CT Manifestations of Encapsulated Fat Necrosis after Operation of Intra-Abdominal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANG Wei ¹ , YANG Fan ² ,  CHEN Wei-xia ¹ , ZHAO Yi-jun ¹

1. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;
2. Department of Radiology, Chengdu First People's Hospital, Chengdu 610041, Sichuan Province, China;

Corresponding author：

CHEN Wei-xia, Email: wxchen25@126.com

Keywords：

CT; Encapsulated fat necrosis; Intra-abdominal cancer; Surgery

DOI：

10.7507/1007-9424.20140279

Video：

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Objective To discuss the diagnostic value of multidetector CT(MDCT) on encapsulated fat necrosis after operation of abdominal cancer, and to investigate the key differences of CT features between encapsulated fat necrosis and postoperative recurrence or metastasis. Methods CT data of 36 patients with encapsulated fat necrosis after operation of abdominal cancer, who received CT in our hospital between Feb. 2012 to May. 2014 during followed-up were retrospectively analyzed, for the purpose of summarizing the CT characteristics. In addition, the clinical presentation, level of carcinoembryonic antigen (CEA) and CA-125 before and after operation were also taken into account, to explore the difference between encapsulated fat necrosis with tumor recurrence and metastasis. Results Among the 36 patients who had suffered from encapsulated fat necrosis after operation of abdominal cancer, 3 patients (8.3%) had 2 lesions and the rest of 33 patients (91.7%) had solitary lesion(a total of 39 lesions). All lesions showed non homogeneous masses consistent with the surgery path and surrounded by fat density ring and soft tissue density capsule. The size of most lesions (94.8%, 37/39) decreased over time. All lesions were found slightly enhancement in portal phase. Five patients with postoperative tumor metastasis, 31 patients had no recurrence or metastasis. Among the 5 patients who had postoperative tumor metastasis at the same time, postoperative CEA was positive in 3 patients, and postoperative CA-125 was positive in 2 patient. Among the other 31 patients who had no recurrence or metastasis, the levels of postoperative CEA and CA-125 of 1 patient were unknown, and the postoperative CEA and CA-125 of 27 patients in the rest patients(90.0%, 27/30) were both negative. Most of them had no special clinical symptoms, only a few (1 patient)patient had mild abdominal pain without other associated symptoms. Conclusion CT is a valuable tool to reveal and diagnose encapsulated fat necrosis in postoperative abdominal cancer. Combined CT findings(such as location, shape, and density) with CEA, CA-125, and clinical presentation, that is easy to differ it from postoperative recurrence and metastasis.

Citation： ZHANG Wei, YANG Fan, CHEN Wei-xia, ZHAO Yi-jun. CT Manifestations of Encapsulated Fat Necrosis after Operation of Intra-Abdominal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(9): 1161-1166. doi: 10.7507/1007-9424.20140279 Copy

