Pancreatic steatosis and metabolic pancreatic disease: a new entity?

Abstract

Overweight and obesity are some of the most important health challenges. Many diseases are related to these metabolic disorders, and, among them, the pancreatic fat accumulation, also called "pancreatic steatosis" or "nonalcoholic fatty pancreas", seems to have an emerging role in different conditions. There are different method to evaluate the fat content in the pancreas, such as histology, different imaging techniques and endoscopic ultrasound, but there is no gold standard for the correct diagnosis and for the identification of "inter/intralobular" and "intra-acinar" pancreatic fat. However, the fat storage in the pancreas is linked to chronic inflammation and to several conditions, such as acute and chronic pancreatitis, type 2 diabetes mellitus and pancreatic cancer. In addition, pancreatic fat accumulation has also been demonstrated to play a role in surgical outcome after pancreatectomy, in particular for the development of postoperative pancreatic fistula. Different possible therapeutic approaches have been proposed, but there is still a lack of evidence. The aim of this review is to report the current evidence about the relationship between the obesity, the pancreatic fat accumulation and its potential role in pancreatic diseases.

Keywords: fatty pancreas; pancreati fat accumulation; pancreatic metabolic disease; pancreatic steatosis.

Fig. 1

Hepatic “intercellular” macrovesicular steatosis (haematoxylin–eosin [HE] staining, 10 × original magnification, personal unpublished picture)

Fig. 2

Hepatic “intracellular/microvesicular” steatosis: In this image, vacuolization of the cytoplasm of some hepatocytes is shown (haematoxylin–eosin [HE] staining, 10 × original magnification, personal unpublished picture)

Fig. 3

Pancreatic “intralobular” steatosis: This is a highly illustrative image showing the presence of marked adipose tissue infiltration into the pancreatic acinar parenchyma (haematoxylin–eosin [HE] staining, 10 × original magnification, personal unpublished data)

Fig. 4

Particular “intra-acinar” fat distribution in the pancreas (haematoxylin–eosin [HE] staining, 10 × original magnification, personal unpublished data)