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Pagkali A, Makris A, Brofidi K, Agouridis AP, Filippatos TD. Pathophysiological Mechanisms and Clinical Associations of Non-Alcoholic Fatty Pancreas Disease. Diabetes Metab Syndr Obes 2024; 17:283-294. [PMID: 38283640 PMCID: PMC10813232 DOI: 10.2147/dmso.s397643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Non-Alcoholic Fatty Pancreas disease (NAFPD), characterized by fat accumulation in pancreatic tissue, is an emerging clinical entity. However, the clinical associations, the underlying molecular drivers, and the pathophysiological mechanisms of NAFPD have not yet been characterized in detail. The NAFPD spectrum not only includes infiltration and accumulation of fat within and between pancreatic cells but also involves several inflammatory processes, dysregulation of physiological metabolic pathways, and hormonal defects. A deeper understanding of the underlying molecular mechanisms is key to correlate NAFPD with clinical entities including non-alcoholic fatty liver disease, metabolic syndrome, diabetes mellitus, atherosclerosis, as well as pancreatic cancer and pancreatitis. The aim of this review is to examine the pathophysiological mechanisms of NAFPD and to assess the possible causative/predictive risk factors of NAFPD-related clinical syndromes.
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Affiliation(s)
- Antonia Pagkali
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasios Makris
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Brofidi
- Department of Internal Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Aris P Agouridis
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Department of Internal Medicine, German Oncology Center, Limassol, Cyprus
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2
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Torres OJM, Vasques RR, Barros CM, Sauaia GA, Mouchrek BDM, Rocha ML, Santos RAP, Falcão MV, Moraes JMA. PANCREATODUODENECTOMY DUE TO LIPOMATOUS PSEUDOHYPERTROPHY OF THE PANCREAS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1754. [PMID: 37729275 PMCID: PMC10510371 DOI: 10.1590/0102-672020230036e1754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Lipomatous pseudohypertrophy of the pancreas, pancreatic lipomatosis, pancreatic steatosis, non-alcoholic fatty pancreatic disease, or fatty pancreas is an extremely rare disease, characterized by the organ enlargement and a localized or diffuse replacement of pancreatic acinar cells by mature adipose tissue, preserving the pancreatic ductal system and islets of Langerhans. AIMS To report a rare case of lipomatous pseudohypertrophy of the pancreas in a symptomatic patient and the surgical treatment employed. METHODS A 24-year-old male patient with weight loss (10 kilograms in 8 months), hyperglycemia, severe and recurrent acute abdominal pain, epigastric discomfort associated with nausea, vomiting, and jaundice for 40 days. Magnetic resonance imaging was performed, revealing an irregular lipomatous pseudohypertrophy of the pancreas, measuring 6.0 × 5.6 cm in the head, uncinate process, and part of the body of the pancreas. The pancreatic duct dilation was diffuse and irregular, associated with atrophy of the remnant parenchyma, particularly in the tail of the pancreas. The patient underwent pancreatoduodenectomy without total mesopancreas excision followed by pancreatojejunostomy. RESULTS The postoperative course was uneventful, the length of stay in the ICU was two days, and the patient was discharged on the seventh postoperative day. CONCLUSIONS The disease treatment depends on the signs and symptoms at presentation and a pancreatoduodenectomy is indicated in patients with severe and recurrent abdominal pain.
