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Zhu WF, Fang S, Qiao JJ. Pancreatic panniculitis as the first presentation of pancreatic ductal adenocarcinoma. Hepatobiliary Pancreat Dis Int 2024; 23:106-108. [PMID: 37640576 DOI: 10.1016/j.hbpd.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Wei-Fang Zhu
- Department of Dermatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shan Fang
- Department of Dermatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jian-Jun Qiao
- Department of Dermatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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2
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El Brihi J, Chee P. Serial lipase measurements in pancreatic panniculitis. BMJ Case Rep 2023; 16:e254370. [PMID: 37899080 PMCID: PMC10619051 DOI: 10.1136/bcr-2022-254370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Pancreatic panniculitis is a rare cutaneous manifestation of pancreatic disease with only scant case reports available to guide management. In this report, a woman in her 60s developed a painful, erythematous and indurated, nodular rash after an episode of acute pancreatitis postendoscopic retrograde cholangiopancreatography (ERCP). While clinically and radiologically the pancreatitis improved with standard conservative management, the panniculitis remained severely debilitating. Repeat testing of serum pancreatic enzymes revealed persistent and marked elevation. Octreotide was started to inhibit pancreatic enzyme release, and the lesions improved, with resolution of the panniculitis correlating with falling serum pancreatic enzyme levels. Hence, serial pancreatic enzyme testing may have utility in monitoring and management of pancreatic panniculitis.
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Affiliation(s)
- Jason El Brihi
- Department of Dermatology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Paul Chee
- Department of Dermatology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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3
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Bashinskaya A, Kammerman J, Butson D, Moody P. Metastatic Pancreatic Acinar Cell Carcinoma: An Unlikely Culprit. Cureus 2023; 15:e38288. [PMID: 37255915 PMCID: PMC10226385 DOI: 10.7759/cureus.38288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 06/01/2023] Open
Abstract
Although acinar cells comprise a large volume of the pancreas, they rarely transform into malignant neoplasms. Once they arise, they rapidly metastasize via hematogenous spread to other organs such as the brain, liver, lung, and skeletal system. Cutaneous involvement, however, is rarely seen in all patients with primary pancreatic neoplasms. The most frequently reported site of cutaneous manifestations is the umbilicus, with the other sites including the trunk, lower extremities, head, and neck. Here, we report a case of metastatic pancreatic acinar cell carcinoma with cutaneous involvement of the patient's scalp.
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Affiliation(s)
- Alena Bashinskaya
- Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Jay Kammerman
- Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - David Butson
- Dermatology, HCA Florida Brandon Hospital, Brandon, USA
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4
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Singh H, Patel P, Parikh S, Zreik H, Caliman N, Kak V. Pancreatitis, panniculitis and polyarthralgia syndrome: A rare complication of pancreatic pathology. Radiol Case Rep 2023; 18:2001-2004. [PMID: 37020599 PMCID: PMC10068013 DOI: 10.1016/j.radcr.2023.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
Pancreatitis, panniculitis, and polyarthralgia (PPP) syndrome is a rare complication of chronic pancreatitis and occurs due to leakage of pancreatic enzymes in the systemic vasculature. This enzyme leakage leads to multiple manifestations such as polyarthralgia, panniculitis, and bone necrosis due to tissue autodigestion.The inciting pancreatic pathology may be masked, and the presentation may be due to one of the systemic consequences of enzyme leakage, which can present as a diagnostic challenge for clinicians. Here we present a patient who presented with nodular lesions and bone necrosis, and was found to have PPP syndrome. Therefore, a proper understanding of pathophysiology and radiology findings can help with prompt diagnosis and early exploration of management options.
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Affiliation(s)
- Harjinder Singh
- Henry Ford Health, Department of Internal Medicine, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
- Corresponding author.
