Lipoma of the Pancreas Diagnosed by EUS-FNA

Kosuke Minaga^1,2*, Yukitaka Yamashita¹ and Yoshito Uenoyama¹

¹Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan

²Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, Osaka-sayama, Japan

*Corresponding Author:

Kosuke Minaga
Department of Gastroenterology and Hepatology
Kinki University Faculty of Medicine, Osaka-sayama
377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan
Tel: +81-72-3660221
Fax: +81-72-3672880
E-mail: kousukeminaga@med.kindai.ac.jp

Received date: May 14, 2015; Accepted date: May 15, 2015; Published date: May 21, 2015

Citation: Minaga K, Yamashita Y, Uenoyama Y (2015) Lipoma of the Pancreas Diagnosed by EUS-FNA. J Gastrointest Dig Syst 5:i105. doi: 10.4172/2161-069X.1000i105

Copyright: © 2015 Minaga K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Keywords

Lipoma of the pancreas; Endoscopic ultrasound-guided fine-needle aspiration; Pancreatic mesenchymal tumor

Clinical Image

Pancreatic mesenchymal tumors are infrequent and account for approximately 1-2 % of all pancreatic tumors [1]. Lipoma of the pancreas is a particularly rare condition, and only 50 cases have been described since the first case report by Bigard et al. in 1989 [2]. Recently, endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) has gained wide acceptance as a safe and well established examination technique for the diagnosis of pancreatic masses. However, only three cases of pancreatic lipoma diagnosed by EUSFNA have been described to date in the literature [3-5]. Herein, we report a case of pancreatic tail lipoma diagnosed by EUS-FNA. A 72- year-old man with an incidental pancreatic mass that was detected by computed tomography (CT) was referred to our hospital.

The CT scan demonstrated a well-bordered, homogenous mass of fatty density with no contrast enhancement at the pancreatic tail (Figure 1a). On magnetic resonance imaging, the lesion had highintensity signals on both T1-weighted and T2-weighted axial sequences. Subsequently, EUS was performed to clarify the etiology of the mass using a curved linear array echoendoscope (GF-UCT260; Olympus, Tokyo, Japan). EUS revealed a 25 × 14-mm hypoechoic mass with hyperechoic strands within, and the mass was surrounded by pancreatic parenchyma (Figure 1b).

Figure 1: (a) Contrast-enhanced CT showing a 25 mm, wellbordered, homogenous mass of fatty density with no contrast enhancement at the pancreatic tail (arrow). (b) EUS image showing a 25 × 14-mm hypoechoic mass with hyperechoic strands within, and the mass was surrounded by pancreatic parenchyma.

To exclude malignant tumors such as liposarcoma and lipoblastoma, we performed EUS-FNA by a transgastric approach using a 22-G needle (Expect; Boston Scientific Corporation, Natick, MA, USA). Two passes were made with suction with no postprocedural complications.

Microscopic examination of the EUS-FNA material showed mature adipose cells characterized by a large fat droplet with no atypia, and no malignant cells were identified (Figure 2a and 2b). Thus, we confirmed the diagnosis of a pancreatic lipoma. The patient was conservatively followed up without surgical resection. Follow-up CT, conducted 1 year later, showed no apparent change in size or characteristics of the lesion.

Figure 2: Histopathological examination from EUS-FNA showing mature adipose cells characterized by a large fat droplet with no atypia. (a) Papanicolaou’s staining, ×200, (b) hematoxylin and eosin staining, ×200.

References

1. Raut CP, Fernandez-del Castillo C (2003) Giant lipoma of the pancreas: case report and review of lipomatous lesions of the pancreas. Pancreas 26: 97-99.
2. Bigard MA, Boissel P, Regent D, Froment N (1989) Intrapancreatic lipoma. First case in the literature. Gastroenterol Clin Biol 13: 505-507.
3. Di Matteo FM, Shimpi L, Pandolfi M, Rabitti C, Fabio C, et al. (2006) EUS diagnosis of pancreatic lipoma: a case report. Gastrointest Endosc 64: 146-148.
4. Suzuki R, Irisawa A, Hikichi T, Shibukawa G, Takagi T, et al. (2009) Pancreatic lipoma diagnosed using EUS-FNA. A case report. JOP 10: 200-203.
5. Pausawasdi N, Apisarnthanarak P, Pongpaibul A, Charatcharoenwitthaya P (2012) Pancreatic lipoma diagnosed by EUS-FNA. Gastrointest Endosc 76: 668-669.