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Affiliation(s)
- Orlando Jorge Martins Torres
- Universidade Federal do Maranhão, Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit – São Luís (MA), Brazil
| | - Rodrigo Rodrigues Vasques
- Universidade Federal do Maranhão, Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit – São Luís (MA), Brazil
| | - Cláudio Matias Barros
- Universidade Federal do Maranhão, Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit – São Luís (MA), Brazil
| | | | - Benedito Dario Murad Mouchrek
- Universidade Federal do Maranhão, Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit – São Luís (MA), Brazil
| | - Marcelo Lima Rocha
- Universidade Federal do Maranhão, Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit – São Luís (MA), Brazil
| | - Rennan Abud Pinheiro Santos
- Universidade Federal do Maranhão, Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit – São Luís (MA), Brazil
| | - Milena Vasconcelos Falcão
- Universidade Federal do Maranhão, Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit – São Luís (MA), Brazil
| | - José Maria Assunção Moraes
- Universidade Federal do Maranhão, Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit – São Luís (MA), Brazil
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3
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Berger Z, Orellana F, Cocio R, Torres F, Simian D, Araneda G, Toledo P. Pancreatic steatosis: A frequent finding in a Chilean population. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 88:118-124. [PMID: 34974993 DOI: 10.1016/j.rgmxen.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/02/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND AIMS Pancreatic steatosis is an incidental radiologic finding in asymptomatic patients, and its clinical importance is unclear. Primary aim: to study the prevalence of pancreatic steatosis (PS) in consecutive patients registered at our hospital, that underwent computed axial tomography (CAT) scanning of the abdomen and pelvis, excluding known pancreatic diseases. Secondary aim: to review the association of PS with the demographic and clinical data of the patients, as well as with hepatic steatosis (HS). MATERIALS AND METHODS An observational study was conducted on adult patients that had CAT scans of the abdomen and pelvis. DEFINITIONS a) tissue density was measured in Hounsfield units (HU) in five 1 cm2 areas of the pancreas, three areas of the spleen, and in segments VI and VII of the liver; b) fatty pancreas: a difference < -10 HU between the mean pancreas and mean spleen densities; and c) fatty liver: density < 40 HU. We registered the epidemiologic and laboratory data of the patients. The association of those factors with the presence of PS was analyzed using SPSS version 24.0 software, and statistical significance was set at a p < 0.05. RESULTS Of the 203 patients, PS was found in 61 (30%). The patients with PS were significantly older and had a higher body mass index. We found no significant association with the rest of the parameters studied, nor with HS (55 patients). None of the patients had symptoms attributable to a disease of the exocrine pancreas. CONCLUSIONS Fatty infiltration of the pancreas is a frequent finding in CAT scans, and its clinical importance is unclear. Aging of the population and the increase in obesity underline the need for future studies on PS.
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Affiliation(s)
- Z Berger
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - F Orellana
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - R Cocio
- Departamento de Imagenología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - F Torres
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - D Simian
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - G Araneda
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - P Toledo
- Sección de Gastroenterología, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
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4
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Nguyen LC, Vu KT, Vo TTT, Trinh CH, Do TD, Pham NTV, Pham TV, Nguyen TT, Nguyen HC, Byeon JS. Brunner’s gland hyperplasia associated with lipomatous pseudohypertrophy of the pancreas presenting with gastrointestinal bleeding: A case report. World J Clin Cases 2021; 9:9670-9679. [PMID: 34877305 PMCID: PMC8610885 DOI: 10.12998/wjcc.v9.i31.9670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/26/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Brunner’s gland hyperplasia (BGH) is a rare benign lesion of the duodenum. Lipomatous pseudohypertrophy (LiPH) of the pancreas is an extremely rare disease. Because each condition is rare, the probability of purely coincidental coexistence of both conditions is extremely low.
CASE SUMMARY We report a 26-year-old man presenting to our hospital with symptoms of recurrent upper gastrointestinal bleeding. Upper gastrointestinal endoscopy showed a huge pedunculated polypoid lesion in the duodenum with bleeding at the base of the lesion. Histopathological examination of the duodenal biopsy specimens showed BGH. Besides, abdominal computed tomography and magnetic resonance imaging revealed marked fat replacement over the entire pancreas, confirmed by histopathological evaluation on percutaneous pancreatic biopsies. Based on the radiological and histological findings, LiPH of the pancreas and BGH were diagnosed. The patient refused any surgical intervention. Therefore, he was managed with supportive treatment. The patient’s symptoms improved and there was no further bleeding.
CONCLUSION This is the first well-documented case showing the coexistence of LiPH of the pancreas and BGH.
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Affiliation(s)
- Long Cong Nguyen
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
- Department of Gastroenterology, School of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi 10000, Viet Nam
| | - Khanh Truong Vu
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
- Department of Gastroenterology, School of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi 10000, Viet Nam
| | - Trang Thi Thuy Vo
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Chau Ha Trinh
- Radiology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Tan Dang Do
- Radiology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Ngoc Thi Van Pham
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Tuyen Van Pham
- Pathology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | | | - Hiep Canh Nguyen
- Pathology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
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5
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Luchini C, Fassan M, Doglioni C, Capelli P, Ingravallo G, Renzulli G, Pecori S, Paolino G, Florena AM, Scarpa A, Zamboni G. Inflammatory and tumor-like lesions of the pancreas. Pathologica 2021; 112:197-209. [PMID: 33179622 PMCID: PMC7931580 DOI: 10.32074/1591-951x-168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Inflammatory/tumor-like lesions of the pancreas represent a heterogeneous group of diseases that can variably involve the pancreatic gland determining different signs and symptoms. In the category of inflammatory/tumor-like lesions of the pancreas, the most important entities are represented by chronic pancreatitis, which includes alcoholic, obstructive and hereditary pancreatitis, paraduodenal (groove) pancreatitis, autoimmune pancreatitis, lymphoepithelial cyst, pancreatic hamartoma and intrapancreatic accessory spleen. An in-depth knowledge of such diseases is essential, since they can cause severe morbidity and may represent a potential life-threatening risk for patients. Furthermore, in some cases the differential diagnosis with malignant tumors may be challenging. Herein we provide a general overview of all these categories, with the specific aim of highlighting their most important clinic-pathological hallmarks to be used in routine diagnostic activities and clinical practice.
