Radiologic-histopathologic correlation of fatty island sign with fat necrosis in atypical lipomatous tumor and lipoma.

AIM: This study aimed to assess the imaging features of atypical lipomatous tumors (ALTs) and lipoma with fat necrosis. METHODS: This study included patients with histopathologically proven fat necrosis within adipocytic tumors who underwent preoperative imaging. Magnetic resonance imaging (MRI) and/or computer tomography (CT) findings of fat necrosis associated with lipomatous tumors were retrospectively reviewed, emphasizing the "fatty island sign (FIS)." FISs were defined as well-demarcated, focal fat-containing areas surrounded by more thickened septa compared with other intratumoral septa. Imaging findings of FIS were compared between ALT and lipoma. RESULTS: Fat necrosis was histopathologically confirmed in 17 patients (6 ALTs and 11 lipomas). Among them, 18 FISs were observed in 10 lesions (59%). Multiple FISs within a lesion were observed in 4 (40%) patients. The median maximum diameter of the FISs was 37 mm. Hypointense areas within FISs relative to the subcutaneous fat on T1- and T2-weighted images were observed in 8 (80%) and 9 (90%), respectively, whereas hyperintense areas within FISs on fat-suppressed T2-weighted images were observed in 2 (20%). Nonfatty solid components within FISs were observed in 2 (20%). On CT, increased fat attenuation and pure fat attenuation within FISs were observed in 6 (86%) and 1 (14%), respectively. The imaging findings of FIS were not significantly different between ALT and lipoma. CONCLUSION: FISs were observed in 59% of the histologically proven ALT and lipoma patients with fat necrosis. The hypointense areas relative to the subcutaneous fat on T1- and T2-weighted images and increased fat attenuation on CT were usually observed within FISs.

Inhibition of Adipocyte Necroptosis Alleviates Fat Necrosis and Fibrosis After Grafting in a Murine Model.

BACKGROUND: Because of the delicate structure of the adipose tissue, fat necrosis accounts for 43.7% of all complications after autologous fat grafting; however, its regulation remains unclear. OBJECTIVES: The purpose of this study was to examine the role of necroptosis in fat graft remodeling after grafting. METHODS: Clinical fat graft necrosis samples were collected, and the expression levels of the necroptosis marker phosphorylated(p)-MLKL were analyzed. Transcriptome analysis was performed on fat grafts before and 1 week after transplantation in C57BL/6 mouse fat grafting models. Additionally, the in vivo effects of RIPK1 inhibitor Nec-1s or RIPK3 inhibitor GSK'872 on the fat grafting complications, including fat necrosis and fibrosis, were investigated. RESULTS: Necroptosis markers were observed and associated with higher occurrence of fibrosis in clinical fat graft necrosis samples compared to normal fat tissue. Amplification and RNA-Seq were conducted on RNA isolated from fat grafts before and after grafting. MLKL, RIPK1, and RIPK3's expression levels were significantly upregulated in comparison to controls. Higher expression levels of necroptotic RNAs were associated with higher levels of DAMPs, including Cxcl2, HMGB1, S100a8, S100a9, Nlrp3, and IL33, and activated proinflammatory signaling pathways, including the TNF, NF-kappa B, and chemokine signaling pathways. Necroptotic inhibitor Nec-1s and GSK'872 robustly suppressed the p-MLKL expression level and significantly inhibited necroptotic cell death, especially in adipocytes. Moreover, administration of Nec-1s and GSK'872 significantly alleviated fat necrosis and subsequent fibrosis in fat grafts. CONCLUSIONS: Collectively, our study findings highlight the potential therapeutic applications of necroptosis inhibitors in preventing fat necrosis and fibrosis after grafting.

Congenital liquified subcutaneous fat necrosis in a newborn: an unusual case.

Subcutaneous fat necrosis of the newborn is a self-limited disorder of the panniculus that arises in the first six weeks of life. Some differential diagnoses may be difficult such as bacterial cellulitis or erysipelas. The prognosis is usually favorable but there are serious complications for which the patient must be regularly monitored, especially hypercalcemia. We report a case of a full-term newborn with a liquidated area of subcutaneous fat necrosis. A surgical incision was performed because of the discomfort and the lack of regression. Hypercalcemia and nephrocalcinosis appeared afterward. A set of clinical, biological, and histological arguments allows the diagnosis of subcutaneous fat necrosis. Follow-up to early detection and to manage such complications is necessary.

