The Prevalence of Non-Alcoholic Fatty Pancreas by Abdominal Ultrasonography

( Nyam Biziya ),( Bayarmaa Nyamaa ),( Bolormaa Purev ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Pancreatic steatosis or fatty pancreas refers to the fat accumulation in the pancreas, which can lead to inflammation and fibrosis, β-cell dysfunction, fibrosis, and, possibly, pancreatic cancer. The aim of this study was to investigate the prevalence and risk factors of fatty pancreas in patients referred to an ultrasonography center of Dornod Medical center. Methods: A cross-sectional study. During 12 months, 627 patients who were referred to our abdominal ultrasonography center for various reasons were evaluated for fatty pancreas. Fatty pancreas was defined as hyperechoic pancreas echotexture compared with spleen echotexture. All patients had gone through laboratory tests and abdominal ultrasonography. Results: The prevalence of fatty pancreas was 45.8%. The fatty pancreas patients had higher levels of aspartate aminotransferase, alanine aminotransferase, serum uric acid, fasting blood glucose, total cholesterol, triglycerides and low-density lipoprotein, and lower levels of high-density lipoprotein than did the non-fatty pancreas patients (all p < 0.05). Conclusions: Fatty pancreas is a common disorder. The prevalence of fatty pancreas in the examined population is approximately 45.8%. Increased age, central obesity and fatty liver disease are independent risk factors for fatty pancreas.

나선 CT에서 췌장 및 주변 혈관의 조영증강에 대한 정량적 연구

김형석 대한영상의학회 1997 대한영상의학회지 Vol.37 No.3

Purpose:To determine by quantitative evaluation of pancreatic and adjacent vascular enhancement during spiral CT, the ideal scan delay for examination of the pancreas. Materials and Methods:Dual(n-90) and triple(n=90) phase spiral CT scans of patients whose pancreas showed no pathologic condition were retrospectively evaluated. Dual-phase scans were performed at 43 seconds(early), and 5-6 minutes(delayed) after the injection of 120-140ml of contrast material at an injection rate of 2-4ml/sec, and ten patients also underwent precontrast scanning. CT attenuation values (HU) were measured in the head, body and tail of the pancreas, aorta, and main portal vein during each phase of all scans. Triple-phase protocol was used to measure the effect of different total volumes and injection rates on enhancement of the pancreas and adjacent vessels. Results:There was no significant difference in the degree of enhancement of the pancreas head, body and tail during each phase(p>0.05). The pancreas was maximally enhanced on 43 second delayed scan(132$\pm$20HU)(p<0.05), and the aorta, on 25-second delayed scan(207$\pm$44HU)(p<0.05). Different total volume of contrast material did not change the enhancement of the pancreas and adjacent vessels. At an injection rate of 2ml/sec, peak enhancement of the pancreas, aorta and portal vein was obtained on 60-65 second delayed scan, and at 4ml/sec, peak enhancement was obtained on 25 second delayed scan(p<0.05). Conclusion:Observing the usual protocols for abdominal spiral CT scanning, the pancreas was most effectively using a 43-second delayed scan. An increased injection rate resulted in earlier enhancement of the pancreas, aorta and portal vein.

원발성 췌장 T세포 림프종: 1예 보고

이경식,박길선,이승영,배일헌,김성진,한기석,차상훈,이옥준 대한영상의학회 2006 대한영상의학회지 Vol.55 No.3

Primary pancreatic lymphoma is a rare extranodal manifestation of any histopathologic subtype of non-Hodgkin's lymphoma that predominantly involves the pancreas, and it comprises less than 0.5% of all pancreatic malignancies. Histopathologically, most primary pancreatic lymphomas are the B-cell phenotypes, and Tcell lymphomas are extremely rare. We describe here the ultrasonography and computed tomography (CT) findings of a pathologically confirmed pancreatic T-cell lymphoma in a 37-year-old female patient. Ultrasonography showed diffuse pancreatic enlargement and a slightly bulging mass in the head and tail of pancreas that had markedly heterogeneous echogeneity. The lesion abutted onto the adjacent vessels, but there was no evidence of luminal narrowing or obstruction. The CT scan showed diffuse enlargement of the pancreas and the bulging contoured mass at the pancreatic head and tail with inhomogeneous enhancement, including multiple hypodense areas. It also showed the patent peripancreatic vessels and multiple LN enlargements around the pancreas. 원발성 췌장 림프종은 췌장 종양의 0.5% 이하에서 발생하는 드문 질환으로, 조직병리학적으로 대부분이 B 세포 비호치킨림프종이며, T 세포 림프종은 특히 빈도가 낮다. 저자들은 20일 전부터 발생한 황달을 주소로 내원하여 원발성 췌장 T 세포 림프종으로 확진된 37세 여자 환자의 초음파검사와 전산화단층촬영 소견을 기술하고자 한다. 초음파 검사에서 불균질한 에코의 미만성 췌장 비대가 있고, 두부와 미부에서는 돌출하는 양상의 종괴를 형성하고 있었다. 주변 혈관을 압박하는 부위도 있었지만 혈류는 유지되어 있었다. 전산화단층촬영에서는 췌장 내부에 다발성의 저밀도 부위를 포함하는 불균질한 조영증강이 있었고, 주변에는 림프절 비대가 있었다. 주변 혈관은 내강이 유지되어 있었고, 간내담관과 총수담관은 광범위한 확장이 있었으나 주췌관의 확장은 없었다.