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Affiliation(s)
- Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, Italy
| | - Claudio Doglioni
- Vita e Salute University, Milan, Italy.,Pathology Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Capelli
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Giuseppe Ingravallo
- Department of Emergency and Organ Transplantation, Section of Pathological Anatomy, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppina Renzulli
- Department of Emergency and Organ Transplantation, Section of Pathological Anatomy, University of Bari Aldo Moro, Bari, Italy
| | - Sara Pecori
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Gaetano Paolino
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Ada M Florena
- Department of Sciences for Promotion of Health and Mother and Child Care, Anatomic Pathology, University of Palermo, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy.,ARC-NET Research Centre, University of Verona, Verona, Italy
| | - Giuseppe Zamboni
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy.,IRCSS Sacro Cuore Don Calabria Hospital, Negrar, Italy
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Luu VD, Duc NM, My TTT, Viet NK, Bang LV, Thong PM. A rare case of lipomatous pseudohypertrophy of the pancreas. Radiol Case Rep 2021; 16:1363-1367. [PMID: 33897930 PMCID: PMC8055528 DOI: 10.1016/j.radcr.2021.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 11/26/2022] Open
Abstract
Lipomatous pseudohypertrophy of the pancreas is a rare disease with unknown etiology, and the pancreas parenchyma is replaced by pancreatic parenchyma by fat tissue. In this article, we aimed to report the case of a 26-year-old male patient admitted to hospital with loss of appetite for 6 months. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scans showed diffuse enlargement and fatty replacement over the whole pancreas, with scattered remnants of pancreatic parenchyma. Histologic results defined lipomatous pseudohypertrophy of the pancreas. To summarize, this case report is to put forward this extremely rare presentation and to sensitize clinicians that this entity can be a cause of exocrine pancreatic insufficiency, which requires patient follow-up for the appropriate treatment.
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Affiliation(s)
- Vu Dang Luu
- Department of Radiology, Bach Mai Hospital, Ha Noi, Viet Nam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Nguyen Minh Duc
- Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam.,Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Viet Nam
| | - Thieu-Thi Tra My
- Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | | | - Luong Viet Bang
- Department of Pathology, Tam Anh General Hospital, Ha Noi, Viet Nam
| | - Pham Minh Thong
- Department of Radiology, Bach Mai Hospital, Ha Noi, Viet Nam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
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7
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Saleh M, Sharma K, Kalsi R, Fusco J, Sehrawat A, Saloman JL, Guo P, Zhang T, Mohamed N, Wang Y, Prasadan K, Gittes GK. Chemical pancreatectomy treats chronic pancreatitis while preserving endocrine function in preclinical models. J Clin Invest 2021; 131:143301. [PMID: 33351784 PMCID: PMC7843231 DOI: 10.1172/jci143301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022] Open
Abstract
Chronic pancreatitis affects over 250,000 people in the US and millions worldwide. It is associated with chronic debilitating pain, pancreatic exocrine failure, and high risk of pancreatic cancer and usually progresses to diabetes. Treatment options are limited and ineffective. We developed a new potential therapy, wherein a pancreatic ductal infusion of 1%-2% acetic acid in mice and nonhuman primates resulted in a nonregenerative, near-complete ablation of the exocrine pancreas, with complete preservation of the islets. Pancreatic ductal infusion of acetic acid in a mouse model of chronic pancreatitis led to resolution of chronic inflammation and pancreatitis-associated pain. Furthermore, acetic acid-treated animals showed improved glucose tolerance and insulin secretion. The loss of exocrine tissue in this procedure would not typically require further management in patients with chronic pancreatitis because they usually have pancreatic exocrine failure requiring dietary enzyme supplements. Thus, this procedure, which should be readily translatable to humans through an endoscopic retrograde cholangiopancreatography (ERCP), may offer a potential innovative nonsurgical therapy for chronic pancreatitis that relieves pain and prevents the progression of pancreatic diabetes.