Abdominal fat necrosis in a female dromedary camel: Clinical, hematobiochemical, sonographic, and pathologic findings.

Background: Abdominal fat necrosis is mostly an incidental finding during rectal examination manifested by the presence of hard necrotic masses of different sizes. Differential diagnosis includes gastrointestinal neoplasia, abdominal abscessation and mummified fetuses. This report describes the clinical, hematological, biochemical, sonographic, and pathologic findings in a female Arabian camel (Camelus dromedaries) with abdominal fat necrosis. Case Description: A 7-year-old female dromedary camel was presented for examination because of weakness and progressive weight loss since months ago. Anthelmintics, analgesics, broad-spectrum antimicrobials, anti-inflammatories and stomachics were administered, but did not result in significant improvement. Preliminary examination of the case revealed emaciation with a body condition score of 2.5 (scale 1-5). The cardiopulmonary, digestive, and urinary systems were evaluated transcutaneously by sonography in the recumbent position. Multiple echogenic masses-located within the intestinal loops were observed alongside few hypoechogenic masses. A hyperechogenic peritoneal effusion and enlarged mesenteric lymph nodes were also detected. Decreased hematocrit value, normocytic normochromic anemia, neutrophilic leukocytosis, hypoalbuminemia, hhyperglobulinemia, hyperglycemia, hyponatremia, and hyperkalemia were detected. A free-hand, ultrasound-guided biopsy was examined histopathologically and revealed multiple abdominal fat necrosis, severe fibrosis, and pancreatitis. Conclusion: It is concluded that, transabdominal ultrasonography in camels was valuable for suspicious of abdominal mesenteric masses and helpful in sampling of a representative biopsy specimen However, histological examination of the biopsy remains the final diagnostic method.

Necrosis grasa del recién nacido / Fat necrosis of the newborn

Resumen: Introducción: Las paniculitis constituyen un grupo de enfermedades que afectan al tejido graso subcutáneo y se manifiestan clínicamente como nódulos. Su patogenia no es del todo clara, por lo general es asintomático. El diagnóstico confirmatorio es histológico. Objetivo: describir las características clínicas e histopatológicas de un caso de necrosis grasa, una forma especifica de paniculitis en el recién nacido (RN). Caso Clínico: RN femenino de 40 semanas, parto cesárea de urgencia por taqui cardia fetal más meconio, APGAR 7-8-9. Requirió oxigeno y presión positiva por 5 min. Al quinto día de vida presentó aumento de volumen en tronco posterior, de coloración eritematosa - violácea, remitente a la palpación, no doloroso. Ecotomografría de piel y partes blandas informó aumento de la ecogenecidad del tejido celular subcutáneo y pérdida de definición de las celdillas adiposas de aproximadamente 42.3 x 9.7 x 20.1 mm, sin presencia de vascularización. Biopsia de piel: epidermis con acantosis irregular y ortoqueratosis en cestas; dermis papilar con infiltrado inflamatorio y dermis reticular y tejido adiposo con presencia de infiltrado linfohistocitiario con tendencia a la formación de nódulos, sin compromiso vascular, leves depósitos de colesterol; compatible con necrosis grasa del recién nacido (NGRN). Paciente tuvo regresión completa de la lesión a los tres meses de vida. Conclusiones: se describe un caso compatible clínica e histológicamente con NGRN; sin complica ciones durante su observación. Por lo general esta patología tiene buen pronóstico, con resolución espontánea, como en nuestro caso.

Abstract: Introduction: Panniculitis is a group of diseases that affect subcutaneous fat tissue and clinically manifest as nodules. Its pathogenesis is not entirely clear, and it is usually asymptomatic. The confirma tory diagnosis is histological. Objective: To describe the clinical and histopathological characteristics of a case of fat necrosis, a specific form of panniculitis in the newborn (NB). Clinical Case: 40-week female NB, born by emergency cesarean section due to fetal tachycardia with meconium, Apgar score 7-8-9. She required oxygen and positive pressure for five minutes. On the fifth day of life, she presen ted an increased volume in the posterior trunk region, with an erythematous - purplish discoloration, which is soft and non-tender to palpation. Skin and soft tissues ultrasound showed increased echo genicity of the subcutaneous cellular tissue and loss of definition of the adipocytes of 42.3 x 9.7 x 20.1 mm approximately, without vascularization. Skin biopsy showed epidermis with irregular acanthosis and basket-weave orthokeratosis; papillary dermis with inflammatory infiltrate, and reticular dermis and adipose tissue with presence of lymphohistiocytic infiltrate with a tendency to form nodules, without vascular involvement, and small cholesterol deposits, compatible with subcutaneous fat ne crosis (SBFN) of the newborn. The patient at three months of age had complete regression of the lesion. Conclusions: a clinically and histologically compatible case with SBFN is described, that did not present complications during observation. In general, this pathology has a good prognosis, with spontaneous resolution as in our case.

