A case of localized pancreatitis with fat replacement in the distal pancreas treated with laparoscopic central pancreatectomy

Abstract

A 40-year-old woman visited our hospital for examination of a pancreas body mass. Abdominal ultrasonography showed a low echoic mass with relative clear margin and some tiny high echo spots. Contrast enhanced CT showed a mass 10 mm in diameter with minute calcifications and slight contrast enhancement in the pancreas body. The distal pancreas had-80 Hounsfield units of CT-value and some linear structures, suggesting fat replacement. Endoscopic ultrasonography showed a well demarcated low echoic mass 15 mm in diameter with a small high echoic spot in the pancreatic body. Under the preoperative diagnosis of low grade malignancy, laparoscopic central pancreatectomy was performed; however, gastrointestinal reconstruction for the pancreas tail was not performed. Histological examination of the pancreas body mass revealed localized fibrosis, infiltration of lymphocytes and calcification, indicating localized pancreatitis. Islet of Langerhans were found in the adipose tissue of the pancreas tail. Postoperative pancreatic exocrine and endocrine deterioration were not observed. The stenosis of the main pancreatic duct was thought to be the main cause of fat replacement, because circulatory disturbance was not found in the distal pancreas. © 2013 The Japanese Society of Gastroenterological Surgery.