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Affiliation(s)
- Mohamed Saleh
- Division of Pediatric Surgery
- Division of Pediatric Endocrinology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Jami L. Saloman
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Department of Neurobiology, Pittsburgh Center for Pain Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ping Guo
- Department of Clinical Science, Colorado State University, Fort Collins, Colorado, USA
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Abstract
Pancreatic steatosis is an emerging clinical entity whose pathophysiology, natural history, and long-term complications are poorly characterized in the current literature. Epidemiological and prospective studies have described prevalence rates between 16% and 35%. Although the natural history is not well known, there are strong associations with obesity, metabolic syndrome, type 2 diabetes mellitus, and nonalcoholic fatty liver disease. Ectopic fat accumulation of the pancreas can cause chronic, low-grade inflammation from adipocytokine imbalances that involve beta cells and acinar cells. This mechanism can lead to pancreatic endocrine and exocrine dysfunction and initiate carcinogenesis. Although it is associated with morbid conditions, pancreatic steatosis may be amendable to treatment with a healthy diet, less meat consumption, exercise, and smoking cessation. Pancreatic steatosis should factor into clinical decision-making and prognostication of patients with pancreatic and systemic disease. This review seeks to describe the pathophysiology, natural history, diagnosis, and complications of this emerging clinically relevant entity.
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9
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Abstract
PURPOSE OF REVIEW Pancreatic steatosis is a clinical entity with emerging significance and impacts patient health in a multitude of ways. It has a high prevalence in the global population with predilections for different demographics by age, sex and ethnicity. Understanding the pathophysiology, clinical features and complications of this entity may be important to understanding the consequences of the ongoing obesity global epidemic. RECENT FINDINGS Obesity and metabolic syndrome contribute to metabolic derangements that result in lipid mishandling by adipocytes. Adipocytokine imbalances in circulation and in the pancreatic microenvironment cause chronic, low-grade inflammation. The resulting beta cell and acinar cell apoptosis leads to pancreatic endocrine and exocrine dysfunction. Furthermore, these adipocytokines regulate cell growth, differentiation, as well as angiogenesis and lymphatic spread. These consequences of adipocyte infiltration are thought to initiate carcinogenesis, leading to pancreatic intraepithelial neoplasia and pancreatic ductal adenocarcinoma. SUMMARY Obesity will lead to millions of deaths each year and pancreatic steatosis may be the key intermediate entity that leads to obesity-related complications. Enhancing our understanding may reveal strategies for preventing mortality and morbidity related to the global epidemic of obesity. Further research is needed to determine the pathophysiology, long-term complications and effective treatment strategies for this condition.
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10
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Matsuda Y. Age-related morphological changes in the pancreas and their association with pancreatic carcinogenesis. Pathol Int 2019; 69:450-462. [PMID: 31339204 DOI: 10.1111/pin.12837] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/26/2019] [Indexed: 12/14/2022]
Abstract
Age-related pathological changes in the pancreas have been unclear because they are often minor and nonspecific. However, recent studies have shown that they are closely related to various pathological conditions such as pancreatic cancer and diabetes mellitus. Knowledge of age-related changes is important to determine appropriate prevention, detection, and treatment strategies for various diseases observed in elderly patients. We present a review of the pathological age-related non-neoplastic changes in the exocrine pancreas such as pancreatic fatty replacement, lobulocentric pancreatic atrophy, pancreatic duct ectasia, and metaplasia of exocrine pancreas, as well as changes in islet cells. We have discussed common pancreatic neoplasms in elderly patients, such as pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasms (IPMNs), and pancreatic ductal adenocarcinoma (PDAC). Age-related pathological changes play a key role in pancreatic carcinogenesis via telomere dysfunction. Further studies are warranted to clarify molecular mechanisms of pancreatic carcinogenesis in elderly patients.
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Affiliation(s)
- Yoko Matsuda
- Department of Pathology and Host-Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
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11
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Abstract
Pancreatic masses consisting of lipomatous components clinically include lipoma, liposarcoma, lipomatous pseudohypertrophy of the pancreas, fat-containing neoplasms such as perivascular epithelioid cell tumor, and malignant neoplasm with lipoid degeneration. We present pancreatic lipomatous hamartoma, which has not been reported hitherto. A solid pancreatic mass was detected from a computed tomographic scan check-up in each of 3 cases of Japanese men. Macroscopically, well-demarcated solid lipomatous masses were detected at the uncus, body, and tail of the pancreas, respectively. Microscopically, the masses predominantly consisted of mature adipocytes with no atypia, but contained characteristics components of pancreatic hamartoma, such as small ducts, a well-preserved acinar structure, and/or fibrous stroma. On the basis of the unique features, lack of islets and absence of periductal elastic fibers, these tumors are a distinct variant of pancreatic hamartoma. Furthermore, high-mobility group AT-hook 2 expression in the fibro-adipocytes of this tumor indicated that these cells are an integral component of the pancreatic lipomatous hamartoma. Consequently, the unique tumors described herein are pancreatic lipomatous hamartoma, which must be discriminated from other lipomatous lesions of the pancreas.
