Emerging Issue – Fatty Pancreas in Pancreatic Cystic Neoplasms: Results of a Matched Case–Control Study

BACKGROUND: Fatty pancreas (FP) is emerging as a concerning focus in pancreatology, though its impact on pancreatic neoplastic cystic lesions (PNCL) risk remains unclear. OBJECTIVE: The study aims to evaluate the prevalence of FP in patients with PNCL and to determine if FP is significantly increased in the subgroup of PNCL with significant risk of malignancy. METHODS: We conducted a retrospective, single-center, matched case-control study on patients diagnosed with PNCL between 2019-2024. We included patients with endosonographic (EUS) and computerized tomography (CT) evaluation. FP was defined by pancreas-to-spleen attenuation ratio (P/S) under 0.7 on CT. Ethical approval was granted by the local ethics committee (346,833/19.05.2023), registered in Clinical Trials (ID: NCT06867172). RESULTS: The study enrolled 22 cases with PNCL and 44 matched controls, adjusted by age, sex, nutritional status and lack of hepato-bilio-pancreatic diseases or major comorbidities. 14 of the 22 patients had lesions with risk of malignancy. No significant differences in P/S ratio (p = 0.496) or in FP prevalence (P/S > 0.7, p = 0.573) were observed between these groups. We could observe that P/S ratio were lower in the tail in patients with premalignant PNCL (p = 0.059). There were no significant differences between pancreatic fat ratio in head, body and tail (p = 0.399). CONCLUSIONS: Although pancreatic fat content did not significantly differ between patients with PNCL and the general population, an observed non-significant increase in steatosis in the pancreatic tail could warrant further investigation. Additional studies are necessary to clarify the role of FP in the progression and risk of pancreatic neoplastic cystic lesions.