Morphological features of the major duodenal papilla in patients with cholelithiasis

Abstract

The high prevalence of the pathology of major duodenal papilla in patients with gallstone disease, the difficulties of diagnosis and treatment determine the relevance of the study. The purpose is to study the morphological features of the major duodenal papilla in patients with cholelithiasis. Material and methods. During autopsies, selection of fragments of major duodenal papilla from 30 dead was performed. The main group consisted of autopsy specimens (n = 15) from the dead, which had stones in the gallbladder in the absence of signs of inflammation of the walls of the gallbladder and bile ducts. Biomaterial samples (n = 15) from the dead, which had no stones and signs of inflammation of the biliary system, were included in the control group. To study the severity of the stromal component, the Mason’s trichrome and the Van Gieson’s stains were used. Light microscopy was carried out using a light microscope Axioplan 2 (Carl Zeiss - Germany) using x10, x20, x40, x100 lenses and x10 eyepiece. For a quantitative assessment of the severity of sclerotic changes, we conducted a morphometric study of preparations stained with picrofuchsin accordimg to Van Gieson. The area of the stromal component was calculated in the resulted images in 5 fields of view under magnification of x200 using the medical software for analysis and processing of digital images ImageJ, initiated by W. Rasband (1997-2012). The expression area was the percentage ratio of the number of pixels of the digital image of the zones of expression of the connective tissue component to the total number of pixels in the image. Results . The quantitative analysis of the severity of sclerotic changes in the periductal tissue in both studied groups showed that in the control observations the expression area of the connective tissue component was 18.84 ± 3.14%, and in the main group (cases of gallstone disease) – 78.06 ± 15.12% (p = 0.0031). Conclusions . 1. In patients with gallstone disease there are consequences of microtrauma of the mucous membrane of the common bile duct and large duodenal papilla, violated typical pattern of epithelial lining, expressed dystrophic changes and desquamation of the epithelium into the lumen of the duct, which in turn was significantly deformed in certain areas with the overgrowth of perifocal connective tissue. 2. Quantitative analysis of the severity of sclerotic changes in the periductal tissue revealed a significant prevalence of the expression area of the connective tissue component in patients with gallstone disease (78.06 ± 15.12%) compared with control observations (18.84 ± 3, 14%), (p = 0.0031). 3. In the case of prolonged course of gallstone disease in the periductal space the expressed collagenization of the periductal space with the presence of coarse fibrous connective tissue and almost complete absence of the smooth muscle component were recorded.