Fat necrosis

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Fat necrosis
Other namesalso known as Balser's necrosis
Breast tissue showing fat necrosis 4X.jpg
Micrograph of breast tissue showing fat necrosis. H&E stain
Specialty Pathology

Fat necrosis is necrosis affecting fat tissue (adipose tissue). [1] The term is well-established in medical terminology despite not denoting a specific pattern of necrosis. [2] Fat necrosis may result from various injuries to adipose tissue, including: physical trauma, enzymatic digestion of adipocytes by lipases, [3] radiation therapy, [4] hypoxia, or inflammation of subcutaneous fat (panniculitis).[ citation needed ]

Contents

The gross appearance of fat necrosis is as an irregular, chalky white area within otherwise normal adipose tissue. [1]

Pathophysiology

Trauma

Traumatic injury of adipose tissue liberates stored fat [1] [3] as well as lipases [1] from adipocytes. The extracellular fat then elicits a swift inflammatory response, attracting macrophages and polymorphonuclear leukocytes which proceed to phagocytose the freed fat. The process eventually leads to fibrosis. The necrotic tissue may eventually form a palpable mass (especially if situated at a superficial site like the breast). [3]

Traumatic fat necrosis commonly affects the breast and may resemble a tumour (especially in case of calcification of the necrotic mass). [1]

Enzymatic digestion

Pancreatic conditions like acute pancreatitis, [3] pancreatic carcinoma, and pancreatic trauma [5] result in liberation of pancreatic lipase which proceeds to digest fat to form free fatty acids which subsequently combine with calcium to form soapy precipitates. [3] [2]

Although the peripancreatic region is the most commonly affected (due to direct contact with enzymes), associated fat necrosis may occur throughout the body in subcutaneous tissue, hand and foot joints, and bone marrow. These extrapancreatic complications are known as pancreatic panniculitis. [5]

Clinical significance

Breast fat necrosis

Causes

Examples of causes include but are not limited to:[ citation needed ]

Epidemiology

Fat necrosis in the breast occurs around 0.6%, this represents 2.75% of lesions that end up being benign. However, 0.8% of fat necrosis occurs from tumors of the breast, 1–9% occurs in breast reduction surgery. Individuals that are high risk include women around the age of 50yrs along with pendulous breasts. [8]

See also

Related Research Articles

<span class="mw-page-title-main">Necrosis</span> Unprogrammed cell death caused by external cell injury

Necrosis is a form of cell injury which results in the premature death of cells in living tissue by autolysis. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who is often regarded as one of the founders of modern pathology. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated digestion of cell components. In contrast, apoptosis is a naturally occurring programmed and targeted cause of cellular death. While apoptosis often provides beneficial effects to the organism, necrosis is almost always detrimental and can be fatal.

<span class="mw-page-title-main">Pancreatitis</span> Inflammation of the pancreas

Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones. There are two main types: acute pancreatitis, and chronic pancreatitis.

<span class="mw-page-title-main">Lipolysis</span> Metabolism involving breakdown of lipids

Lipolysis is the metabolic pathway through which lipid triglycerides are hydrolyzed into a glycerol and free fatty acids. It is used to mobilize stored energy during fasting or exercise, and usually occurs in fat adipocytes. The most important regulatory hormone in lipolysis is insulin; lipolysis can only occur when insulin action falls to low levels, as occurs during fasting. Other hormones that affect lipolysis include leptin, glucagon, epinephrine, norepinephrine, growth hormone, atrial natriuretic peptide, brain natriuretic peptide, and cortisol.

<span class="mw-page-title-main">Adipose tissue</span> Loose connective tissue composed mostly by adipocytes

Adipose tissue is a loose connective tissue composed mostly of adipocytes. It also contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, vascular endothelial cells and a variety of immune cells such as adipose tissue macrophages. Its main role is to store energy in the form of lipids, although it also cushions and insulates the body.

<span class="mw-page-title-main">Breast augmentation</span> Surgical procedure

Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts. Although in some cases augementation mammoplasty is applied to correct congenital defects of the breasts and the chest wall in other cases it is used purely as a cosmetic surgery, primary breast augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.