| | - Parth Patel
- Henry Ford Health, Department of Internal Medicine, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
| | - Shamik Parikh
- Henry Ford Health, Department of Internal Medicine, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
| | - Hassan Zreik
- Henry Ford Health, Department of Internal Medicine, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
| | - Neil Caliman
- Henry Ford Health, Department of Pathology, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
| | - Vivek Kak
- Henry Ford Health, Department of Internal Medicine, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
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5
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Mahmoud A, Soliman I, Kania B, Ghrewati M, Baddoura W. Panniculitis and pancreatitis: Inflammation and necrotic mechanisms in a patient with alcohol use disorder and alarming suspicion for malignant process. Radiol Case Rep 2023; 18:1560-1563. [PMID: 36815142 PMCID: PMC9939540 DOI: 10.1016/j.radcr.2023.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/11/2023] Open
Abstract
Panniculitis is an inflammatory process localized to subcutaneous tissue, with etiologies including infection, malignancy, external insults, enzymatic destructive processes, and inflammatory disorders. The incidence of panniculitis manifesting as necrosis of subcutaneous fat tissue associated with pancreatic diseases is low, which may encompass associated periarthritis with bone necrosis and panniculitis (Pancreatitis, panniculitis and polyarthritis syndrome). Pancreatitis, panniculitis and polyarthritis syndrome is considered to derive from the systemic activity of enzymes within the pancreas, which leads to disturbances within the microcirculatory system, and fat necrosis of medullary bone marrow; however, the exact pathophysiology remains unknown. Here, we present a case of a 53-year-old male with a history of chronic pancreatitis who presented with lower abdominal pain found to have osteolytic pelvic lesions considered to be panniculitis secondary to pancreatitis. Our patient provided an interesting clinical picture given his alcohol use disorder, and lytic lesions which lead the team initially towards a malignant etiology of panniculitis such as myeloma; however, given his negative studies, it was presumed his panniculitis was derived from his chronic pancreatitis. Overall, additional literature is warranted regarding the extensive workup of lytic bone lesions that present in patients who have acute vs chronic pancreatitis.
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Affiliation(s)
- Anas Mahmoud
- Department of Internal Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503 USA
| | - Isaac Soliman
- Department of Internal Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503 USA,Corresponding author.
| | - Brooke Kania
- Department of Internal Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503 USA
| | - Moutaz Ghrewati
- Department of Hematology-Oncology, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503 USA
| | - Walid Baddoura
- Department of Gastroenterology, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503 USA
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6
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Lee CL, Holter S, Borgida A, Dodd A, Ramotar S, Grant R, Wasson K, Elimova E, Jang RW, Moore M, Kim TK, Khalili K, Moulton CA, Gallinger S, O’Kane GM, Knox JJ. Germline BRCA2 variants in advanced pancreatic acinar cell carcinoma: A case report and review of literature. World J Gastroenterol 2022; 28:6421-6432. [PMID: 36533108 PMCID: PMC9753052 DOI: 10.3748/wjg.v28.i45.6421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Pancreatic acinar cell carcinoma (PACC) is a rare tumor. Up to 45% of PACCs have alterations in the DNA damage repair pathway and 23% harbor rearrangements in the BRAF or RAF1 genes. We present a PACC case with a germline BRCA2 likely pathogenic variant (LPV) to highlight the impact of genomic testing on treatment decisions and patient outcomes. In our larger case series, we provide clinic-based information on additional 10 PACC patients treated in our center.
CASE SUMMARY A 70-year-old male was diagnosed with advanced PACC. At presentation, he was cachectic with severe arthralgia despite prednisolone and a skin rash that was later confirmed to be panniculitis. He was treated with modified FOLFIRINOX (mFFX) with the knowledge of the germline BRCA2 LPV. Following 11 cycles of mFFX, a computed tomography (CT) scan demonstrated significant tumor response in the pancreatic primary and hepatic metastases, totaling 70% from baseline as per Response Evaluation Criteria in Solid Tumors. Resolution of the skin panniculitis was also noted. We identified two additional PACCs with druggable targets in our case series. Our data contribute to practical evidence for the value of germline and somatic profiling in the management of rare diseases like PACC.
CONCLUSION This patient and others in our larger case series highlight the importance of genomic testing in PACC with potential utility in personalized treatment.
