Although the endocrine pancreas appears to play an important role in the pa
thophysiology of sickle cell disease, very little is known about the morpho
logic changes in this tissue. Our study was initiated to delineate the micr
oscopic features of the endocrine pancreas in a large autopsy series of sic
kle cell hemoglobinopathies. From more than 650 cases archived at the Centr
alized Pathology Unit for Sickle findings and/or for microscopic studies, i
ncluding histochemical stains (trichrome, reticulin, iron), and immunohisto
chemical stains (insulin, glucagon, somatostatin, and pancreatic polypeptid
e). The gross examinations were recorded as unremarkable in 65% of the auto
psies. In childhood and adolescence (less than or equal to 18 years)- pancr
eas weights (50.76 +/- 5.16SE gm) were significantly greater (p < 0.0001) t
han age-matched controls (30.42 +/- 3.59SE gm). In adulthood, pancreas weig
hts (108.34 +/- 5.29SE gm) were not significantly different from controls (
110 gm). Microscopic findings included vascular congestion (48%), edema (65
%), siderosis (31%), and nesidioblastosis (76%), which included islet cell
dispersion (53%), hyperplasia (23%), and hypertrophy (25%). Analysis by age
groups suggested that islet cell dispersion/hyperplasia persists unchanged
, whereas diameters of compact islets tend to increase with age. These find
ings may be related to local tissue hypoxia and/or increased metabolic ener
gy needs in sickle cell disease.