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12
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Baleato-González S, Vieira Leite C, García-Figueiras R. The morphological and functional diagnosis of a rare entity: lipomatous pseudohypertrophy of the pancreas. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:207. [PMID: 29332406 DOI: 10.17235/reed.2018.5367/2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lipomatous pseudohypertrophy of the pancreas is a rare entity characterized by a replacement, focal or diffuse, of the normal pancreatic tissue by mature fatty tissue. Its definitive diagnosis is made based on histopathologic analysis. Nevertheless, typical imaging findings can allow a non-invasive diagnosis and help its clinical approach.
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Affiliation(s)
| | - Cecilia Vieira Leite
- Servicio de Radiología, Hospital Clínico Universitario Santiago de Compostela, españa
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13
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Fuchizaki U, Miyazawa M, Nakayama A. Vanishing Pancreas. Gastroenterology 2018; 155:280-281. [PMID: 29409874 DOI: 10.1053/j.gastro.2018.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 12/02/2022]
Affiliation(s)
| | - Masaki Miyazawa
- Department of Gastroenterology, Keiju Medical Center, Nanao, Japan
| | - Akira Nakayama
- Department of Gastroenterological Surgery, Keiju Medical Center, Nanao, Japan
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14
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Abstract
The pancreas is a complex organ that may give rise to large number of neoplasms and non-neoplastic lesions. This article focuses on benign neoplasms, such as serous neoplasms, and tumorlike (pseudotumoral) lesions that may be mistaken for neoplasm not only by clinicians and radiologists, but also by pathologists. The family of pancreatic pseudotumors, by a loosely defined conception of that term, includes a variety of lesions including heterotopia, hamartoma, and lipomatous pseudohypertrophy. Autoimmune pancreatitis and paraduodenal ("groove") pancreatitis may also lead to pseudotumor formation. Knowledge of these entities will help in making an accurate diagnosis.
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Affiliation(s)
- Olca Basturk
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Gokce Askan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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15
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Abstract
The metabolic consequences of visceral fat deposition are well known, and the presence of intrapancreatic fat (IPF) has been recognized for decades. However, our knowledge about the distribution of fat in the pancreas and its clinical implications is in a nascent stage. Various terms have been proposed to describe IPF; for the purpose of this narrative review, we chose the general term fatty pancreas. Herein, we describe the radiologic, endoscopic, and histopathologic aspects of diagnosing fatty pancreas and provide an overview of the diseases associated with this condition. Our purpose is to highlight diagnostic challenges and identify specific clinical questions that would benefit from further study. As evident in this review, IPF is associated with various metabolic diseases, pancreatitis, pancreatic cancer, and precancer-yet establishing causality needs careful, further study.
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16
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A case report on total pancreatic lipomatosis: An unusual entity. Int J Health Sci (Qassim) 2017; 11:71-73. [PMID: 29085272 PMCID: PMC5654180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Total pancreatic lipomatosis (PL) is an unusual entity of pathologic significance and speculative origin. It refers to complete replacement of pancreatic parenchyma by fat cells. Fat replacement may vary from mild fatty infiltration to massive replacement of the pancreas by adipose tissue, resulting in malabsorption syndrome due to pancreatic insufficiency. We present a case of a 60-year-old elderly woman with atypical abdominal complaints, diabetes mellitus, weight loss, and steatorrhea. Abdominal computed tomograms were diagnostic of PL. Magnetic resonance imaging verified this impression. The patient improved clinically after the 8-week trial of high-dose oral pancreatic enzyme replacement therapy. There is a marked reduction of steatorrhea and weight gain. This case report focuses on pathophysiology, diagnosis, and treatment guidelines of PL.
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17
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Abstract
Chronic pancreatitis is a debilitating condition often associated with severe abdominal pain and exocrine and endocrine dysfunction. The underlying cause is multifactorial and involves complex interaction of environmental, genetic, and/or other risk factors. The pathology is dependent on the underlying pathogenesis of the disease. This review describes the clinical, gross, and microscopic findings of the main subtypes of chronic pancreatitis: alcoholic chronic pancreatitis, obstructive chronic pancreatitis, paraduodenal ("groove") pancreatitis, pancreatic divisum, autoimmune pancreatitis, and genetic factors associated with chronic pancreatitis. As pancreatic ductal adenocarcinoma may be confused with chronic pancreatitis, the main distinguishing features between these 2 diseases are discussed.
