Lipoma of the pancreas, a case report and a review of the literature

Lipomas of the pancreas are very rare.There are fewer than 25 reported cases of lipoma originating from the pancreas.We present a case of pancreatic lipoma in a 61-year-old woman with magnetic resonance imaging findings and confirmatory histological findings.We discuss and highlight the radiological features distinguishing a pancreatic lipoma from other fatty lesions of the pancreas and pancreatic liposarcoma and provide a brief review of the literature.     

白血病胰腺浸润的影像学表现

目的:探讨白血病胰腺浸润的影像特征,为临床治疗提供参考信息。方法:回顾性分析经临床及病理证实的7例白血病胰腺浸润患者的CT和MRI表现,7例患者中4例行MRI平扫及增强扫描,1例行MRI平扫,2例行CT平扫及增强扫描。结果:5例累及胰头部,2例同时累及胰头和胰尾部。6例表现为肿块型,1例同时表现为弥漫型和肿块型;肿块型表现为类圆形、不规则状肿块;弥漫型表现为受累部位肿胀,与胰腺轮廓一样;2例肿块型伴远侧胰管扩张。2例CT上表现为等密度;5例MRI上表现为T₁WI呈等信号,T₂WI呈等或稍低信号,DWI呈高信号。6例增强扫描均表现为乏血供,强化程度明显低于胰腺。结论:白血病胰腺浸润的CT和MRI表现具有一定特征性,正确认识并诊断对临床治疗有重要作用。     

磁共振成像对胰腺脂肪沉积的定量研究进展

胰腺脂肪沉积是指胰腺腺泡或胰岛细胞中三酰甘油累积,或胰腺实质被脂肪组织替代。大多数胰腺脂肪沉积是生理性的,有些与胰腺疾病相关,近年来许多研究发现胰腺脂肪沉积还与代谢综合征的发生、发展有关,因此对胰腺脂肪沉积早期诊断和干预可为相关疾病的治疗提供思路。磁共振成像可以对胰腺脂肪沉积进行定量分析,并且具有高度准确性。就其相关研究进展予以综述。     

影像技术在胰腺脂肪浸润与2型糖尿病相关性研究中的应用进展

胰腺脂肪浸润与2型糖尿病(T2DM)的发病有相关性,通过测量胰腺的脂肪含量可以评估胰腺的脂肪浸润情况,对T2DM的预防、早期诊断有非常重要的临床意义。相对于组织病理学活检技术,通过影像学方法测量胰腺脂肪含量具有安全、简单、可重复性高等优点。就基于超声、CT及多种MRI脂肪定量技术在胰腺脂肪浸润与T2DM相关性分析中的研究进展予以综述。     

Schwachman-Diamond syndrome. A case report

Schwachman-Diamond syndrome is an autosomal recessive disorder consisting of exocrine pancreatic insufficiency and neutropenia. The typical pathological finding with this syndrome is fatty infiltration in the pancreas of patients. We report a case of Scwachman-Diamond syndrome examined with abdominal ultrasonography, CT and radiography.     

Fat containing unusual tumor of the pancreas

Fat-containing pancreatic tumors are very rare. In the literature, less than ten cases of lipoma originating from the pancreas have been reported. We present a case of pancreatic lipoma in a 65-year-old woman with findings of ultrasonography, computed tomography, and magnetic resonance imaging in addition to a brief review of the literature.     

Case report. Uterine lipoma: advantage of MRI over ultrasound

Pure fatty tumours of the uterus are exceedingly rare. A case of uterine lipoma demonstrated on ultrasound and MRI with pathological correlation is described. Ultrasound suggested the presence of a uterine lipoma but MRI permitted an unequivocal diagnosis. The usefulness of the various imaging methods is discussed in correctly diagnosing this entity and avoiding unnecessary surgery in the asymptomatic patient.     