1.	Buswell WA. Traumatic fat necrosis of the face in children[J]. Br J Plast Surg, 1979, 32(2):127-128.
2.	Crawford EA, King JJ, Fox EJ, et al. Symptomatic fat necrosis and lipoatrophy of the posterior pelvis following trauma[J]. Orthopedics, 2009, 32(6):444-448.
3.	Lee SA, Chung HW, Cho KJ, et al. Encapsulated fat necrosis mimicking subcutaneous liposarcoma:radiologic findings on MR, PET-CT, and US imaging[J]. Skeletal Radiol, 2013, 42(10):1465-1470.
4.	Felipo F, Vaquero M, del Agua C. Pseudotumoral encapsulated fat necrosis with diffuse pseudomembranous degeneration[J]. J Cutan Pathol, 2004, 31(8):565-567.
5.	Tsai TS, Evans HA, Donnelly LF, et al. Fat necrosis after trauma:a benign cause of palpable lumps in children[J]. AJR Am J Roentgenol, 1997, 169(6):1623-1626.
6.	Lee SK, Lee JH, Han CH, et al. Calcified subcutaneous fat necrosis induced by prolonged exposure to cold weather:a case report[J]. Pediatr Radiol, 2001, 31(4):294-295.
7.	Strohm B, Hobson A, Brocklehurst P, et al. Subcutaneous fat necrosis after moderate therapeutic hypothermia in neonates[J]. Pediatrics, 2011, 128(2):e450-e452.
8.	Lyle WG, Bossard KR, Day DS. Sclerosing lobular hyperplasia of the breast after reduction mammaplasty[J]. Ann Plast Surg, 2000, 45(4):454-457.
9.	Wagner IJ, Tong WM, Halvorson EG. A classification system for fat necrosis in autologous breast reconstruction[J]. Ann Plast Surg, 2013, 70(5):553-556.
10.	Parikh RP, Doren EL, Mooney B, et al. Differentiating fat necrosis from recurrent malignancy in fat-grafted breasts:an imaging classification system to guide management[J]. Plast Reconstr Surg, 2012, 130(4):761-772.
11.	Fujishiro S, Mitsumori M, Kokubo M, et al. Cosmetic results and cornplications after breast conserving therapy for early breast cancer[J]. Breast Cancer, 2000, 7(1):57-63.
12.	Davies J, Lagattolla NR, Scholey G. Fat necrosis associated with the subcutaneous injection of enoxaparin[J]. Postgrad Med J, 2001, 77(903):43-44.
13.	Anderson DR, Narla LD, Dunn NL. Subcutaneous fat necrosis of the newborn[J]. Pediatr Radiol, 1999, 29(10):794-796.
14.	Norton KI, Som PM, Shugar JM, et al. Subcutaneous fat necrosis of the newborn:CT findings of head and neck involvement[J]. AJNR Am J Neuroradiol, 1997, 18(3):547-550.
15.	Vasireddy S, Long SD, Sacheti B, et al. MRI and US findings of subcutaneous fat necrosis of the newborn[J]. Pediatr Radiol, 2009, 39(1):73-76.
16.	Schmidt-Hermes HJ, Loskant G. Calcified fat necrosis of the female breast[J]. Med Welt, 1975, 26(24):1179-1180.
17.	Hurt MA, Santa Cruz DJ. Nodular-cystic fat necrosis. A reevaluation of the so-called mobile encapsulated lipoma[J]. J Am Acad Dermatol, 1989, 21(3 Pt 1):493-498.
18.	Przyjemski CJ, Schuster SR. Nodular-cystic fat necrosis[J]. J Pediatr, 1977, 91(4):605-607.
19.	Kikuchi I, Okazaki M, Narahara S. The so-called mobile encapsulated lipoma[J]. J Dermatol, 1984, 11(4):410-412.
20.	Sahl WJ Jr. Mobile encapsulated lipomas. Formerly called encapsulated angiolipomas[J]. Arch Dermatol, 1978, 114(11):1684-1686.
21.	Ohtake N, Gushi A, Matsushita S, et al. Encapsulated fat necrosis in a patient with Ehlers-Danlos syndrome[J]. J Cutan Pathol, 1997, 24(3):189-192.
22.	Kiryu H, Rikihisa W, Furue M. Encapsulated fat necrosis-a clinicopathological study of 8 cases and a literature review[J]. J Cutan Pathol, 2000, 27(1):19-23.
23.	Singh AK, Gervais DA, Hahn PF, et al. Acute epiploic appendagitis and its mimics[J]. Radiographics, 2005, 25(6):1521-1534.
24.	Takao H, Yamahira K, Watanabe T. Encapsulated fat necrosis mimicking abdominal liposarcoma:computed tomography findings[J]. J Comput Assist Tomogr, 2004, 28(2):193-194.
25.	Kamaya A, Federle MP, Desser TS. Imaging manifestations of abdominal fat necrosis and its mimics[J]. Radiographics, 2011, 31(7):2021-2034.
26.	李辉, 王坤, 俞海平, 等.脂肪坏死MR表现的实验研究[J].东南大学学报:医学版, 2012, 31(5):594-599.
27.	Herzog K, Burgdorf W, Hewicker-Trautwein M. Mobile encapsulated bodies comprising fat necrosis and fibrous tissue in the abdominal cavity of cows[J]. J Comp Pathol, 2010, 143(4):309-312.
28.	Hagino T, Ishizuka K, Sato E, et al. Mobile submuscular mass resembling a hard-boiled egg:case report[J]. J Orthop Sci, 2003, 8(4):613-615.
29.	Hanami Y, Hiraiwa T, Yamamoto T. Nodular cystic fat necrosis with calcification and metaplastic ossification[J]. Am J Dermatopathol, 2012, 34(7):782-784.
30.	Janzen J, Rothenberger-Janzen K, Giannini O. "Hard boiled egg" in the peritoneal cavity[J]. Lancet, 1999, 353(9166):1801.
31.	Sewkani A, Jain A, Maudar K, et al.'Boiled egg'in the peritoneal cavity-a giant peritoneal loose body in a 64-year-old man:a case report[J]. J Med Case Rep, 2011, 5(1):297-299.