문맥 윤상 췌장 2예

장지영 ( Ji Young Jang ),정용은 ( Young Eun Chung ),강창무 ( Chang Moo Kang ),최성훈 ( Sung Hoon Choi ),황호경 ( Ho Kyoung Hwang ),이우정 ( Woo Jung Lee ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.1

Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery. (Korean J Gastroenterol 2012;60:52-55)

증상을 동반한 거대 가성낭종을 형성한 이소성 췌장 1예

박성순 ( Sung Soon Park ),신윤미 ( Yoon Mi Shin ),임성우 ( Seong Woo Lim ),김석형 ( Seok Hyung Kim ),전원중 ( Won Joong Jeon ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ) 대한내과학회 2006 대한내과학회지 Vol.70 No.6

Heterotopic pancreas is the presence of pancreatic tissue that lacks anatomic and vascular continuity with the main body of the pancreas. Most patients with heterotopic pancreas are asymptomatic. Any pathologic change in the normal pancreas also can occur in heterotopic pancreas; namely, pancreatitis, cyst formation, hemorrhage, necrosis and neoplastic chang. But pancreatic pseudocyst formation is extremely rare in heterotopic pancreas. Recently, we experienced a case of gastric heterotopic pancreas in a 22-year-old women complicated by chronic pancreatitis with pseudocyst formation. She underwent a antrectomy with Billroth I reconstruction. Symptoms were relieved after operation. Microscopic findings were compatible with gastric heterotopic pancreas with pseudocyst formation. Herein, we report a case of symptomatic heterotopic pancreas with huge pseudocyst formation and the pertinent literatures were reviewed briefly.(Korean J Med 70:706-710, 2006)

췌장의 림프상피성 낭종

윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim),박용현(Yong Hyun Park),김용일(Yong Il Kim),김우호(Woo Ho Kim),김선희(Sun Whe Kim),김재규(Jae Gyu Kim),한준구(Joon Koo Han) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.4

Cystic lesions of the pancreas can be histologically classified into several distinct categories including pseudocyst, congenital true cyst, acquired true cyst, and cystic neoplasm. A lymphoepithelial cyst of the pancreas is a distinctive lesion characterized by the presence of mature, keratinizing squamous lining surrounded by lymphoid tissue and is reported mostly as a single case. We report the first case of a lymphoepithelial cyst of the pancreas proven histologically in Korea. A 60-year-old woman presented a pancreatic mass. Six months ago, a 5 to 10 mm multiple papular skin rash developed and was associated with fever and pruritus. Thereafter, jaundice, fatigue, and anorexia developed. These symptoms and signs resolved spontaneously 20 days later. At that time, ultrasonography of the abdomen demonstrated a 4.5 cm predominantly cystic mass arising from the body of the pancreas. Her past medical history indicated no alcohol intake, gallbladder disease or previous pancreatitis. On admission, physical examination of the abdomen was unremarkable. Serum amylase and the liver function test were also unremarkable. Serum CEA was 9.2 ng/mL. Computed tomography of the abdomen showed a 4.5 c cystic low attenuation mass in the body of the pancreas. Fine needle aspiration was performed. The CEA was 1252 ng/mL and amylase was 2840 U/dL. The cytologic examination revealed some degenerated epithelial cells and lymphocytes. At laparotomy, a smooth, encapsulated, well-circumscribed mass was found in the body of the pancreas. The mass did not invade the pancreas or other adjacent structures. The mass was completely excised. The specimen consisted of a 4 cm thin walled cyst filled with yellowish fluid. The lining was smooth and trabecular in part. Microscopically, the cyst was lined by a squamous epithelium and the epithelial lining was surrounded by lymphoid tissues with scattered germinal centers. (Korean J Gastroenterol 1997; 30:559-563)

흰쥐 췌장을 지배하는 운동 및 감각신경세포체의 표지부위

이창현,정순용,차영옥,정승호,송창호,이무삼 대한해부학회 1995 Anatomy & Cell Biology Vol.28 No.6

췌장의 림프상피성 낭종 1예

김재규,윤용범,김정룡,한준구,김선회,박용현,김우호,김용일 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.4