Focal fatty replacement of the pancreas: usefulness of chemical shift MRI

OBJECTIVE: The purpose of this study was to describe the typical CT and chemical shift MRI findings and to evaluate their usefulness in the diagnosis of focal fatty replacement of the pancreas in five patients. CONCLUSION: The presence of a perceptible focal low-attenuation lesion in the pancreas on CT and the reduction in signal intensity of the lesion on the opposed phase of chemical shift MR images are useful for differentiating focal fatty replacement of the pancreas from true pancreatic neoplasm. Therefore, these imaging findings obviate invasive diagnostic procedures and surgery in the care of patients with focal fatty replacement of the pancreas.     

Lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses

OBJECTIVE: Our objectives were to evaluate the reliability of MRI in distinguishing simple lipomas, lipoma variants, and well-differentiated liposarcomas (atypical lipomas) and to identify various imaging mimics of well-differentiated liposarcoma. MATERIALS AND METHODS: One hundred twenty-six consecutively imaged grossly fatty masses were retrospectively reviewed. MRI examinations, their prospective interpretations, and their corresponding pathology reports were compared to determine the reliability of MRI in distinguishing simple lipomas, lipoma variants, and well-differentiated liposarcomas. RESULTS: The success of MRI in identifying well-differentiated liposarcomas among other fatty masses was as follows: sensitivity, 100%; specificity, 83%; accuracy, 84%; positive predictive value, 38%; and negative predictive value, 100%. MRI was 100% specific in the diagnosis of simple lipoma. Sixty-three percent of lesions considered suspicious for well-differentiated liposarcoma were actually simple lipomas (13%) and benign lipoma variants (50%), including chondroid lipoma (13%), osteolipoma (6%), hibernoma (6%), lipoleiomyoma (6%), angiolipoma (6%), and infarcted lipoma (13%). CONCLUSION: Because of differences in treatment, prognosis, and long-term follow-up, it is important to preoperatively distinguish simple lipomas from well-differentiated liposarcomas. MRI is highly sensitive in the detection of well-differentiated liposarcomas and highly specific in the diagnosis of simple lipomas. However, when an extremity or body wall lesion is considered suspicious for well-differentiated liposarcoma, it is more likely (64%) to represent one of many benign lipoma variants.     

Age-related changes in normal adult pancreas: MR imaging evaluation

Objective

To investigate age-related changes in normal adult pancreas as identified by magnetic resonance imaging (MRI).

Materials and methods

We examined 115 patients without pancreatic diseases (21–90 years) who underwent upper abdominal MRI to evaluate the normal pancreatic MRI findings related to aging. The parameters examined were the pancreatic anteroposterior (AP) diameter, pancreatic lobulation, pancreatic signal intensity (SI), depiction of the main pancreatic duct (MPD), grade of the visual SI decrease on the opposed-phase T1-weighted images compared with in-phase images, and enhancement effect of the pancreas in the arterial phase of dynamic imaging.

Results

The pancreatic AP diameter significantly reduced (head, p = 0.0172; body, p = 0.0007; tail, p < 0.0001), and lobulation (p < 0.0001) and parenchymal fatty change (p < 0.0001) became more evident with aging. No significant correlation was observed between aging and pancreatic SI, however the SI on the in-phase T1-weighted images tended to decrease with aging. No significant correlation was observed between aging and the depiction of the MPD as well as aging and contrast enhancement.

Conclusion

MRI findings of pancreatic atrophy, lobulation, and fatty degeneration are characteristic changes related to aging, and it is necessary to recognize these changes in the interpretation of abdominal MRI in patients with and without pancreatic disease.     