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Affiliation(s)
- Cha Len Lee
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Spring Holter
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Ayelet Borgida
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Anna Dodd
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Stephanie Ramotar
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Robert Grant
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Kristy Wasson
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Elena Elimova
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Raymond W Jang
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Malcolm Moore
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Tae Kyoung Kim
- Department of Medical Imaging, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Korosh Khalili
- Department of Medical Imaging, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Carol-Anne Moulton
- Hepatobiliary/Pancreatic Surgical Program, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Steven Gallinger
- Hepatobiliary/Pancreatic Surgical Program, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Grainne M O’Kane
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
| | - Jennifer J Knox
- Division of Medical Oncology and Hematology, Wallace McCain Center for Pancreatic Cancer, Princess Margaret Cancer Centre, Toronto M5G1Z5, ON, Canada
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Haenen SM, Tol JAMG, van Steen SCJ, Busch OR, Sarasqueta AF, Roshani S, Wolkerstorfer A, van der Linden MMD, Wilmink JW, Post HC, Besselink MG. Painful lower limb nodules as first symptom of resectable pancreatic acinar cell cancer: a case report. J Med Case Rep 2022; 16:356. [PMID: 36195885 PMCID: PMC9533525 DOI: 10.1186/s13256-022-03595-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Pancreatic panniculitis is characterized by subcutaneous fat necrosis and is a rare presentation of an underlying pancreatic disease, appearing in approximately 2-3% of all patients with a pancreatic disease. The nodules usually involve the lower extremities. Pancreatic panniculitis is commonly associated with acute or chronic pancreatitis, and occasionally with pancreatic cancer, especially acinar cell carcinoma. CASE PRESENTATION A 77-year-old Caucasian woman with no significant medical history was referred to our center with multiple painful, itchy, and warm red/blue cutaneous nodules on the left lower leg. These skin lesions were consistent with the clinical diagnosis of panniculitis. The skin biopsy obtained showed a predominantly lobular panniculitis with fat necrosis of which the aspect was highly suspicious for pancreatic panniculitis. Further analysis revealed high lipase serum of > 3000 U/L (normal range < 60 U/L), and on computed tomography scan a mass located between the stomach and the left pancreas was seen. Endoscopic ultrasonography-guided fine-needle biopsy confirmed the diagnosis of acinar cell carcinoma. After discussing the patient in the pancreatobiliary multidisciplinary team meeting, laparoscopic distal pancreatectomy including splenectomy and en bloc wedge resection of the stomach due to tumor in-growth was performed. The cutaneous nodules on both legs disappeared 1-2 days after surgery. No long-term complications were reported during follow-up. One year after surgery, the patient presented with similar symptoms as preoperatively. Computed tomography scan showed local recurrence and distal metastases, which were subsequently confirmed by biopsy. She started with palliative folinic acid-fluorouracil-irinotecan-oxaliplatin chemotherapy but stopped after two cycles because of disease progression. The patient died 2 months later, 13 months after surgical resection. CONCLUSION This case illustrates the importance of clinically recognizing cutaneous nodules and pathological recognizing the specific microscopic changes as sign of a (malignant) pancreatic disease.
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Affiliation(s)
- S M Haenen
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - J A M G Tol
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S C J van Steen
- Department of internal medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - O R Busch
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - A Farine Sarasqueta
- Department of pathology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S Roshani
- Department of pathology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | | | - J W Wilmink
- Department of medical oncology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - H C Post
- Department of medical oncology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
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8
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Yee MD, Patel A, Young KE, Wanat KA. Ulcerated, tender nodules of the lower extremities. JAAD Case Rep 2022; 27:167-169. [PMID: 36106055 PMCID: PMC9464646 DOI: 10.1016/j.jdcr.2022.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Nougnignon Comlan Deguenonvo G, Thiam I. [Multivisceral pancratic cytosteatonecrosis found at autopsy]. Ann Pathol 2021; 42:424-427. [PMID: 34920904 DOI: 10.1016/j.annpat.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/21/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Pancreatic cytosteatonecrosis is a rare condition associated with various pancreatic diseases such as acute or chronic pancreatitis and pancreatic cancer. We report a case of pancreatic cytosteatonecrosis discovered at autopsy. OBSERVATION This is a young man, 29 years old, alcoholic, non-smoker, who consulted for abdominal pain, vomiting, fever (38°). Renal ultrasound showed signs of acute renal failure, with severe anemia at 6g/dl and hyperleukocytosis. Lipasemia has not been tested. The treatment combined hemodialysis, punctures of effusions, analgesics, antibiotics and diuretics. The death occurred after 45 days of hospitalization. The medical autopsy requested showed an abdominal cavity dotted with multiple whitish, chalky, "candle-stained" nodules scattered throughout the peritoneum. Microscopy confirmed the diagnosis by showing large areas of adiponecrosis associated with polymorphic, diffuse leukocyte infiltrates and calcifications. CONCLUSION This observation is original by the discovery at autopsy of one of the major complications of acute pancreatitis. This situation is dramatic because the death could be avoided. You have to think about it in order to ask for the dosage of lipasemia. The "digestion" of pancreatic enzymes are responsible for intra-pancreatic and peri-pancreatic complications. Chronic alcoholism and cholelithiasis are the main risk factors.
