A Steatosic Pancreas in a Non-obese Patient

Excerpt

We recently observed a steatosic pancreas with a minimal parenchymal component during a pancreaticoduodenectomy in an 80-year-old patient (Fig. 1). The patient presented to the emergency room with jaundice and abdominal pain. The computed tomography examination showed the presence of common bile duct dilatation secondary to a 30-mm tumour located in the head of the pancreas. The past medical history showed the patient had received a triple coronary artery bypass and had arterial hypertension and hypercholesterolaemia. The patient’s body mass index was 24.5 kg/m². The pre-operative imaging studies showed a fatty pancreas with a “rarified” parenchymal component (Fig. 2) and no Wirsung duct dilatation. The parenchymal section inside the pancreatic capsule revealed a steatosic pancreas that had a fatty appearance and consistency. The Wirsung duct and pancreatic parenchyma were surrounded by adipose tissue, which was easily recognized by its different consistency and colour (Fig. 1). There was no post-operative pancreatic fistula observed. The pathological analysis showed a periampullary adenocarcinoma (pT3N1) with 10% pancreatic adiposity. The effects of pancreatic steatosis have been poorly investigated, and interest in this research area is increasing .1 The “fatty replacement” refers to a distinct phenomenon characterized by damage to acinar cells and replacement by adipose tissue. The histological characterization shows an increased number of adipocytes and not intracellular accumulation of triglycerides as in the liver. The risk factors for developing a fatty pancreas include the following: obesity, alcohol abuse, dyslipidaemia, hypertension, age, male gender, and hyperferritinaemia.

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