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Subcutaneous fat necrosis of the newborn: clinical and histopathological correlation

Abstract: Subcutaneous fat necrosis of the newborn is a rare benign panniculitis found in term and post-term neonates. Diagnosis is based on clinical characteristics and specific alterations in the adipocytes, detected by anatomical pathology. Subcutaneous fat necrosis of the newborn can occur in uncomplicated pregnancy and childbirth. However, perinatal complications such as asphyxia, hypothermia, seizures, preeclampsia, meconium aspiration, and even whole-body cooling used in newborns with perinatal hypoxia/anoxia may be associated with this entity.

Membranous lipodystrophy: case report and review of the literature

Membranous lipodystrophy is a distinct type of membranocystic fat necrosis. It is associated with many local and systemic diseases, including vascular disorders. The histopathological changes which characterize this phenomenon are variably sized cysts in the fat lobules of the subcutaneous tissue, which are surrounded by eosinophilic membranes projecting into the cystic space. We report a case of secondary membranous lipodystrophy associated with both hypertension and venous insufficiency.

Subcutaneous fat necrosis of the newborn: clinical manifestations in two cases / Necrose gordurosa subcutanea do recem-nascido: manifestacoes clinicas de dois casos

Subcutaneous fat necrosis of the newborn is an unusual form of panniculitis, with few cases described in medical literature. The disease affects newborns at term or post-term, with normal general health. We describe two cases of newborns affected by the disease. One of them already had lesions since birth. Also, we discuss the use of puncture for diagnostic assistance.

A Necrose Gordurosa Subcutânea do Recém-Nascido é uma paniculite incomum com poucos casos descritos na literatura médica. A doença acomete recém-nascidos a termo ou pós-termo, com saúde geral normal. Relatamos dois casos de recém-nascidos acometidos pela doença. Um deles já apresentava lesões ao nascer. Também discutimos o uso da punção para auxílio diagnóstico.

Paniculitis mesentérica / Mesenteric panniculitis

La paniculitis mesentérica es una entidad caracterizada por inflamación crónica e inespecífica del mesenterio. Existe poca información y a menudo confusa sobre sus características, así como sobre la actitud a seguir una vez que se evidencia en una prueba de imagen. Nos proponemos describir las características epidemiológicas, clínicas, analíticas, radiológicas y patológicas de los pacientes con paniculitis mesentérica publicados en la literatura, así como las entidades posiblemente causales o asociadas a la paniculitis mesentérica, según la opinión de los autores de cada estudio. Por último, revisaremos las diferentes opciones terapéuticas utilizadas y la respuesta a las mismas. Para ello se realizó una búsqueda bibliográfica en las principales bases de datos médicas, seleccionando aquellos artículos con información sobre estos aspectos, recogiendo dicha información en una base de datos que se almacenó en el paquete estadístico SPSS para su posterior análisis y resumen (AU)

Mesenteric panniculitis is a condition characterized by chronic nonspecific inflammation of the mesentery. There is little and often confusing information about its characteristics and the approach to take once it has been demonstrated by an imaging test. We propose to describe the epidemiological, clinical, laboratory, radiological and pathological features of the patients with mesenteric panniculitis reported in the literature, as well as possible disorders causal or associated with mesenteric panniculitis, in the opinion of the authors of each study. Finally, we will review the different therapeutic options used and the response to them. To that end a literature search was performed from the main medical databases selecting ítems with information on these aspects. This information was collected on a database stored in SPSS software for further analysis and summary (AU)

Necrose adiposa do recém-nascido: a propósito de dois casos clínicos / Fat necrosis of the newborn: report on two cases

A necrose adiposa subcutânea do recém-nascido é uma paniculite rara do período neonatal. Surge, geralmente, em recém-nascidos de termo ou pós-termo, nas primeiras 4 semanas de vida, e em associação com trauma obstétrico. Caracteriza-se pelo aparecimento de placas ou nódulos subcutâneos duros, localizados ao tronco, nádegas ou coxas. O seu curso é, geralmente, benigno e autolimitado, embora possa acompanhar-se de hipercalcemia, o que obriga a uma vigilância periódica até à resolução das lesões cutâneas. Os autores descrevem 2 casos de necrose adiposa subcutânea do recém-nascido, um num recémnascido de termo, outro num prematuro, ambos associados a partos traumáticos e a sofrimento fetal.

