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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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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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Paul J, Shihaz AVH. PANCREATIC STEATOSIS: A NEW DIAGNOSIS AND THERAPEUTIC CHALLENGE IN GASTROENTEROLOGY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:216-220. [PMID: 32490903 DOI: 10.1590/s0004-2803.202000000-27] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/20/2020] [Indexed: 02/08/2023]
Abstract
Fat infiltration in the pancreas is called pancreatic steatosis and it has several synonyms such as pancreatic lipomatosis, non-alcoholic fatty pancreatic disease, lipomatous pseudohypertrophy, fatty replacement, fatty pancreas and fatty infiltration. Pancreatic steatosis describes a disease ranging from infiltration of fat in the pancreas to pancreatic inflammation, and development of pancreatic fibrosis. There are multiple aetiologies of this condition, such as metabolic syndrome, alcohol intake, viral infections, toxins, congenital syndromes, etc. Pancreatic steatosis is usually diagnosed by trans-abdominal ultrasound, computed tomography scan and magnetic resonance imaging. Fatty infiltration in pancreas may lead to pancreatitis, diabetes mellitus and may be a predisposing cause of pancreatic cancer. Now a day, pancreatic steatosis is a common incidental finding during abdominal ultrasonography for other reasons and is a new challenge in Gastroenterology. But there is no guideline for pancreatic steatosis till now. In this review article, we are trying to give an overall idea (aetiologies, diagnosis, management, clinical significances) on pancreatic steatosis.
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Affiliation(s)
- Jayanta Paul
- Desun Hospital and Heart Institute, Department of Gastroenterology, Kolkata, India
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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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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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