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18
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Catanzaro R, Cuffari B, Italia A, Marotta F. Exploring the metabolic syndrome: Nonalcoholic fatty pancreas disease. World J Gastroenterol 2016; 22:7660-7675. [PMID: 27678349 PMCID: PMC5016366 DOI: 10.3748/wjg.v22.i34.7660] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/25/2016] [Accepted: 08/10/2016] [Indexed: 02/06/2023] Open
Abstract
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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Abstract
Pancreatic lipomatosis – also commonly called fat replacement – represents the most frequent benign pathologic condition of the adult pancreas. Most cases remain asymptomatic, and only some rare extreme degrees of lipomatosis or fat replacement may lead to exocrine pancreatic insufficiency. The precise etiology of the entity remains unclear, and the condition has been found associated with several diseases comprising diabetes mellitus, metabolic syndrome, acquired or hereditary pancreatitis, alcoholic hepatitis, cystic fibrosis and condition comprising increasing age, body mass index, or more precisely visceral fat index, and use of steroid therapy. Numerous cases are also associated with condition compromising the permeability of the pancreas ductal system, such as intraductal calculus, pancreatic tumors, and congenital or experimental stenosis. Uneven lipomatosis and fat replacement are also common presentations and responsible for the great diversity of imaging features. The reasons for uneven presentations are controversial and probably interweave embryologic or ductal hypotheses. Lipomatous pseudohypertrophy of the pancreas represents the most extreme situation of pancreatic lipomatosis and is considered, probably in a contestable way, as a rare, specific, and distinct entity. We hereby present an extensive pictorial review of the broad spectrum of imaging features of this entity. The images are extracted from a compilation of cases collected in our department over more than a decade. We review and discuss the embryologic and ductal hypothesis, the differential diagnosis. Finally, we illustrate some unusual presentations and evolutions.
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Dobromylskyj MJ, Dobromylskyj P. Selective fatty replacement of the exocrine pancreas in a domestic shorthair cat: histopathological findings with long-term outcome. JFMS Open Rep 2015; 1:2055116915593967. [PMID: 28491371 PMCID: PMC5362021 DOI: 10.1177/2055116915593967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2015] [Indexed: 12/25/2022] Open
Abstract
The clinical, histopathological findings and eventual outcome of a cat with marked and selective fatty replacement of the exocrine pancreas are described in this case report. A 9-year-old female neutered domestic shorthair cat presenting with polyphagia, weight loss and intermittent vomiting was diagnosed on histopathology with severe exocrine pancreatic atrophy, with relative sparing of the endocrine pancreas and replacement of the acinar cells by mature adipose tissue. This case report discusses the histological findings in this case and the eventual outcome, as well as the potential underlying causes of this histological change.
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Proksell S, Chennat J, Hashash JG. A rare cause of chronic diarrhea and weight loss. Clin Gastroenterol Hepatol 2014; 12:A21-2. [PMID: 24370556 DOI: 10.1016/j.cgh.2013.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/15/2013] [Accepted: 12/17/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Siobhan Proksell
- Department of Internal Medicine, University of Pittsburgh Medical Center, Montefiore Hospital, Pittsburgh, Pennsylvania
| | - Jennifer Chennat
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jana G Hashash
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract
Hereditary pancreatitis is an autosomal dominant disorder with 80% penetrance and variable expressivity. The vast majority of cases have been linked to mutations within the cationic trypsinogen gene, also referred to as serine protease 1 (PRSS1). Other than inheritance, PRSS1 pancreatitis has been considered clinically and pathologically indistinguishable from other etiologies of chronic pancreatitis. However, to date, the histologic findings of PRSS1 pancreatitis have not been well described. We, therefore, collected pancreatic specimens from 10 PRSS1 patients of various ages and examined their clinicopathologic features. Patients at the time of resection ranged in age from 9 to 66 years (median, 29 y), with a slight female predominance (60%). All patients reported a history of intermittent abdominal pain, with an age of onset ranging from infancy to 21 years of age. Examination of the gross and microscopic findings suggested a sequential pattern of changes with increasing patient age. In pediatric patients (n=4), although in most cases the pancreas was grossly normal, there was microscopic variation in lobular size and shape. Although the central portions of the pancreas displayed parenchymal loss accompanied by loose perilobular and interlobular fibrosis, the periphery was remarkable for replacement by mature adipose tissue. These changes were more developed in younger adults (n=2), in whom fatty replacement seemed to extend from the periphery to the central portions of the pancreas. With older patients (n=4), the pancreas showed marked atrophy and extensive replacement by mature adipose tissue with scattered islets of Langerhans and rare acinar epithelium concentrated near the main pancreatic duct. In summary, PRSS1 hereditary pancreatitis is characterized by progressive lipomatous atrophy of the pancreas.
