Pancreatic steatosis and its correlation with clinicopathological features in patients with pancreatic neuroendocrine neoplasms

Background and objective:The incidence of pancreatic neuroendocrine neoplasms(pNENs)has been increasing year by year,and pancreatic steatosis has been paid more and more attention to by clinicians.Our study aims to reveal the correlation between pancreatic steatosis,clinicopathological parameters,and the prognosis of patients with pNENs.Methods:The clinicopathological data of patients with pNENs who underwent surgical resections in our institution from January 2013 to May 2022 were retrospectively analyzed.The mean computed tomography(CT)values of the pancreas and spleen were used to assess the severity of the pancreatic steatosis.Pearson Chi-square test,T test,Mann Whitney U test,Univariate Cox re-gression,and Multivariate Cox regression were used to explore the relationship between pancreatic steatosis and age,sex,body mass index,tumor type,tumor location,tumor stage,blood lipid,prognosis,and other factors.Results:A total of 122 patients were included in our study,and 19.67%have pancreatic steatosis.The incidence of pancreatic steatosis was significantly higher in patients with fatty liver than in patients without fatty liver(36.8%vs 16.5%,P=.04).In insu-linoma,the incidence of pancreatic steatosis in elderly patients was significantly higher than in young and middle-aged patients(41.7%vs 9.3%,P=.025).There was no significant difference in lipid levels between the pancreatic steatosis group and the non-pancreatic steatosis group(P>.05).Kaplan-Meier curves show that the prognosis of stage III/IV patients was significantly worse than that of stage I/II patients(P<.001).However,there was no significant difference in prognosis between patients with and without pancreatic steatosis(P=.404).Conclusion:The incidence of pancreatic steatosis was significantly higher in those with fatty liver than those without fatty liver.There is a high incidence of pancreatic steatosis in elderly patients with insulinoma.American Joint Committee on Cancer(AJCC)stage,but not pancreatic steatosis,significantly affected the prognosis of patients with pNENs.

Enlarged pancreas: not always a cancer

Pancreatic fat accumulation has been described with various terms including pancreatic lipomatosis, pancreatic steatosis, fatty replacement, fatty infiltration, fatty pancreas, lipomatous pseudohypertrophy and nonalcoholic fatty pancreas disease. It has been reported to be associated with type 2 diabetes mellitus, acute pancreatitis, pancreatic cancer and the formation of pancreatic fistula. The real incidence of this condition is still unknown. We report a case of pancreatic steatosis in a non-obese female patient initially diagnosed with a mass in the head of the pancreas. Magnetic resonance imaging（MRI） was carried out to define the characteristics of the pancreatic mass. MRI confirmed the diagnosis of fat pancreas. Enlarged pancreas is not always a cancer, but pancreatic steatosis is characterized by pancreatic enlargement. MRI could give a definite diagnosis of pancreatic steatosis or cancer.

Nonalcoholic fatty pancreas disease:An emerging clinical challenge

Nonalcoholic fatty pancreas disease(NAFPD)is an emerging disease that has gained an increasing amount of attention in recent years.It describes fat accumulation in the pancreas with insignificant alcohol consumption,but the pathogenesis is largely unknown.A wide range of terms have been used to describe the phenomenon of pancreatic fat accumulation,but NAFPD remains an under-recognized and non-independent disorder.Obesity,age,sex,race,and unhealthy lifestyle are established independent risk factors for NAFPD,which is strongly associated with metabolic syndrome,type 2 diabetes,pancreatitis,pancreatic fistula,pancreatic cancer,and nonalcoholic fatty liver disease.At present,imaging techniques are common diagnostic aids,but uniform criteria and consensus are lacking.Therapeutically,healthy diet,weight loss,and exercise are the mainstays to reduce pancreatic fat accumulation.It can be seen that there is a limited understanding of NAFPD at this stage and further exploration is needed.Previous studies have revealed that NAFPD may directly affect diagnosis and clinical decision-making.Therefore,exploring the pathophysiological mechanism and clinical associations of NAFPD is a major challenge for researchers and clinicians.