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Affiliation(s)
| | - Ibou Thiam
- Laboratoire d'anatomie et de cytologie pathologiques, Pavillon Bichat, C.H.N.U. Aristide Le DANTEC, avenue Pasteur, BP : 3001, Dakar, Sénégal
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10
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Ariga H, Yonezaki S, Kashimura J, Takayashiki N. Pancreatic panniculitis in a patient with pancreatic adenosquamous carcinoma. Clin J Gastroenterol 2020; 14:382-385. [PMID: 33124679 DOI: 10.1007/s12328-020-01269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/10/2020] [Indexed: 11/26/2022]
Abstract
Pancreatic panniculitis is a rare complication of pancreatic diseases. We aimed to evaluate a case of pancreatic panniculitis. A 58-year-old woman was referred to our hospital with complaints of painful cutaneous nodules on her limbs. Various diagnostic tests confirmed pancreatic panniculitis and pancreatic adenosquamous carcinoma. We diagnosed pancreatic panniculitis by a skin nodule biopsy that revealed fine basophilic material within anucleate cells and neutrophil infiltration. Abdominal imaging detected a tumor with necrosis on the pancreas and endoscopic ultrasound-guided fine-needle aspiration revealed it as an adenocarcinoma. The patient underwent pancreatoduodenectomy after neoadjuvant chemotherapy. The tumor was composed of differentiated adenocarcinoma and squamous cell carcinoma and diagnosed as adenosquamous carcinoma. This is the first report of pancreatic panniculitis in a patient with adenosquamous cell carcinoma of the pancreas.
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Affiliation(s)
- Hiroyuki Ariga
- Department of Gastroenterology, Mito Kyodo General Hospital, 3-2-7 Miya-machi, Mito, Ibaraki, 310-0015, Japan.
| | - Syun Yonezaki
- Department of General Medicine, Mito Kyodo General Hospital, Mito, Japan
| | - Junya Kashimura
- Department of Gastroenterology, Mito Kyodo General Hospital, 3-2-7 Miya-machi, Mito, Ibaraki, 310-0015, Japan
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11
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Yasuda MR, Roller LA, Fagenholz PJ, Hoang MP. Case 33-2020: A 55-Year-Old Man with Abdominal Pain, Joint Swelling, and Skin Lesions. N Engl J Med 2020; 383:1664-1671. [PMID: 33085865 DOI: 10.1056/nejmcpc1916257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mariko R Yasuda
- From the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Harvard Medical School - both in Boston
| | - Lauren A Roller
- From the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Harvard Medical School - both in Boston
| | - Peter J Fagenholz
- From the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Harvard Medical School - both in Boston
| | - Mai P Hoang
- From the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Massachusetts General Hospital, and the Departments of Dermatology (M.R.Y.), Radiology (L.A.R.), Surgery (P.J.F.), and Pathology (M.P.H.), Harvard Medical School - both in Boston
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12
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Yamashita Y, Joshita S, Ito T, Maruyama M, Wada S, Umemura T. A case report of pancreatic panniculitis due to acute pancreatitis with intraductal papillary mucinous neoplasm. BMC Gastroenterol 2020; 20:286. [PMID: 32831035 PMCID: PMC7445916 DOI: 10.1186/s12876-020-01430-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pancreatic panniculitis is a rare skin manifestation in pancreatic disease patients that most frequently develops on the lower legs. We report the unique case of a 68-year-old man who suffered from pancreatic panniculitis on his trunk associated with acute pancreatitis due to an intraductal papillary mucinous neoplasm. CASE PRESENTATION A 68-year-old man complained of a 2-day history of a tender subcutaneous nodule on his trunk. Laboratory tests and abdominal contrast computed tomography were consistent with acute pancreatitis due to an intraductal papillary mucinous neoplasm. A skin biopsy of the nodule histologically displayed lobular panniculitis with characteristic "ghost cells", which indicated pancreatic panniculitis. CONCLUSIONS In order to avoid a missed or delayed diagnosis, clinicians should bear in mind that pancreatic panniculitis can be the first manifestation of pancreatic disease when encountering subcutaneous nodules on the trunk.