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Adsay NV, Basturk O, Saka B, Bagci P, Ozdemir D, Balci S, Sarmiento JM, Kooby DA, Staley C, Maithel SK, Everett R, Cheng JD, Thirabanjasak D, Weaver DW. Whipple made simple for surgical pathologists: orientation, dissection, and sampling of pancreaticoduodenectomy specimens for a more practical and accurate evaluation of pancreatic, distal common bile duct, and ampullary tumors. Am J Surg Pathol 2014; 38:480-93. [PMID: 24451278 PMCID: PMC4051141 DOI: 10.1097/pas.0000000000000165] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pancreaticoduodenectomy (PD) specimens present a challenge for surgical pathologists because of the relative rarity of these specimens, combined with the anatomic complexity. Here, we describe our experience on the orientation, dissection, and sampling of PD specimens for a more practical and accurate evaluation of pancreatic, distal common bile duct (CBD), and ampullary tumors. For orientation of PDs, identification of the "trapezoid," created by the vascular bed at the center, the pancreatic neck margin on the left, and the uncinate margin on the right, is of outmost importance in finding all the pertinent margins of the specimen including the CBD, which is located at the upper right edge of this trapezoid. After orientation, all the margins can be sampled. We submit the uncinate margin entirely as a perpendicular inked margin because this adipose tissue-rich area often reveals subtle satellite carcinomas that are grossly invisible, and, with this approach, the number of R1 resections has doubled in our experience. Then, to ensure proper identification of all lymph nodes (LNs), we utilize the orange-peeling approach, in which the soft tissue surrounding the pancreatic head is shaved off in 7 arbitrarily defined regions, which also serve as shaved samples of the so-called "peripancreatic soft tissue" that defines pT3 in the current American Joint Committee on Cancer TNM. With this approach, our LN count increased from 6 to 14 and LN positivity rate from 50% to 73%. In addition, in 90% of pancreatic ductal adenocarcinomas there are grossly undetected microfoci of carcinoma. For determination of the primary site and the extent of the tumor, we believe bisectioning of the pancreatic head, instead of axial (transverse) slicing, is the most revealing approach. In addition, documentation of the findings in the duodenal surface of the ampulla is crucial for ampullary carcinomas and their recent site-specific categorization into 4 categories. Therefore, we probe both the CBD and the pancreatic duct from distal to the ampulla and cut the pancreatic head to the ampulla at a plane that goes through both ducts. Then, we sample the bisected pancreatic head depending on the findings of the case. For example, for proper staging of ampullary carcinomas, it is imperative to take the sections perpendicular to the duodenal serosa at the "groove" area, as ampullary carcinomas often extend to this region. Amputative (axial) sectioning of the ampulla, although good for documentation of the peri-Oddi spread of the intra-ampullary tumors, unfortunately disallows documentation of mucosal spread of the papilla of Vater tumors (those arising from the edge of the ampulla, where the ducts transition to duodenal mucosa and extending) into the neighboring duodenum. Axial sectioning also often fails to document tumor spread to the "groove" area. In conclusion, knowledge of the gross characteristics of the anatomic hallmarks is essential for proper dissection of PD specimens. The approach described above allows practical and accurate documentation and staging of pancreas, distal CBD, and ampullary cancers.