<span class="mw-page-title-main">Breast reduction</span> Plastic surgery procedure

Reduction mammoplasty is the plastic surgery procedure for reducing the size of large breasts. In a breast reduction surgery for re-establishing a functional bust that is proportionate to the patient's body, the critical corrective consideration is the tissue viability of the nipple–areola complex (NAC), to ensure the functional sensitivity and lactational capability of the breasts. The indications for breast reduction surgery are three-fold – physical, aesthetic, and psychological – the restoration of the bust, of the patient's self-image, and of the patient's mental health.

<span class="mw-page-title-main">Panniculitis</span> Medical condition

Panniculitis is a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue. Symptoms include tender skin nodules, and systemic signs such as weight loss and fatigue.

<span class="mw-page-title-main">Acute pancreatitis</span> Medical condition

Acute pancreatitis (AP) is a sudden inflammation of the pancreas. Causes, in order of frequency, include: a gallstone impacted in the common bile duct beyond the point where the pancreatic duct joins it; heavy alcohol use; systemic disease; trauma; and, in children, mumps. Acute pancreatitis may be a single event; it may be recurrent; or it may progress to chronic pancreatitis and/or pancreatic failure.

<span class="mw-page-title-main">Dystrophic calcification</span> Calcification occurring in degenerated or necrotic tissue

Dystrophic calcification (DC) is the calcification occurring in degenerated or necrotic tissue, as in hyalinized scars, degenerated foci in leiomyomas, and caseous nodules. This occurs as a reaction to tissue damage, including as a consequence of medical device implantation. Dystrophic calcification can occur even if the amount of calcium in the blood is not elevated, in contrast to metastatic calcification, which is a consequence of a systemic mineral imbalance, including hypercalcemia and/or hyperphosphatemia, that leads to calcium deposition in healthy tissues. In dystrophic calcification, basophilic calcium salt deposits aggregate, first in the mitochondria, then progressively throughout the cell. These calcifications are an indication of previous microscopic cell injury, occurring in areas of cell necrosis when activated phosphatases bind calcium ions to phospholipids in the membrane.

<span class="mw-page-title-main">Cullen's sign</span> Medical condition

Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.

Coagulative necrosis is a type of accidental cell death typically caused by ischemia or infarction. In coagulative necrosis, the architectures of dead tissue are preserved for at least a couple of days. It is believed that the injury denatures structural proteins as well as lysosomal enzymes, thus blocking the proteolysis of the damaged cells. The lack of lysosomal enzymes allows it to maintain a "coagulated" morphology for some time. Like most types of necrosis, if enough viable cells are present around the affected area, regeneration will usually occur. Coagulative necrosis occurs in most bodily organs, excluding the brain. Different diseases are associated with coagulative necrosis, including acute tubular necrosis and acute myocardial infarction.

Pancreatic diseases are diseases that affect the pancreas, an organ in most vertebrates and in humans and other mammals located in the abdomen. The pancreas plays a role in the digestive and endocrine system, producing enzymes which aid the digestion process and the hormone insulin, which regulates blood sugar levels. The most common pancreatic disease is pancreatitis, an inflammation of the pancreas which could come in acute or chronic form. Other pancreatic diseases include diabetes mellitus, exocrine pancreatic insufficiency, cystic fibrosis, pseudocysts, cysts, congenital malformations, tumors including pancreatic cancer, and hemosuccus pancreaticus.

Subcutaneous fat necrosis of the newborn is a rare form of lobular panniculitis occurring in newborns that is usually self-remitting and non-recurring. Proposed causes include perinatal stress, local trauma, hypoxia and hypothermia, though the exact cause is unknown. It has been suggested that the brown fat seen in newborns is more sensitive to hypoxic injury than fat seen in adults, and that such hypoxia, usually in the context of a complicated birth, leads to the fat necrosis. Complications can include hypercalcemia, hyperlipidemia, dehydration, hypoglycemia, seizures, vomiting, constipation, and thrombocytopenia, and can present months after the onset of SCFN symptoms.

<span class="mw-page-title-main">White adipose tissue</span> Fatty tissue composed of white adipocytes

White adipose tissue or white fat is one of the two types of adipose tissue found in mammals. The other kind is brown adipose tissue. White adipose tissue is composed of monolocular adipocytes.

Estrogenic fat is a form of adipose tissue which develops under the influence of estrogen, and particularly estradiol, in women.