肩关节周围浸润性脂肪瘤的磁共振诊断

目的探索浸润性脂肪瘤的磁共振特征。方法收集病理证实的肌肉内脂肪瘤患者8例,观察肿物磁共振图像的形状、大小、边界、信号特点。结果病变呈梭形,均位于横纹肌内,长径与肌纤维走形一致。8例肿物边界清晰或有包膜,3例内部信号不均匀。其余均呈短T1、长T2高信号影,脂肪抑制像上呈低信号影。结论浸润性脂肪瘤表现呈多样,多数为均匀一致高信号影,磁共振成像基于脂肪成像的特点,检查有助于此病的诊断。     

Pitfalls in ultrasonographic diagnosis with fatty infiltration of the liver

Problems in ultrasonography in patients with fatty infiltration of the liver include the possible misinterpretation of small, solid, focal lesions within the liver as being cystic; attributing the relative sonolucency of the pancreas to pancreatitis in the absence of pancreatic disease; and an inability to display normal right renal anatomy using the liver as a "window." Recognition of these problems and careful attention to equipment settings and scanning techniques should prevent errors.     

Pancreas bifidum: an extremely rare cause of acute pancreatitis

A wide spectrum of anomalies of the pancreas, the pancreatic ductal system and the biliary tree are commonly encountered at radiologic evaluation. Pancreas bifidum, also known as bifid pancreas or fish-tail pancreas, is an extremely rare congenital branching anomaly of the main pancreatic duct characterized by its duplication. These 2 separate ducts are laid from the pancreatic tail to neck and they generally join at the pancreas body-tail draining via the major papilla; the pancreatic parenchyma is also bifurcated with separated dorsal and caudal buds. The clinical impact of this condition is not well established: although some authors sustained that probably does not cause or contribute to abdominal pain or overt pancreatic diseases, others argued that could be considered as a possible cause of acute pancreatitis.We herewith describe the case of a 51-year-old woman presenting to our hospital with epigastric pain, nausea, and vomiting. Biochemical tests were suspicious for acute pancreatitis. Ultrasound examination was negative. MRI, including MR cholangiopancreatography revealed bifid pancreas characterized by duplication of the main pancreatic duct with 2 separate ducts that join at the pancreas head and draining via the minor papilla. On T2-weighted images the ventral bud of the pancreas was enlarged and characterized by slightly hyperintensity without peripancreatic fluid collections. The MRI findings were consistent with acute pancreatitis limited to the ventral bud of a bifid pancreas. Patient was treated with intravenous fluid resuscitation, pain control and institution of early enteral nutrition and discharged on the seventh day after admission.     

自身免疫性胰腺炎的MRI诊断

目的:探讨自身免疫性胰腺炎(AIP)的MRI诊断价值。方法:搜集12例临床证实的AIP患者资料,12例均行MRI平扫、增强扫描及磁共振胰胆管水成像(MRCP),分析总结AIP的MRI表现特点。结果:12例AIP中7例表现为弥漫性胰腺体积增大,1例表现为胰腺体尾部肿大,MRI平扫胰腺信号欠均匀,T1WI呈高低混杂信号,T2WI信号普遍增高,另4例以胰头肿大为主,MRI示胰头区类似软组织信号肿块影,与周围胰腺组织信号一致;病灶增强扫描动脉期强化不明显,门脉期逐渐强化;MRCP示胆总管胰腺段变细,伴肝内外胆管不同程度扩张,胰腺管弥漫性狭窄。结论:AIP的MRI表现具有一定特异性,对AIP的临床诊断及治疗有一定指导意义。     

Magnetic resonance tomographic findings in spinal lipomas

The diagnosis of spinal lipoma was confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) in six patients. MRI was superior to CT and myelography in detection of a tethered cord in combination with a lipoma. Fatty tissue, especially in the extradural intraspinal compartment, is not necessarily a pathologic finding. The etiology of spinal lipomas remains obscure. The seemingly idiosyncratic genesis of fatty tissue is discussed with reference to one of the patients in this series.     