Subcutaneous fat necrosis of the newborn is an uncommon disorder occurring during the prenatal stage. Generally occurring in full-term neonates or during the first four weeks after a traumatic delivery, the disorder is characterized by the appearance of hard subcutaneous nodules or plaques on the trunk, buttocks or thighs. It is normally a benign and transient condition, although it may be complicated by hypocalcemia, which requires close monitoring until skin lesions are cured. The authors describe two cases of subcutaneous fat necrosis of the newborn, one occurring in a full-term neonate and the other in a premature newborn, both related to traumatic delivery and fetal distress.

Necrosis grasa pericárdica asintomática / Asymptomatic pericardial fat necrosis

La necrosis grasa pericárdica es una entidad poco frecuente, benigna y de causa desconocida. Se suele presentar como un dolor torácico agudo, de características pleuríticas, en personas previamente sanas. Radiológicamente se asocia con un aumento de densidad de localización anterior, a nivel paracardíaco, de contornos bien definidos, en la radiografía de tórax posteroanterior. Con carácter excepcional, constituye un hallazgo incidental. El objetivo de esta nota clínica es presentar un caso de necrosis grasa pericárdica en un varón de 38 años asintomático, hallado intraoperatoriamente durante la resección de un carcinoma pulmonar(AU)

Pericardial fat necrosis is an uncommon benign condition of unknown cause. It presents as acute pleuritic chest pain in previously healthy persons associated with a well-defined anterior paracardiac density on posteroanterior chest radiography. Exceptionally, it constitutes an incidental finding. The objective of this study is to report a clinical case of pericardial fat necrosis in an asymptomatic 38-year-old man, found intraoperatively during a lung carcinoma resection(AU)

Hipercalcemia mantenida secundaria a necrosis grasa subcutánea / Maintained hypercalcemia secondary to subcutaneous fat necrosis

Introducción: La necrosis grasa subcutánea del recién nacido es una paniculitis transitoria aguda de presentación infrecuente en la infancia, con lesiones cutáneas características y de evolución generalmente benigna. De las diversas complicaciones asociadas, la hipercalcemia es la más frecuente y la más severa. Caso clínico: Neonato de sexo femenino nacida de gestación a término, que ingresa en una Unidad de Neonatología por síndrome de aspiración meconial. En las primeras horas de vida presenta acidosis mixta severa, hipoglucemia, trombopenia y recibe tratamiento con ventilación mecánica y antibioterapia. Presenta nódulos violáceos en la región glutea y la espalda a los 4 días de vida, con diagnóstico final de necrosis grasa subcutánea tras estudio histopatológico. Las lesiones cutáneas han evolucionado favorablemente. Durante los primeros meses de vida presentó hipercalcemia moderada que cursó clínicamente con episodios de irritabilidad, rechazo de tomas y estancamiento ponderal. Recibió tratamiento con hidratación intravenosa, exclusión de vitamina D y corticoides, con normalización de los niveles de calcio sérico a los12 meses de edad sin evidencia de calcificaciones tisulares. Conclusiones: Es imprescindible un seguimiento precoz y prolongado de los pacientes con necrosis grasa subcutánea, sobre todo para la detección temprana de alteraciones metabólicas potencialmente graves como la hipercalcemia (AU)

Introduction: Subcutaneous fat necrosis of the newborn is an uncommon panniculitis, with carachteristical skinlesions; prognosis is considered good. Several complications have been reported, being hypercalcaemia the most frequent and severe. Case: Female newborn had a history of meconium aspiration syndrome, acidosis, hypoglicemia and thrombocytopenia,thus she was treated with mechanical ventilation and antibiotics in a Neonatal Unit. Violaceus subcutaneous nodules in back and buttocks appeared at day 4. Diagnosis of subcutaneous fat necrosis was made by dermatologists based on clinical and histological findings obtained by skinbiopsy; cutaneous lesions disappeared after several months. The patient had moderate symptomatic hypercalcaemia, presenting irritability, feeding problems and failure to thrive, and she received treatment with intravenous fluids and short-term oral steroids therapy. Serum calcium was normal by 12 months-old with no evidence of tissue calcifications (AU)