Sclerema neonatorum is a rare and severe skin condition that is characterized by diffuse hardening of the subcutaneous tissue with minimal inflammation.

Acquired generalized lipodystrophy (AGL), also known as Lawrence syndrome and Lawrence–Seip syndrome, is a rare skin condition that appears during childhood or adolescence, characterized by fat loss affecting large areas of the body, particularly the face, arms, and legs. There are four types of lipodystrophy based on its onset and areas affected: acquired or inherited, and generalized or partial. Both acquired or inherited lipodystrophy present as loss of adipose tissues, in the absence of nutritional deprivation. The near-total loss of subcutaneous adipose tissue is termed generalized lipodystrophy while the selective loss of adipose tissues is denoted as partial lipodystrophy. Thus, as the name suggests, AGL is a near-total deficiency of adipose tissues in the body that is developed later in life. It is an extremely rare disease with only about 100 cases reported worldwide. There are three main etiologies of AGL suspected: autoimmune, panniculitis-associated, or idiopathic. After its onset, the disease progresses over a few days, weeks, months, or even in years. Clinical presentations of AGL are similar to other lipodystrophies, including metabolic complications and hypoleptinemia. Treatments are also similar and mainly supportive for symptomatic alleviation. Although HIV- or drug-induced lipodystrophy are types of acquired lipodystrophy, their origins are very specific and distinct and hence are usually not discussed with AGL.

<span class="mw-page-title-main">Ductal cells</span>

Ductal cells refer to the epithelial cell lining of the pancreatic duct that deliver enzymes from the acinar cells to the duodenum. They have the essential function of producing bicarbonate-rich (HCO3-) secretion to neutralize stomach acidity. The hormone secretin stimulates ductal cells and is responsible for maintaining the duodenal pH and preventing duodenal injury from acidic chyme. Ductal cells mix their production with acinar cells to make up the pancreatic juice.

Fat removal procedures are used mostly in cosmetic surgery with the intention of removing unwanted adipose tissue. The procedure may be invasive, as with liposuction, or noninvasive using laser therapy, radiofrequency, ultrasound or cold to reduce fat, sometimes in combination with injections.

<span class="mw-page-title-main">Stem cell fat grafting</span>

Stem cellfat grafting is autotransplantation of adipose-derived stem cells (ADSCs) extracted from fat-abundant donor sites to other areas such as the face, breast, and hip to reconstruct the operative areas into desirable shapes. ADSCs are multipotent stem cells found in adipose tissues, displaying similar differentiation potentials to bone marrow-derived mesenchymal stem cells (BM-MSCs).

References

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  2. 1 2 Kumar, Vinay; Abbas, Abul K.; Aster, Jon C., eds. (2015). Robbins and Cotran pathologic basis of disease (Ninth ed.). Philadelphia, PA: Elsevier/Saunders. pp. 43–44. ISBN   978-1-4557-2613-4.
  3. 1 2 3 4 5 Cross, Simon S. (2013). Underwood's Pathology (6th ed.). Churchill Livingstone. p. 85. ISBN   978-0-7020-4672-8.
  4. "https://www.cancer.gov/publications/dictionaries/cancer-terms/def/fat-necrosis". www.cancer.gov. 2011-02-02. Retrieved 2024-06-16.{{cite web}}: External link in |title= (help)
  5. 1 2 Lee, P. C.; Howard, J. M. (May 1979). "Fat necrosis". Surgery, Gynecology & Obstetrics. 148 (5): 785–789. ISSN   0039-6087. PMID   432796.
  6. Kerridge, William D.; Kryvenko, Oleksandr N.; Thompson, Afua; Shah, Biren A. (2015-03-16). "Fat Necrosis of the Breast: A Pictorial Review of the Mammographic, Ultrasound, CT, and MRI Findings with Histopathologic Correlation". Radiology Research and Practice. 2015: 613139. doi: 10.1155/2015/613139 . PMC   4378709 . PMID   25861475.
  7. Genova, Rafaella; Garza, Robert F. (2020), "Breast Fat Necrosis", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   31194348 , retrieved 2020-11-12
  8. Rice, Hannah; Warland, Jane (October 2013). "Bearing Witness: Midwives experiences of witnessing traumatic birth". Women and Birth. 26: S39. doi:10.1016/j.wombi.2013.08.215. ISSN   1871-5192.