M. T. Fohtung1, K. Sandrasegaran1, N. Zyromski1 1Indiana University School Of Medicine,General Surgery,Indianapolis, IN, USA
Introduction: Pancreatic lipomas are a rare and benign form of the mesenchymal neoplasms that make up 1%-2% of all pancreatic neoplasms. They are often diagnosed incidentally during radiographic imaging and treatment in the 69 reported cases in the literature has mostly been conservative although there is no consensus on the histopathologic significance of lipomas or whether surgical intervention is warranted. In this study, we describe 74 cases of intrapancreatic lipomas from a single institution over a 12-year period to elucidate the natural history including associated symptoms, the need for intervention and the potential for dedifferentiation to liposarcoma.
Methods: In the period from January 2001 to December 2013, we selected patients over the age of 18 diagnosed with pancreatic lipoma based on Ultrasound, CT scan and MR imaging. Clinical data was coupled with radiographic images and reviewed. Age at the time of diagnosis, gender, presenting symptoms, location of lipoma in pancreas, size on imaging, surgical intervention and pathological findings were evaluated.
Results: Pancreatic lipomas were identified in 74 patients including 41 women and 33 men aged 31-88 (median age 64). Most of the neoplasms were located in the head of the pancreas (n=32) followed by the body (n=16), tail (n=16), neck (n=6) and uncinate (n=6). The lipomas ranged in size from 0.1cm to 4.8cm. The majority of patients had no symptoms at presentation (n=36) while others had abdominal pain (n=26), dysphagia (n=1), jaundice (n=1), pelvic pain (n=1), chest pain (n=2), nausea/vomiting (n=2), dyspnea (n=1), constipation (n=1). One lipoma was pathologically confirmed and no patients underwent surgical resection.
Conclusion: Pancreatic lipomas are rare benign mesenchymal neoplasms with increasing incidence as the use of radiographic imaging continues to expand. Most reported cases are managed conservatively with follow-up imaging especially when the lipoma has well defined margins and causes no obstruction to the pancreatic duct or common bile duct. Given the lack of consensus, questions remain about the histopathological significance concerning dedifferentiation to liposarcoma and whether surgical resection should then be considered as an intervention. This large single center study will help shed more light on these questions.