Abstract Pancreatic lipomas are exceptionally rare benign mesenchymal tumors that may closely resemble well-differentiated liposarcomas on imaging, particularly when large or atypical. We report the case of a 60-year-old man who presented with abdominal pain, nausea, and vomiting, and was found to have a large fat-containing mass in the pancreatic head on computed tomography. Imaging characteristics—including size, mild heterogeneity, and a cystic component—raised strong suspicion for a well-differentiated liposarcoma. Due to diagnostic uncertainty and potential oncologic risk, the patient underwent a pancreaticoduodenectomy (Whipple procedure). Histopathological evaluation revealed a benign pancreatic lipoma composed of mature adipocytes without atypia or lipoblasts. This case highlights the diagnostic limitations of imaging in differentiating benign from malignant fat-containing pancreatic lesions and underscores the essential role of histopathology for definitive diagnosis. Surgical resection remains crucial when imaging is inconclusive or when malignancy cannot be confidently excluded.
Mohammadzadeh et al. (2026) studied this question.