Paniculitis lipomembranosa / Lipomembranous panniculitis

La paniculitis lipomembranosa o esteatonecrosis membranoquística es una alteración del tejido adiposo que se suelen manifiestar en forma de placasescleróticas de tendencia crónica, localizadas en la parte inferior de las piernas. Es casi exclusiva de mujeres en su mayoría obesas, diabéticas y con unsevero componente de estasis venoso. Los hallazgos histológicos característicos son los de una paniculitis lobulillar en la que por confluencia se vanformando cavidades quísticas, rodeadas de tejido graso con signos claros de esteatonecrosis. Presentamos el caso de una mujer de 36 años que habíadesarrollado en la zona de un traumatismo previo una lesión dolorosa que a la palpación estaba constituida por múltiples formaciones nódulo-quísticas.El estudio dermatopatológico puso de manifiesto la presencia de estructuras quísticas localizadas en los lóbulos y a nivel de los septos, rodeadasde tejido graso, con signos evidentes de esteatonecrosis, presencia significativa de histiocitos espumosos y rotura de las membranas celulares con formaciónde microquistes. Las cavidades quísticas estaban delimitadas en su cara interna por una membrana serpiginosa, anuclear, homogénea y eosinofílica,PAS+, de aspecto granulado, que incluso en algunas áreas llegaba a formar pseudopapilas que se proyectaban hacia el interior del quiste. Seha sugerido que la isquemia es la causa patogénica fundamental de la paniculitis lipomembranosa, aunque también se especulan otros factores comoun trauma previo. La razón de porqué estos cambios son más prominentes en determinados enfermos y no en otros, que padecen también la mismaenfermedad, sigue sin conocerse en la actualidad (AU)

TLipo-membranous panniculitis or membrano-cystic steatonecrosis is an alteration of the adipose tissue. Sclerotic plaques with tendency to becomechronic, do usually appear located on the lower area of the legs. It is almost exclusive in female mostly obese and diabetic and with a severe componentof venous stasis. It has the histologic features of a lobule panniculitis, cystic cavities surrounded by fatty tissue with clear signs of steatonecrosisare formed by confluence. We present the case of a 36 years old female who developed a painful lesion on the location of a previous lesion, it hadnumerous nodule-cystic formations we noticed on palpation. The dermato-pathological study showed up the presence of cystic structures located onthe lobules and at the level of the septum, surrounded by fatty tissue, with clear signs of steatonecrosis, a significant presence of frothy histiocytes andbreakage of the cellular membranes with formation of micro-cysts. The cystic cavities were limited in their inner side by a serpiginous membrane, nonuclear, homogeneous and eosinophilic, PAS+, with a granulated appearance. It even formed in some areas pseudo-papillae, which projected themselvestowards the interior of the cyst. It has been suggested that ischemia is the main pathogenic cause for lipo-membranous panniculitis, althoughother reasons are also considered such as a previous trauma. Nowadays, we do not still know the reason why these changes are more prominent incertain patients than in other with the same disease (AU)

Lesión dermatológica secundaria a pancreatitis aguda / Dermatological lesion secondary to acute pancreatitis

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Paniculitis pancreática en un paciente con metástasis de carcinoma pancreático / Pancreatic panniculitis in a patient with metastases from pancreatic carcinoma

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Necrose gordurosa da mama: correlacao clinico-radiologica / Breast fat necrosis: clinic-radiologic correlation

Os autores apresentan 13 casos de necrose gorgurosa da mama, fazendo correlacao clinico-patologica com as alteracoes radiologicas

Necrose gordurosa multinodular mamária: diagnóstico diferencial com o sarcoma da mama através da citologia por punçäo aspirativa / Mammary multinodular fat necrosis: differential diagnosis with breast carcinoma through cytology by aspiration puncture

A necrose gordurosa da mama é um processo de desintegraçäo de células adiposas, acompanhado de uma reaçäo granulomatosa de intensidade variável. É decorrente do reconhecimento de lipídios extravasados do citoplasma de adipócitos como substâncias estranhas ao meio extracelular. O quadro clínico-radiológico pode ocasionar dificuldades no diagnóstico diferencial com neoplasias mamárias. Neste relato é descrito um caso de necrose gordurosa multinodular mamária sendo enfatizada a importância da citologia por punçäo aspirativa com agulha fina para a confirmaçäo do diagnóstico.