CT appearance of incidental pancreatic lipomas: a case series

Hois, Erin L.; Hibbeln, John F.; Sclamberg, Joy S.

doi:10.1007/s00261-005-0362-0

Cited by 25 publications

(31 citation statements)

References 11 publications

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“…On USG, pancreatic lipoma may appear hypo-, iso-or hyperechoic. It is a small hypoechoic lesion with sharp irregular borders [3,5] as was also present in our case. Legmann et al [5] identified characteristic features of homogenous fat density (HU -80 to -120) with no central or peripheral enhancement on CT. A sharp demarcation with no evidence of infiltration into surrounding pancreatic or extra-pancreatic tissues [5] shows its benign nature.…”

Section: Discussionmentioning

confidence: 73%

“…It may occur anywhere in the body, and frequently in the gastrointestinal tract when intra-abdominal, and rarely within the pancreas. The incidence of pancreatic lipoma was calculated to be 0.083% [3], but recently, a retrospective review of 100 abdominal CT revealed Volume 4 Issue 5 -2017 much higher incidence [4]. This suggests cases are not being reported or missed rather than being rare.…”

Section: Discussionmentioning

confidence: 99%

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Pancreatic Lipoma and its Differentiation from Various Fat Containing Lesions in the Pancreas: An Imaging Guide

Bhatt

Ahmad

Tandon

et al. 2017

IJRRT

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Lipoma of the pancreas is a rare benign tumor which is usually discovered incidentally on imaging. Being innocuous in nature it does not require surgical removal and therefore needs to be differentiated from various pancreatic masses. Unlike other pancreatic tumors, it can be confirmed on CT or MRI imaging and does not require invasive histopathological examination to establish a definite diagnosis. We present a case of pancreatic lipoma in a 46 year old female, detected incidentally on ultrasound and confirmed on Computed Tomography by demonstrating the characteristic imaging features of lipoma and thus, no further histopathological confirmation was required. This case report presents a brief review of literature re-emphasizing the importance of imaging in distinguishing lipoma from other fat containing lesions of the pancreas and thus re-enforcing the "masterly inactivity" policy for these lesions. A confident imaging diagnosis of a pancreatic mass being a lipoma would obviate the anxiety of the patient as well as the clinician regarding the need for further management.. Keywords:Lipoma; Liposarcoma; Pancreas; Computed tomography Copyright: ©2017 Ahmad et al. much higher incidence [4]. This suggests cases are not being reported or missed rather than being rare. Being an innocuous lesion, many radiologists may not feel the need to mention it. Moreover, small lesions may be difficult to recognize on thick slices due to volume averaging effects. It is usually less than 5cm and clinically silent or may present with abdominal pain, biliary or pancreatic duct obstruction when large. Symptomatic intra-pancreatic lipoma may require surgical treatment. On USG, pancreatic lipoma may appear hypo-, iso-or hyperechoic. It is a small hypoechoic lesion with sharp irregular borders [3,5] as was also present in our case. Legmann et al. [5] identified characteristic features of homogenous fat density (HU -80 to -120) with no central or peripheral enhancement on CT. A sharp demarcation with no evidence of infiltration into surrounding pancreatic or extra-pancreatic tissues [5] shows its benign nature. Histologic confirmation is not required as a definite diagnosis can be made on the basis of CT alone. Lipomas appear hyper intense on both T1 and T2 weighted sequences, similar to intra-abdominal and subcutaneous fat. Fat-suppressed images show homogeneous suppression of signal intensity within the tumour. Like CT, MRI also does not show contrast enhancement. Butler et al.[6] followed intra-pancreatic lipomas for 12 years; majority of which were asymptomatic at presentation, none required intervention, or showed interval growth or change in imaging appearance. This proved that lipomas are stable in size and morphology. Interval follow-up is required to prove their benign nature to differentiate them from early liposarcoma. Only one case report exists in literature showing a morphological change and increase in size in a pancreatic lipoma seven years after the diagnosis was established [7]. A liposarcoma was proved on endos...