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Affiliation(s)
- Yuki Yamashita
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Satoru Joshita
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Tetsuya Ito
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Masafumi Maruyama
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Shuichi Wada
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Takeji Umemura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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13
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Clinical characteristics, treatment, and outcome of pancreatitis, panniculitis, and polyarthritis syndrome: a case-based review. Clin Rheumatol 2020; 40:1625-1633. [PMID: 32776311 DOI: 10.1007/s10067-020-05333-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022]
Abstract
A 42-year-old Caucasian female presented with lower limb panniculitis and bilateral ankle arthritis in the absence of abdominal or other localizing symptoms. Abdominal imaging revealed subacute pancreatitis with pseudocyst formation. The clinical manifestations were compatible with pancreatitis, panniculitis, and polyarthritis syndrome (PPP syndrome), a very rare complication of pancreatic disease. The patient improved with conservative treatment for the pancreatic disease and systemic corticosteroids for the cutaneous and articular manifestations. We identified 59 patients with the PPP syndrome from the literature, the majority of patients being male (74.6%) with a median age of 49 (IQR 41-63.5) years. Acute pancreatitis is the most frequent underlying disorder (54.2%), but gastrointestinal symptoms are absent in 45.8% of patients. Pancreatic panniculitis has a predilection for the lower limbs, which are affected in 98.3% of cases. However, the cutaneous lesions may also involve the upper limbs and trunk. Arthritis is typically symmetric and polyarticular in nature, affecting both large and small joints. Of all patients who received treatment, 78.6% had a poor response. Death occurred in 27.1% of cases after a median duration of 8 (IQR 3.5-14) weeks.
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14
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Kim EJ, Park MS, Son HG, Oh WS, Moon KW, Park JM, Kang CD, Lee S. Pancreatitis, Panniculitis, and Polyarthritis Syndrome Simulating Cellulitis and Gouty Arthritis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 74:175-182. [DOI: 10.4166/kjg.2019.74.3.175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/28/2019] [Accepted: 06/15/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Ee Jin Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Min Soo Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hyung-Gon Son
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Won Sup Oh
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ki Won Moon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jin Myung Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Chang Don Kang
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seungkoo Lee
- Department of Anatomic Pathology, Kangwon National University School of Medicine, Chuncheon, Korea
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15
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Pancreatic Panniculitis: A Series of 4 Cases Associated With Pancreatic and Ampullary Disease. Pancreas 2018; 47:e62-e64. [PMID: 30199491 DOI: 10.1097/mpa.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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16
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Affiliation(s)
- Sanminder Singh
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Farzam Gorouhi
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Thomas Konia
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Barbara Burrall
- Department of Dermatology, University of California, Davis, Sacramento, California
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17
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Montes de Oca MK, Jamison RA. Pancreatic panniculitis as the initial presentation of intrahepatic cholangiocarcinoma. JAAD Case Rep 2018; 4:528-530. [PMID: 30023419 PMCID: PMC6047103 DOI: 10.1016/j.jdcr.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mary Katherine Montes de Oca
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina
- Samford University, Birmingham, Alabama
| | - Richard Andrew Jamison
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina
- Division of Dermatology, Greenville Health System, Greenville, South Carolina
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18
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Costa JM, Costa RS, Carvalho SD. Tender red subcutaneous nodules in an adult female: a challenging diagnosis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018. [PMID: 29527902 DOI: 10.17235/reed.2018.5472/2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pancreatic panniculitis is an uncommon and rare skin complication of systemic fat necrosis associated with pancreatitis post-ampullectomy. Besides the rarity of the condition, the clinical history and physical examination for diagnosis is also important.
