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Pancreatic lipomatosis

Pancreatic lipomatosis refers to fat accumulation in the pancreatic parenchyma. This finding is most often associated with obesity and aging. 

It tends to be the commonest pathological condition involving the pancreas. The condition may occasionally simulate a mass-like lesion particularly when fatty replacement is uneven 1

Many terms have been used in the literature to refer to similar conditions. Recognizing these differences, one nomenclature proposes that the general terms for pancreatic fat accumulation include pancreatic lipomatosis, fatty pancreas, and pancreatic steatosis 8,9. The most extreme variant is lipomatous pseudohypertrophy, characterized by pancreatic enlargement, but some consider this a distinct entity 8.

The entity can be divided by etiology 8:

  • fatty replacement: death of acinar cells with subsequent replacement with adipocytes
  • fatty infiltration or nonalcoholic fatty pancreas disease: pancreatic accumulation of adipocytes in association with obesity/metabolic syndrome
  • even pancreatic lipomatosis
  • uneven pancreatic lipomatosis 3,9
    • type 1a: preferential fatty replacement of the head, sparing the uncinate process and peribiliary region
    • type 1b: preferential fatty replacement of head, neck, and body, sparing the uncinate process and peribiliary region
    • type 2a: preferential fatty replacement of head, including uncinate process, and sparing the peribiliary region
    • type 2b: total fatty replacement of the pancreas except the peribiliary region

Several etiologies are well established 8:

Less established etiologies include the following 8:

Imaging differential considerations include:

Pancreatic pathology
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Article information

rID: 8600
Synonyms or Alternate Spellings:
  • Nonalcoholic fatty pancreas disease
  • Fatty infiltration of the pancreas
  • Fatty pancreas
  • Fatty infiltration of pancreas
  • Lipomatosis of pancreas
  • Lipomatosis of the pancreas
  • Fatty replacement of the pancreas
  • Pancreatic steatosis
  • Steatotic pancreas
  • Steatosis of the pancreas

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Cases and figures

  • Figure 1: causes of pancreatic lipomatosis
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  • Case 1: T2
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  • Case 1: T1 out-of-phase
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  • Case 1: T1 in-phase
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  • Case 2: T1 out-of-phase
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  • Case 2: T1 in-phase
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  • Case 3: total pancreatic lipomatosis in cystic fibrosis
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  • Case 4: presumably result of aging
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  • Case 5: Shwachman Diamond syndrome
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  • Case 6: pancreatic lipomatosis
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  • Case 7: in cystic fibrosis
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