Sonographic findings in pancreatic lipomatosis

So, Benny; Cooperberg, PL; Rg, Gibney; Bogoch, A.

doi:10.2214/ajr.149.1.67

Cited by 27 publications

(13 citation statements)

References 6 publications

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“…24,25 It usually correlates directly with BMI and presence of diabetes mellitus and/or pancreatitis. 26–29 Lipomatous pseudohypertrophy, by contrast, is the label applied to those cases associated with pseudotumor formation by fat, replacing almost an entire segment of exocrine parenchyma. 8 Until now, this entity has been documented in the literature mostly by individual case reports 1–20 (Tables 2A and B).…”

Section: Discussionmentioning

confidence: 99%

Lipomatous Pseudohypertrophy of the Pancreas

Altinel¹,

Basturk²,

Sarmiento³

et al. 2010

Pancreas

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Objectives Owing to the challenges in obtaining pancreatic biopsies, pancreatic resection for presumed malignancy is often performed without histological confirmation. As a result, benign lesions are sometimes surgically removed. One such condition, which is poorly defined in the literature, is referred to as lipomatous pseudohypertrophy (LPH) of the pancreas. Methods Five cases of LPH were analyzed. Results Four patients underwent surgical resection, 3 of which were diagnosed preoperatively by radiology as having ductal adenocarcinoma. The fourth case was correctly interpreted by magnetic resonance imaging as LPH, but the patient underwent resection because of the intractable pain due to pancreatitis. The fifth patient has been placed on watchful waiting. Two tumors were in the pancreatic head, one in the tail, one in the uncinate process, and one demonstrated diffuse involvement. Microscopically, they were characterized as having normal lipocytes without lipoblasts or inflammation. Within the adipose tissue, scattered microscopic foci of pancreatic parenchyma could be seen. Conclusion Lipomatous pseudohypertrophy of the pancreas is a distinct entity characterized by localized/diffuse replacement of pancreatic parenchyma with mature adipose tissue. It forms a pseudotumor that may be difficult to distinguish clinically from pancreatic adenocarcinoma. This entity should be considered when evaluating patients with a new diagnosis of a hypodense pancreatic neoplasm on imaging.

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Section: Discussionmentioning

confidence: 99%

Lipomatous Pseudohypertrophy of the Pancreas

Altinel¹,

Basturk²,

Sarmiento³

et al. 2010

Pancreas

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“…Therefore, data are mainly based on case reports of extreme cases of complete fatty replacement of pancreas with fatty tissue[36,52,199-201]. …”

Section: Clinical Significancementioning

confidence: 99%

Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease

Catanzaro¹,

Cuffari²,

Italia³

et al. 2016

WJG

162

132

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After the first description of fatty pancreas in 1933, the effects of pancreatic steatosis have been poorly investigated, compared with that of the liver. However, the interest of research is increasing. Fat accumulation, associated with obesity and the metabolic syndrome (MetS), has been defined as “fatty infiltration” or “nonalcoholic fatty pancreas disease” (NAFPD). The term “fatty replacement” describes a distinct phenomenon characterized by death of acinar cells and replacement by adipose tissue. Risk factors for developing NAFPD include obesity, increasing age, male sex, hypertension, dyslipidemia, alcohol and hyperferritinemia. Increasing evidence support the role of pancreatic fat in the development of type 2 diabetes mellitus, MetS, atherosclerosis, severe acute pancreatitis and even pancreatic cancer. Evidence exists that fatty pancreas could be used as the initial indicator of “ectopic fat deposition”, which is a key element of nonalcoholic fatty liver disease and/or MetS. Moreover, in patients with fatty pancreas, pancreaticoduodenectomy is associated with an increased risk of intraoperative blood loss and post-operative pancreatic fistula.

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“…It is known that a similar kind of tissue might be seen in the pancreas. Nevertheless, the pathogenesis of pancreatic involvement has not been understood clearly [13]. Lipomatous hypertrophy of the pancreas is macroscopically characterized by pancreatic enlargement and microscopically characterized by replacement of the exocrine tissue by fat.…”

Section: Discussionmentioning

confidence: 99%

“…Small degrees of adipose replacement might not carry any clinical symptom. However, when lipomatosis occurs, the patient may suffer from atypical abdominal pain, associated with the pancreatic mass and malabsorption, which is a consequence of pancreatic enzyme insufficiency [13,14]. Recent developments in screening methods give useful information for defining this disorder [15].…”

Section: Discussionmentioning

confidence: 99%

Fat replacement of the malignant pancreatic tissue after neoadjuvant therapy

et al. 2010

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Pancreatic lipomatosis is characterized as massive lipid infiltration of the pancreatic tissue. Although its etiology is ill defined; obesity, diabetes mellitus, chronic pancreatitis, hereditary pancreatitis, and conditions that cause pancreatic ductal obstruction, for example tumors and stones, are related to its pathogenesis. Recently, with the increased use of computerized tomography and magnetic resonance imaging, it has become possible to observe the fat replacement of the pancreas. Herein, we report a 60-year-old man complaining of abdominal pain and weight loss. Preoperative work-up revealed a locally advanced (Stage III) pancreatic adenocarcinoma. Multimodal treatment was carried out and a 100% complete response was detected after neoadjuvant therapy. The patient underwent a standard pancreaticoduodenectomy, without complications. The tissue pathology revealed lipomatosis of the pancreas. He was disease-free and symptom-free at 1 year follow-up. To our knowledge, this is the first report in the literature of pancreatic head carcinoma with total fat replacement of the pancreas after neoadjuvant chemoradiotherapy.

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Sonographic findings in pancreatic lipomatosis

Cited by 27 publications

References 6 publications

Lipomatous Pseudohypertrophy of the Pancreas

Lipomatous Pseudohypertrophy of the Pancreas

Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease

Fat replacement of the malignant pancreatic tissue after neoadjuvant therapy

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