemoglobin of 2.2 g x dL(-1) and acute pancreatitis. Although hypothermia decreases oxygen and substrate consumption by tissues and can be cerebro-protective, the ideal rewarming strategy is unclear when the oxygen-delivery system is profoundly deficient, as with severe anemia. In this patient, truncal active external rewarming with a forced-air system, heated inhalation, and slow warmed transfusion yielded a 1.5 degrees C x h(-1) rate of rewarming and a good outcome. We discuss the numerous protective and detrimental factors affecting oxygenation and ventilation during hypothermia coupled with profound anemia and the possible etiologic explanations for coexistent hypothermia and pancreatitis.
Pancreas. 2004 Nov ;29 (4):254-63
15502640
Cit:28
Charles E Binkley,
Lizhi Zhang,
Joel K Greenson,
Thomas J Giordano,
Rork Kuick,
Dave Misek,
Samir Hanash,
Craig D Logsdon,
Diane M Simeone
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
OBJECTIVES Tissue desmoplasia occurs in a number of disease states, but its molecular basis is poorly understood. To determine which genes are overexpressed in cells contained within the desmoplastic stroma of pancreatic adenocarcinoma and chronic pancreatitis, we undertook genetic profiling of microdissected tissue samples of pancreatic adenocarcinoma, chronic pancreatitis, normal pancreas, and pancreatic cancer cell lines. We observed that samples of both pancreatic adenocarcinoma and chronic pancreatitis showed elevated expression of many shared genes compared with the normal pancreas. We hypothesized that these common genes likely important in stromal production and/or function could be identified using a strategy that involved comparisons between pancreatic adenocarcinoma, chronic pancreatitis, normal pancreas, and pancreatic cancer cell lines. METHODS We performed oligonucleotide microarray analysis of 6800 different genes expressed in 10 samples of pancreatic adenocarcinoma, 5 samples of normal pancreas, 5 samples of chronic pancreatitis, and 7 pancreatic cancer cell lines. Microarray findings were validated with RT-PCR, and immunohistochemistry was used to verify protein localization to the stromal compartment of both pancreatic cancer and chronic pancreatitis. RESULTS We employed a deductive comparison whereby genes expressed in the normal pancreas and pancreatic cancer cell lines were selectively eliminated from those expressed in common by pancreatic adenocarcinoma and chronic pancreatitis. This strategy identified 107 genes predicted to be expressed within cells of the stromal compartment of both pancreatic adenocarcinoma and chronic pancreatitis. CONCLUSIONS These genes are likely important factors in epithelial-stromal signaling in pancreatic desmoplasia and may serve as diagnostic or therapeutic targets.
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