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19
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Guanziroli E, Colombo A, Coggi A, Gianotti R, Marzano AV. Pancreatic panniculitis: the "bright" side of the moon in solid cancer patients. BMC Gastroenterol 2018; 18:1. [PMID: 29301491 PMCID: PMC5755411 DOI: 10.1186/s12876-017-0727-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022] Open
Abstract
Background Pancreatic panniculitis is a rare complication of pancreas disorders occurring in 0.3–3% of patients, most often accompanied by the pancreatic acinar carcinoma. It presents multiple, painful, deep, ill-defined, red-brown, migratory nodules and plaques of hard elastic consistency; often ulcerated and typically located on the lower proximal and distal extremities. The pathogenesis is not fully understood, but it is thought to result from lipolysis and fat necrosis with secondary tissue inflammation induced by pancreatic enzymes. Histopathology shows subcutaneous lobular fat necrosis with anuclear adipocytes (called ghost cells) surrounded by a mixed inflammatory infiltrate. Focal calcification may also be seen. The treatment is directed to the underlying disorder, which may result in regression of skin lesions. Case presentation We present two cases of pancreatic panniculitis with similar clinical, laboratory, and histopathological features associated with different internal malignancy. The first case, after extensive investigations showed the presence of a pancreatic carcinoma with multiple liver metastases and a poor prognosis. The second one instead is the first case in literature where painful subcutaneous nodules of the legs were the early manifestation of a neuroendocrine carcinoma of the adrenal gland. Conclusions Although subcutaneous fat necrosis usually occurs late in the course of a malignancy, recognition of the association with pancreatic panniculitis may prevent a long delay in the diagnosis and management of the occult neoplasm. It should be primarily considered when panniculitis is widespread and persistent, and frequent relapses or tendency to ulcerate of the nodules are regarded as red flags.
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Affiliation(s)
- Elena Guanziroli
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, I.R.C.C.S. Fondazione Cà Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122, Milan, Italy.
| | - Antonella Colombo
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, I.R.C.C.S. Fondazione Cà Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122, Milan, Italy
| | - Antonella Coggi
- Unità Operativa di Dermatologia, I.R.C.C.S. Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaele Gianotti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, I.R.C.C.S. Fondazione Cà Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122, Milan, Italy
| | - Angelo Valerio Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, I.R.C.C.S. Fondazione Cà Granda, Ospedale Maggiore Policlinico, via Pace 9, 20122, Milan, Italy
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20
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King T, Rabindranathnambi R, Van Schalkwyk GS. An uncommon cause of panniculitis. Clin Exp Dermatol 2017; 43:351-353. [PMID: 29230861 DOI: 10.1111/ced.13322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 11/28/2022]
Affiliation(s)
- T King
- Department of Dermatology, Derby Teaching Hospitals, London Road Community Hospital, London Road, Derby, UK
| | - R Rabindranathnambi
- Department of Dermatology, Derby Teaching Hospitals, London Road Community Hospital, London Road, Derby, UK
| | - G S Van Schalkwyk
- Department of Dermatology, Derby Teaching Hospitals, London Road Community Hospital, London Road, Derby, UK
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21
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Rao P, Coffman N, Ferreira JP. A Diagnostic Dilemma in a Patient with Polyarthritis. Am J Med 2017; 130:e497-e498. [PMID: 28545884 DOI: 10.1016/j.amjmed.2017.04.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Prashant Rao
- Department of Internal Medicine, University of Arizona, Tucson.
| | - Nathan Coffman
- Department of Internal Medicine, University of Arizona, Tucson
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22
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Evans AC, Singhi AD, Zeh HJ, Bahary N, Brand RE. An Unexpected Etiology of Pancreatic Panniculitis: A Case Report. J Pancreat Cancer 2017; 3:1-4. [PMID: 29082362 DOI: 10.1089/crpc.2016.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pancreatic panniculitis is a rare cause of subcutaneous fat necrosis secondary to elevated serum levels of pancreatic enzymes. It is most often associated with pancreatic acinar cell carcinoma, but has also been seen in patients with pancreatitis. CASE REPORT We present a case of a 64 year old Caucasian man without symptoms of pancreatitis who presents with pancreatic panniculitis manifesting in multiple subcutaneous ulcerating nodules of the bilateral lower extremities, discovered to have a previously unreported etiology for this condition. He had no evidence of pancreatitis or malignancy, but instead a pancreatic-portal fistula resulting in panniculitis. CONCLUSION Peripancreatic vascular lesions must also be considered in the differential diagnosis of pancreatic panniculitis. The diagnosis, pathology, and treatment of pancreatic panniculitis are reviewed herein.