미소낭과 대낭성 변이가 혼합된 췌장의 장액성 낭선종: 1예 보고

조소희,나성은,변재영,조송미 대한영상의학회 2001 대한영상의학회지 Vol.45 No.1

췌장의 장액성 낭선종은 일반적으로 미소낭성 선종으로 알려져 있다 장액성 낭선종의 전형적인 소견은 2 cm 이하의 수많은 작은 미세소낭으로 구성되어 단면상 스폰지 모양을 보이는 분엽상의 종괴로. 특징적인 중심부 반흔이나 석회화를 흔히 동반하는 것으로 알려져 있다. 그러나 최근 장액성 낭선종의 비전형적인 유형으로 2 cm이상의 대낭성 (macrocystic) 장액성 낭선종이나 단방성 (unilocular) 장액성 낭선종 등의 변종이 보고되고 있다. 저자들은 2 cm이하의 수많은 미세소낭으로 이루어지고 중심부 석회화를 동반한 전형적 형태와 주변부 석회화를 동반하고 2 cm이상의 대낭으로 이루어진 변이 형태가 나란히 존재하여 하나의 장액성 낭선종를 형성한 증례 1 예를 경험하였기 에 병리 조직소견과 함께 CT 및 MR 영상소견을 보고한다. Serous cystadenomas of the pancreas are generally considered to be microcystic adenomas. Typical serous cystadenomas of the pancreas are encapsulated tumors composed of tiny cysts less than 2 cm in size showing sponge-like appearance with a central stellate scar or calcification on the cross-section. It has been recently reported, however, that serous cystadenomas may have macrocystic variants (major cysts more than 2 cm in sized that are radiologically indistinguishable from mucinous cystadenomas of the pancreas. We report the CT and MR imaging findings in a patient with mixed microcystic and macrocystic serous cystadenoma of the pancreas, indicating the histopathologic correlation. The mass was composed of two different types of cyst: multiple, small ( < 2 ctrl with central calcification; and large ( >2 cm) with peripheral calcification.

췌장의 고형 유두상 상피종의 방사선학적 소견 : 병리 소견과 비교

양익,임주원,고영태,임재훈,양달모,김은경,곽정호,Yang, Ik,Lim, Joo-Won,Ko, Young-Tae,Lim, Jae-Hoon,Yang, Dal-Mo,Kim, Eun-Kyung,Kwak, Jeong-Ho 대한영상의학회 1994 대한영상의학회지 Vol.30 No.1

목 적: 췌장의 고형유두상상피종에 대한 CT 및 초음파의 전형적인 소견들이 여러 문헌에 보고 되었으나 저자들의 경험한 바에 따르면 이들 전형적인 소견 이외에도 비전형적인 소견들이 있어 육안적 조직소견과 함께 비교하여 보고한다. 대상 및 방법: 1980년부터 1992년까지 12년간 수술로 확진된 췌장의 고형유두상상피종 14예를 대상으로 하였는데 남녀비는 1:13이었고 연령별로는 15세부터 49세까지로 평균 연령은 27세이며 CT에 13예, 초음파는 12예에서 시행하였다. 방법으로는 CT와 초음파에서 종괴의 위치, 크기, 밀도, 석회화, 중격등을 후향적으로 분석하여 수술 소견 및 육안적 병리조직과의 상호 관련성을 비교하였다. 결 과: 종괴의 위치는 두부 6예(43%), 미부 5예(36%), 체부 1예(7%) 그 외 두-체부,체-미부 각각 1예(7%)로 비교적 \ulcorner\ulcorner은 나이의 (평균 연령 27세) 여자(93%)였다. 전형적인 소견은 CT 및 초음파에서 주위 조직과 경계가 분명한 종괴로 고형성 종괴는 비교적 피막으로 잘 싸여진 과립상, 유두상 조직으로 보였고 낭성 종괴는 초코렛 색의 진흑같은 출혈성 괴사 조직이었다. 비전형적인 소견으로 종괴내의 석회화는 6예(43%), 중격은 4예(31%)볼 수 있었다. 석회화의 양상은 종괴의 주변부, 내부등에서 다양한 소견으로 보였다. 결 론 : 췌장의 고형유두상상피종의 전형적인 방사선학적, 병리학적 소견 외 종괴의 석회화, 중격등을 육안 병리 소견으로 확인하였는데 이런 비전형적인 방사선학적 소견의 이해는 췌장의 고형유두상상피종의 정확한 수술전 진단을 하는데 도움이 될 것이다. Purpose : Computed tomographic(CT). ultrasonographic(US) findings of soild and papillary epithelial neoplasm of the pancreas were correlated with pathologic findings for the better understanding of this disease entity. Materials and Methods : A retrospective review of CT and US of 14 cases of solid and papillary epithelial neoplasm of the pancreas was carried out in terms of the margin, internal architecture, calcification and septation, and this was correlated with gross pathologic findings.Results : CT and US findings were well defined round masses consisting of both solid and cystic components. Five cases were cystic, four cases were solid and five cases were mixed. Cystic portion of the tumor represented variable degree of hemorrhagic necrosis. Six cases contained foci of calcification , which were linear, marginal and amorphous. Marginal calcification interfered US examination of the mass in three cases. Internal septum was demonstrated in four cases on CT, one case on US and three cases on gross specimen.Conclusions : Our results indicate that calcification and internal septum were considered as a part of radiologic findings in solid and papillary epithelial neoplasm of the pancreas.