675 JOP. Journal of the Pancreas - http://pancreas.imedpub.com/ - Vol. 17 No. 6 – Nov 2016. [ISSN 1590-8577] CASE REPORT JOP. J Pancreas (Online) 2016 Nov 08; 17(6):675-678. ABSTRACT Lipoma is a benign tumour of mature fat cells/adipocytes which are of mesenchymal origin. It can occur in any part of the gastrointestinal tract but is rarely encountered in the pancreas. Pancreatic lipomas are usually asymptomatic until their size exceeds beyond 2 cm or are found in the head of the pancreas and cause compression / obstruction of the ampulla. Lipomas exceeding 2 cm may ulcerate and can cause anaemia. Histopathological confirmation is rare because surgical intervention is not needed in most cases. Homogeneous lipoid attenuation on computerized tomography distinguishes it from well differentiated liposarcoma. Endoscopic Ultrasound guided fine needle aspiration cytology has been suggested to confirm the diagnosis. Surgical intervention is indicated if the pancreatic lipoma is symptomatic or difficult to distinguish it from liposarcoma non-invasively. We hereby present our experience with one such case of a 50-year-old female who approached our surgical clinic for occasional pain in right upper abdomen with other upper gastrointestinal symptoms. Received May 23rd, 2016 - Accepted August 04th, 2016 Keywords Pancreatic Neoplasms Abbreviations CECT contrast enhanced computerized tomography; EUS endoscopic ultrasound; FNCA fine needle aspiration cytology; MRCP magnetic resonance cholangiopancreatography; MRI magnetic resonance imaging Correspondence Ajaz A Wani Department of General Surgery Hamdard Institute of Medical Sciences and Research Centre and Hakeem, Abdul Hameed Centenary Hospital, Hamdard Nagar New Delhi, 110062 Tel +91-9810635864 E-mail cajaz11@yahoo.co.in Pancreatic Lipoma - A Case Report with Review of Literature Mir Najib Ahmad, Musharraf Husain, Ajaz Ahmed Wani, Raja Nadeem, Prakhar Gupta, Shahbaz Alam, Mohammad Imran Department of General Surgery, Hamdard Institute of Medical Sciences and Research Centre and Hakeem Abdul Hameed Centenary Hospital, Hamdard Nagar, New Delhi, India INTRODUCTION Pancreatic tumours have epithelial, mesenchymal or non- ductal origin. Epithelial tumours compromise the majority of them, with adenocarcinoma accounting for about 85%. Non-ductal tumours compromise only about 5-15% while as mesenchymal tumours are very rare and account for about 1% - 2% [1, 2]. Amongst the mesenchymal tumours, pancreatic lipomas or liposarcomas form an even rare subset. Increased use of computed tomography and magnetic resonance imaging has brought forth an increasing number of cases of pancreatic lipomas (Incidentalomas). Upon review of the literature, most of the cases were incidental and were diagnosed before surgery by imaging modalities like computerized tomography, magnetic resonance imaging while the patients were being investigated for some unrelated abdominal complaints. No histopathological confirmation was deemed necessary when the imaging suggested a benign lesion. CASE REPORT A Fifty-year-old female presented to our surgery clinic with complaints of on and off pain upper abdomen with radiation to back and lower chest area since past 5 months. She had associated dyspeptic symptoms. She had no known medical co-morbidities. Physical examination was unremarkabale. Routine biochemical evaluation (CBC, LFT, RFT) was within normal limits. CA 19-9 level was 4.3 U/mL(Normal). Ultrasonography was suggestive of cholelithiasis with chronic cholecystitis. A lobulated hypoechoic lesion measuring approx. 4.2×2.0 mm was seen in relation to the pancreatic head. The patient underwent CECT abdomen which revealed a lesion with fat attenuation, measuring approximately 11×4.4×3.7 mm in relation to the uncinate process of the pancreas (Figure 1abc). Rest of the abdominal evaluation was noncontributory. The patient underwent routine elective laparoscopic cholecystectomy. She was discharged on the second post- operative day. Follow up was initially weekly for a month and then 3-monthly. Her laboratory investigations were repeated, results were in normal range. DISCUSSION Pancreatic lipomas are rare benign mesenchymal tumors. They are compromised of lobules of mature adipocytes with a thin collagenous capsule. The first case of pancreatic lipoma was reported by Bigard et al. [3] in 1989 who reported a hypoechoic mass in the head of the pancreas which was histopathologically confirmed as a lipoma. The size can vary between 1 to 30 cm upon presentation. Histologic confirmation of pancreatic lipoma is rare [2, 4, 5, 6, 7, 8, 10, 11]. Lipomas located in the area of head are hypothesized to originate from the retroperitoneal or mesenteric fat that gets trapped between dorsal and ventral pancreatic buds during embryonic fusion. The etiopathogenesis of lipomas