Pancreatic calculi containing brushite: Ultrastructure and pathogenesis

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Abstract
Six pancreatic calculi were analyzed by X-ray powder diffraction and scanning electron microscopy. All were found to contain calcite; however, small amounts of two other morphologically distinct deposits containing only Ca were also detected in some of the stones. It is suggested that these substances may be vaterite and aragonite. In addition, significant deposits of brushite, CaHPO4·2H2O, were identified on the outer surfaces of three of the stones. This substance has not been previously reported as a constituent of pancreatic calculi, and its presence is surprising since physico-chemical factors such as phosphate concentration and fluid pH do not favor its deposition. We suggest that precipitation of calcite in the pancreatic duct occurs as the primary event in the formation of pancreatic calculi and that it may continue until the duct is completely occluded. There-after, further growth causes injury to the duct wall resulting in the calcite core being exposed to phosphate in the tissue fluid. Deposition of brushite follows.