Abstract
A 68-year-old woman had suffered from diabetes mellitus for 13 years which had been poorly controlled. She was required to have her left leg amputated three times for diabetic gangrene.
She was admitted to our hospital this time because of a need of amputation for newly developed gangrene in the right leg. The patient had been on 16-32 units of lente insulin during hospital course, but there were no symptoms and signs due to other hormonal abnormalities or hypof unction of the external pancreatic secretion. 3 weeks following surgery, she expired with cerebrovascular disease.
At autopsy, the pancreas appeared normal in shape and size and weighed 70g. The exocrine acini and ducts in the body and tail of the pancreas were completely replaced by adipose tissue, while the head maintained the normal structure of the tissue. There were collections of lymphoid cells in the tail. No calculi or other obstructive masses were found in the head and the body.
Although the etiology remains unknown, the change in the pancreas seems to be the acquired rather than the congenital. It is possible that the obstruction of the duct which occurred through certain mechanism might lead to the partial atrophy of the exocrine pancreas and finally to the replacement by adipose tissue in that portion.
Of interest is the coexistence of multiple endocrine adenomatosis found in this patient at autopsy i. e., non-B cell adenoma of the pancreatic islet, adenomas of the bilateral adrenal cortex and nodular goiter. However, it seems that there is no definite relationship between the adenomatosis and the replacement by adipose tissue in the exocrine pancreas.