Computed tomography and histologic appearance of pancreatic metastases from distant sources

The computed tomographic and histologic appearances in 34 cases of autopsy-confirmed metastatic tumors of the pancreas including secondary malignant lymphoma are discussed. In 18 (53.8%) the pancreas appeared abnormal on computed tomography, the lesions being classified into three types: In 8 cases there was diffuse enlargement of the pancreas; in 9 cases a localized mass; and one patient had multiple low attenuated nodules within the organ. Histologic investigation revealed that metastatic carcinoma involved the pancreatic lobules. The degree of infiltration in the interlobular connective tissue was related to the invasiveness of the tumors. In the majority of cases with diffuse infiltration the pancreatic lobules were destroyed and varying degrees of proliferation of malignant cells into the interlobular septa were documented. In patients with localized infiltration there was extensive invasion of the carcinoma within the pancreatic lobule. Dilatation of the pancreatic duct and/or organ-related symptoms were occasionally seen in these cases.     

胰腺脂肪浸润的CT诊断及临床相关性分析

目的:探讨胰腺脂肪浸润的CT诊断价值以及与高血糖、2型糖尿病、高血脂、脂肪肝以及高血压的相关性分析。方法:总结50例胰腺脂肪浸润患者的血糖、血脂值及脂肪肝、高血压的发生情况,设立对照组并与之对比分析。结果:50例胰腺脂肪浸润患者,患者的血糖升高37例、确诊2型糖尿病(T2DM)32例,血脂升高48例,高血压42例、脂肪肝50例。与对照组差别显著(P0.001)。结论:CT能够准确诊断胰腺和肝脏脂肪浸润;胰腺脂肪浸润与高血糖、2型糖尿病、高血压、高血脂、脂肪肝存在高度相关;研究结果能为该类患者临床诊断与治疗提供可靠的依据。     

胰腺疾病的MRI诊断

随着MBI成像技术的迅速发展和MBI的广泛应用，利用MBI诊断胰腺疾病正引起人们的普遍关注。现代MRI技术包括屏气T1加权成像及其脂肪抑制、T2加权成像及其脂肪抑制、MBI动态增强扫描、MR胰胆管成像和MR血管成像。这些脉冲序列各自有不同的组织对比机制，而且是互相补充的，它们的综合应用，可以较全面地评价胰腺及胰腺病变，从而明显改善了MBI对胰腺疾病的检测和诊断。本文着重介绍胰腺的MR成像技术，正常解剖、先天性异常和常见疾病的NR诊断价值。     

MRI of pancreatic neuroendocrine tumours.

Neuroendocrine tumours of the pancreas are rare and are frequently difficult to demonstrate. Several imaging modalities have been used to demonstrate these tumours, but recent reports have suggested that MRI may have an important role in their localization. We review the spectrum of MRI appearances of pancreatic neuroendocrine tumours.     

Cystic fibrosis in adolescents and adults: fatty replacement of the pancreas--CT evaluation and functional correlation

PURPOSE: To compare the computed tomographic (CT) features of pancreatic fatty replacement in adolescents and adults with cystic fibrosis (CF) with those in control subjects and to correlate the degree of fatty replacement with the functional status of the pancreas. MATERIALS AND METHODS: CT scans in 15 patients with CF (group 1) and in 15 control subjects without CF (group 2) were evaluated for thickness and degree of pancreatic fatty replacement. Thickness was measured at four anatomic levels. The pattern of pancreatic fatty replacement was visually evaluated in four pancreatic regions. Images were semiquantitatively analyzed by two readers. The degree of fatty replacement was correlated with the functional status of the pancreas. RESULTS: In group 1, pancreatic glandular tissue was significantly thinner (P < .001) and the degree of fatty replacement was significantly greater in the four regions (P < .001) than those in group 2. In Group 1, no relationship was found between the degree of pancreatic fatty replacement and that of pancreatic endocrine dysfunction. A significant relationship was found between the degree of fatty replacement and that of pancreatic exocrine dysfunction (P < .001). CONCLUSION: In patients with CF, pancreatic glandular tissue is significantly reduced in size. Pancreatic fatty replacement is the most frequent pattern in older patients with CF and correlates with pancreatic exocrine dysfunction.