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Pancreatic Lipoma and its Differentiation from Various Fat Containing Lesions in the Pancreas: An Imaging Guide

Bhatt

Ahmad

Tandon

et al. 2017

IJRRT

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“…On CT, a lipoma is depicted as a homogeneous, well-marginated, hypodense mass with an attenuation coefficient consistent with that of fat. 10 In addition, no contrast enhancement is noted. 10 In contrast, focal fatty infiltration of the pancreas usually appears as a heterogeneous, ill-defined, hypodense lesion.…”

Section: Discussionmentioning

confidence: 96%

“…Histopathologically, focal fatty infiltration is in direct contact with the surround- ing pancreatic parenchyma and contains foci of the atrophic pancreatic parenchyma, whereas a lipoma should have a thin capsule and should contain septa of connective tissue instead of pancreatic parenchyma. 10 On sonography, the differentiation between focal fatty infiltration and lipomatous tumors is difficult due to their similar echogenicity. On CT, a lipoma is depicted as a homogeneous, well-marginated, hypodense mass with an attenuation coefficient consistent with that of fat.…”

Section: Discussionmentioning

confidence: 99%

Sonographic appearance of focal fatty infiltration of the pancreas

Yang

Kim

Ryu

et al. 2009

J of Clinical Ultrasound

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“…Teratomun duvarı epitel ve konnektif doku içermesiyle lipomdan farklılık gösterir. Teratom sıklıkla cerrahi eksizyon gerektirir 1 . Bizim olgumuzda lezyonda farklı yüksek dansiteli herhangi bir komponent izlenmedi.…”

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Intrapancreatic lipoma: Imaging findings

Bülbül¹,

Yanık²,

Yildar³

et al. 2013

BSBD

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bsbd@balikesir.edu.tr www.bau-sbdergisi.com ÖZET Pankreatik lipomlar pankreasın mezenkimal tümörleri olup literatürde sınırlı sayıda olgu bildirilmiştir. Lezyon büyük olmadığı ya da bası bulguları oluşturmadığı sürece asemptomatiktir. Pankreasın ultrasonografi (USG) ile değerlendirilmesindeki sınırlılıklar nedeniyle özellikle küçük boyutlu lezyonların USG ile tespiti güç olabilir. Bilgisayarlı tomografi (BT) ve magnetik rezonans görüntülemede (MRG) homojen iç yapıda, düzgün sınırlı, vücudun diğer bölgelerindeki yağ doku ile benzer dansite/sinyal özelliği gösterirler. Kontrast tutulumu ve peripankreatik yağ dokuya uzanımları görülmez. Ayırıcı tanıda fokal yağlı infiltrasyon, teratom, liposarkom gibi yağ doku içeren lezyonlar bulunur. Özellikle malign tümör olan liposarkomdan ayrım önemlidir. Lezyonun büyük boyutta (>5cm) ve heterojen iç yapıda olması, kontrast tutulumu göstermesi, takipte boyut artışı malignite lehinedir. BT ve MRG lipomların tespiti ve ayırıcı tanısında çok önemlidir.Anahtar Kelimeler: bilgisayarlı tomografi, lipom, magnetik rezonans görüntüleme, pankreas SUMMARYPancreatic lipomas are mesenchymal tumors of pancreas and limited numbers of cases were reported in the literature. Lesion is asymptomatic unless it is a large mass or it causes compression findings. Because of the limitations in sonographic evaluation of pancreas, it can be difficult detecting lesions especially the small ones. In computed tomography (CT) and magnetic resonance imaging (MRI) they have homogenous internal structure, smooth borders and same density/intensity like fat tissues at the other parts of body. They do not enhance, or extend to peripancreatic fat tissue. Fat containing lesions like focal fatty infiltration, teratoma, and liposarcoma are in differential diagnosis. It is particularly important to differentiate from liposarcoma which is malignant. Bigger size (>5cm), heterogeneous internal structure, contrast enhancement and size increasing are in favor of malignancy. CT and MRI are very important in detecting and differential diagnosis of lipomas.

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CT appearance of incidental pancreatic lipomas: a case series

Cited by 25 publications

References 11 publications

Pancreatic Lipoma and its Differentiation from Various Fat Containing Lesions in the Pancreas: An Imaging Guide

Pancreatic Lipoma and its Differentiation from Various Fat Containing Lesions in the Pancreas: An Imaging Guide

Sonographic appearance of focal fatty infiltration of the pancreas

Intrapancreatic lipoma: Imaging findings

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