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Affiliation(s)
- N. Volkan Adsay
- Department of Pathology Emory University School of Medicine and Winship Cancer Institute Atlanta, GA
| | - Olca Basturk
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Burcu Saka
- Department of Pathology Emory University School of Medicine and Winship Cancer Institute Atlanta, GA
| | - Pelin Bagci
- Department of Pathology Emory University School of Medicine and Winship Cancer Institute Atlanta, GA
| | - Denizhan Ozdemir
- Department of Pathology Emory University School of Medicine and Winship Cancer Institute Atlanta, GA
| | - Serdar Balci
- Department of Pathology Emory University School of Medicine and Winship Cancer Institute Atlanta, GA
| | - Juan M. Sarmiento
- Department of General Surgery Emory University School of Medicine and Winship Cancer Institute Atlanta, GA
| | - David A. Kooby
- Department of Surgical Oncology, Emory University School of Medicine and Winship Cancer Institute Atlanta, GA
| | - Charles Staley
- Department of Surgical Oncology, Emory University School of Medicine and Winship Cancer Institute Atlanta, GA
| | - Shishir K. Maithel
- Department of Surgical Oncology, Emory University School of Medicine and Winship Cancer Institute Atlanta, GA
| | - Rhonda Everett
- Department of Pathology Emory University School of Medicine and Winship Cancer Institute Atlanta, GA
| | | | | | - Donald W. Weaver
- Department of General Surgery, Wayne State University and Karmanos Cancer Institute, Detroit, MI
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Masuda A, Tanaka H, Ikegawa T, Matsuda T, Shiomi H, Takenaka M, Matsuki N, Kakuyama S, Sugimoto M, Fujita T, Arisaka Y, Hayakumo T, Hara S, Azuma T, Kutsumi H. A case of lipomatous pseudohypertrophy of the pancreas diagnosed by EUS-FNA. Clin J Gastroenterol 2012; 5:282-6. [PMID: 26182394 DOI: 10.1007/s12328-012-0318-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Accepted: 06/06/2012] [Indexed: 12/17/2022]
Abstract
We report the case of a 56-year-old female with lipomatous hypertrophy of the pancreas. Abdominal CT and MRI showed fatty replacement over the entire pancreas. The pancreatic parenchyma was completely absent. ERCP showed no abnormal findings in the main pancreatic duct. EUS-FNA was performed to achieve a definitive diagnosis. Histological features of the FNA specimens revealed that adipose tissue generally replaced the pancreatic parenchyma, and pancreatic acini were identified with a scattered distribution. To consider the differential diagnosis of lipomatous pseudohypertrophy of the pancreas, it is necessary to distinguish it from obesity, diabetes, and age-related pancreatic fat infiltration and liposarcoma. By performing EUS-FNA, it was possible to obtain a definitive diagnosis in this patient. In conclusion, EUS-FNA may be helpful to make a definitive diagnosis in patients with lipomatous hypertrophy of the pancreas.
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Affiliation(s)
- Atsuhiro Masuda
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hiroshi Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takuya Ikegawa
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomokazu Matsuda
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hideyuki Shiomi
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Mamoru Takenaka
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Nobuyuki Matsuki
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Saori Kakuyama
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Maki Sugimoto
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tsuyoshi Fujita
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yoshifumi Arisaka
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takanobu Hayakumo
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shigeo Hara
- Division of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Azuma
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hiromu Kutsumi
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Abstract
More research is now focused on pancreatic steatosis. Multiple definitions, clinical associations and synonyms for pancreatic steatosis are described in the literature and can be confusing. The integration and comparison of several studies concerning this topic is therefore challenging. In the past, pancreatic steatosis was considered an innocuous condition, a bystander of many underlying diseases (such as congenital syndromes, hemochromatosis and viral infection). However, evidence that pancreatic steatosis (strongly associated with obesity and the metabolic syndrome) has a role in type 2 diabetes mellitus, pancreatic exocrine dysfunction, acute pancreatitis, pancreatic cancer and the formation of pancreatic fistula after pancreatic surgery is emerging. This Review focuses on the different etiological factors and the clinical consequences of pancreatic steatosis.
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Affiliation(s)
- Mark M Smits
- Department of Gastroenterology & Hepatology, Vrije Universiteit University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
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Shimada M, Shibahara K, Kitamura H, Demura Y, Hada M, Takehara A, Nozaki Z, Sasaki M, Konishi K, Maeda Y. Lipomatous Pseudohypertrophy of the Pancreas Taking the Form of Huge Massive Lesion of the Pancreatic Head. Case Rep Gastroenterol 2010; 4:457-464. [PMID: 21103205 PMCID: PMC2988859 DOI: 10.1159/000321989] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 70-year-old woman presented with hypogastric pain. Computed tomography and magnetic resonance imaging revealed a retroperitoneal tumor 18.0 cm in diameter with fatty tissue density, ventrally compressing the pancreatic head. We suspected a well-differentiated liposarcoma compressing the pancreas. At laparotomy, the tumor mass was the size of an infant's head; its center was located in the area corresponding to the pancreatic uncus. It was continuous with the pancreatic parenchyma through a poorly demarcated border, and we resected as much of the tumor mass as possible while conserving the pancreatic capsule. Histopathological examination indicated lipomatous pseudohypertrophy of the pancreas with proliferation of mature fatty tissue as the main constituent. At the periphery, islands of acinar tissue were retained among the fatty infiltration, which also contained branches of the pancreatic duct and islets of Langerhans. Previous reports have stated that this disorder only causes fatty replacements throughout the pancreas or in the pancreatic body and tail; however, in this patient, imaging and macroscopic examination revealed no fatty replacements in the pancreatic body and tail. We report this case, which we consider extremely rare, along with a brief review of the literature.
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