Lipomatous pseudohypertrophy of the pancreas associated with chronic pulmonary suppuration in an adult

Siegler, David

doi:10.1136/pgmj.50.579.53

Cited by 43 publications

(21 citation statements)

References 9 publications

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“…2,4,6,7,9,10,14–16,26,27 Hoyer 16 discussed the possibility of a congenital anomaly, in view of the incidence in childhood, but thought that the condition was more probably acquired, due to injury of the pancreatic parenchyma by infective or toxic agents.…”

Section: Discussionmentioning

confidence: 99%

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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%

“…4,40 Yoshimura et al 10 and Sasaki et al 2 also reported that LPH might be related to chronic hepatitis B or other chronic advanced hepatic lesions that cause a fatty change and Mallory body formation. In fact, one of our patients had a fatty change in the right lobe of the liver, which was demonstrated by MRI.…”

Section: Discussionmentioning

confidence: 99%

Lipomatous Pseudohypertrophy of the Pancreas

Altinel¹,

Basturk²,

Sarmiento³

et al. 2010

Pancreas

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“…A literature search of Japana Centra Revuo Medicina and PubMed revealed only 27 other cases worldwide, including those in which the condition was diagnosed with imaging alone [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. Unlike steatosis resulting from obstruction of the pancreatic duct by pancreatolithiasis or a tumor, the causal factors of this disease are unknown.…”

Section: Discussionmentioning

confidence: 99%

Lipomatous Pseudohypertrophy of the Pancreas Taking the Form of Huge Massive Lesion of the Pancreatic Head

Shimada¹,

Shibahara²,

Kitamura³

et al. 2010

Case Rep Gastroenterol

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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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“…Pancreatic lipomatosis is also known as ''lipomatous pseudohypertrophy'' [4]. Lipomatous pseudohypertrophy is characterized macroscopically by enlargement of the pancreatic tissue and microscopically by replacement of the exocrine system by fat cells [5,6]. Besides, this situation is more common with conditions like obesity and diabetes mellitus.…”

Section: Introductionmentioning

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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Lipomatous pseudohypertrophy of the pancreas associated with chronic pulmonary suppuration in an adult

Cited by 43 publications

References 9 publications

Lipomatous Pseudohypertrophy of the Pancreas

Lipomatous Pseudohypertrophy of the Pancreas

Lipomatous Pseudohypertrophy of the Pancreas Taking the Form of Huge Massive Lesion of the Pancreatic Head

Fat replacement of the malignant pancreatic tissue after neoadjuvant therapy

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