1. Buswell WA. Traumatic fat necrosis of the face in children[J]. Br J Plast Surg, 1979, 32(2):127-128.
2. Crawford EA, King JJ, Fox EJ, et al. Symptomatic fat necrosis and lipoatrophy of the posterior pelvis following trauma[J]. Orthopedics, 2009, 32(6):444-448.
3. Lee SA, Chung HW, Cho KJ, et al. Encapsulated fat necrosis mimicking subcutaneous liposarcoma:radiologic findings on MR, PET-CT, and US imaging[J]. Skeletal Radiol, 2013, 42(10):1465-1470.
4. Felipo F, Vaquero M, del Agua C. Pseudotumoral encapsulated fat necrosis with diffuse pseudomembranous degeneration[J]. J Cutan Pathol, 2004, 31(8):565-567.
5. Tsai TS, Evans HA, Donnelly LF, et al. Fat necrosis after trauma:a benign cause of palpable lumps in children[J]. AJR Am J Roentgenol, 1997, 169(6):1623-1626.
6. Lee SK, Lee JH, Han CH, et al. Calcified subcutaneous fat necrosis induced by prolonged exposure to cold weather:a case report[J]. Pediatr Radiol, 2001, 31(4):294-295.
7. Strohm B, Hobson A, Brocklehurst P, et al. Subcutaneous fat necrosis after moderate therapeutic hypothermia in neonates[J]. Pediatrics, 2011, 128(2):e450-e452.
8. Lyle WG, Bossard KR, Day DS. Sclerosing lobular hyperplasia of the breast after reduction mammaplasty[J]. Ann Plast Surg, 2000, 45(4):454-457.
9. Wagner IJ, Tong WM, Halvorson EG. A classification system for fat necrosis in autologous breast reconstruction[J]. Ann Plast Surg, 2013, 70(5):553-556.
10. Parikh RP, Doren EL, Mooney B, et al. Differentiating fat necrosis from recurrent malignancy in fat-grafted breasts:an imaging classification system to guide management[J]. Plast Reconstr Surg, 2012, 130(4):761-772.
11. Fujishiro S, Mitsumori M, Kokubo M, et al. Cosmetic results and cornplications after breast conserving therapy for early breast cancer[J]. Breast Cancer, 2000, 7(1):57-63.
12. Davies J, Lagattolla NR, Scholey G. Fat necrosis associated with the subcutaneous injection of enoxaparin[J]. Postgrad Med J, 2001, 77(903):43-44.
13. Anderson DR, Narla LD, Dunn NL. Subcutaneous fat necrosis of the newborn[J]. Pediatr Radiol, 1999, 29(10):794-796.
14. Norton KI, Som PM, Shugar JM, et al. Subcutaneous fat necrosis of the newborn:CT findings of head and neck involvement[J]. AJNR Am J Neuroradiol, 1997, 18(3):547-550.
15. Vasireddy S, Long SD, Sacheti B, et al. MRI and US findings of subcutaneous fat necrosis of the newborn[J]. Pediatr Radiol, 2009, 39(1):73-76.
16. Schmidt-Hermes HJ, Loskant G. Calcified fat necrosis of the female breast[J]. Med Welt, 1975, 26(24):1179-1180.
17. Hurt MA, Santa Cruz DJ. Nodular-cystic fat necrosis. A reevaluation of the so-called mobile encapsulated lipoma[J]. J Am Acad Dermatol, 1989, 21(3 Pt 1):493-498.
18. Przyjemski CJ, Schuster SR. Nodular-cystic fat necrosis[J]. J Pediatr, 1977, 91(4):605-607.
19. Kikuchi I, Okazaki M, Narahara S. The so-called mobile encapsulated lipoma[J]. J Dermatol, 1984, 11(4):410-412.
20. Sahl WJ Jr. Mobile encapsulated lipomas. Formerly called encapsulated angiolipomas[J]. Arch Dermatol, 1978, 114(11):1684-1686.
21. Ohtake N, Gushi A, Matsushita S, et al. Encapsulated fat necrosis in a patient with Ehlers-Danlos syndrome[J]. J Cutan Pathol, 1997, 24(3):189-192.
22. Kiryu H, Rikihisa W, Furue M. Encapsulated fat necrosis-a clinicopathological study of 8 cases and a literature review[J]. J Cutan Pathol, 2000, 27(1):19-23.
23. Singh AK, Gervais DA, Hahn PF, et al. Acute epiploic appendagitis and its mimics[J]. Radiographics, 2005, 25(6):1521-1534.
24. Takao H, Yamahira K, Watanabe T. Encapsulated fat necrosis mimicking abdominal liposarcoma:computed tomography findings[J]. J Comput Assist Tomogr, 2004, 28(2):193-194.
25. Kamaya A, Federle MP, Desser TS. Imaging manifestations of abdominal fat necrosis and its mimics[J]. Radiographics, 2011, 31(7):2021-2034.
26. 李辉, 王坤, 俞海平, 等.脂肪坏死MR表现的实验研究[J].东南大学学报:医学版, 2012, 31(5):594-599.
27. Herzog K, Burgdorf W, Hewicker-Trautwein M. Mobile encapsulated bodies comprising fat necrosis and fibrous tissue in the abdominal cavity of cows[J]. J Comp Pathol, 2010, 143(4):309-312.
28. Hagino T, Ishizuka K, Sato E, et al. Mobile submuscular mass resembling a hard-boiled egg:case report[J]. J Orthop Sci, 2003, 8(4):613-615.
29. Hanami Y, Hiraiwa T, Yamamoto T. Nodular cystic fat necrosis with calcification and metaplastic ossification[J]. Am J Dermatopathol, 2012, 34(7):782-784.
30. Janzen J, Rothenberger-Janzen K, Giannini O. "Hard boiled egg" in the peritoneal cavity[J]. Lancet, 1999, 353(9166):1801.
31. Sewkani A, Jain A, Maudar K, et al.'Boiled egg'in the peritoneal cavity-a giant peritoneal loose body in a 64-year-old man:a case report[J]. J Med Case Rep, 2011, 5(1):297-299.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

CT Manifestations of Encapsulated Fat Necrosis after Operation of Intra-Abdominal Cancer

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