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Affiliation(s)
- A C Evans
- Division of Gastroenterology and Hepatology, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213
| | - A D Singhi
- Department of Pathology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Scaife Hall A616.2, Pittsburgh, PA 15213
| | - H J Zeh
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 414, Pittsburgh, PA 15232
| | - N Bahary
- Department of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213
| | - R E Brand
- Division of Gastroenterology and Hepatology, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213
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Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome: MRI features of intraosseous fat necrosis involving the feet and knees. Skeletal Radiol 2017; 46:279-285. [PMID: 27928580 DOI: 10.1007/s00256-016-2549-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 02/08/2023]
Abstract
Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is extremely rare and presents as a triad of the three diseases. The patient usually presents with mild or absent abdominal symptoms. Here, we report on a case of a 66-year-old male who presented with pain and swelling in both legs and mild abdominal pain. He was diagnosed with acute pancreatitis by pancreatic enzyme analysis and abdominal computed tomography (CT) and with skin lesions of panniculitis through a biopsy. Magnetic resonance imaging (MRI) revealed multifocal intraosseous fat necrosis and arthritis involving both the feet and the knees. Therefore, we report a case of PPP syndrome with intraosseous fat necrosis involving both the feet and the knees.
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24
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Dieker W, Derer J, Henzler T, Schneider A, Rückert F, Wilhelm TJ, Krüger B. Pancreatitis, panniculitis and polyarthritis (PPP-) syndrome caused by post-pancreatitis pseudocyst with mesenteric fistula. Diagnosis and successful surgical treatment. Case report and review of literature. Int J Surg Case Rep 2017; 31:170-175. [PMID: 28152495 PMCID: PMC5288313 DOI: 10.1016/j.ijscr.2017.01.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/15/2017] [Accepted: 01/16/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Pancreatitis, panniculitis and polyarthritis syndrome is a very rare extra-pancreatic complication of pancreatic diseases. PRESENTATION OF CASE While in most cases this syndrome is caused by acute or chronic pancreatitis, we report a case of a 62-year-old man presenting with extensive intraosseous fat necrosis, polyarthritis and panniculitis caused by a post-pancreatitis pseudocyst with a fistula to the superior mesenteric vein and extremely high blood levels of lipase. This became symptomatic 2.5 years after an episode of acute pancreatitis and as in most cases abdominal symptoms were absent. Treatment by surgical resection of the pancreatic head with the pseudocyst and mesenteric fistula led to complete remission of all symptoms. DISCUSSION A review of the literature revealed that all publications are limited to case reports. Most authors hypothesize that an unspecific damage can cause a secretion of pancreatic enzymes to the bloodstream leading to a systemic lipolysis and fat tissue necrosis, especially of subcutaneous tissue, bone marrow, inducing panniculitis, polyarthritis and osteonecrosis. Even if caused by an acute pancreatitis abdominal symptoms are often mild or absent in most cases leading to misdiagnosis and poor prognosis. CONCLUSION While symptomatic treatment with NSAR and cortisone showed poor to moderate response, causal treatment can be successful depending on the underlying pancreatic disease.
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Affiliation(s)
- Wulf Dieker
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Johannes Derer
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Thomas Henzler
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Alexander Schneider
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Felix Rückert
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Torsten J Wilhelm
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Bernd Krüger
- University Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
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25
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Kim HR, Ahn JS, Noh JH, Jeon HJ, Oh JS, Choi SW, Lim DH. Pancreatic Neuroendocrine Tumor Presenting with Arthritis and Panniculitis. JOURNAL OF RHEUMATIC DISEASES 2017. [DOI: 10.4078/jrd.2017.24.5.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Hyung Rae Kim
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jae-Sung Ahn
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jin-Hee Noh
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hee-jeong Jeon
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ji Seon Oh
- Division of Rheumatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Seung Won Choi
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Doo-Ho Lim
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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26
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Evans AC, Singhi AD, Zeh HJ, Bahary N, Brand RE. An Unexpected Etiology of Pancreatic Panniculitis: A Case Report. J Pancreat Cancer 2017. [PMID: 29082362 PMCID: PMC5656292 DOI: 10.1089/pancan.2016.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Pancreatic panniculitis is a rare cause of subcutaneous fat necrosis secondary to elevated serum levels of pancreatic enzymes. It is most often associated with pancreatic acinar cell carcinoma, but has also been seen in patients with pancreatitis. Case report: We present a case of a 64-year-old Caucasian man without symptoms of pancreatitis, who presents with pancreatic panniculitis manifesting in multiple subcutaneous ulcerating nodules of the bilateral lower extremities, discovered to have a previously unreported etiology for this condition. He had no evidence of pancreatitis or malignancy, but instead a pancreatic-portal fistula resulting in panniculitis. Conclusion: Peripancreatic vascular lesions must also be considered in the differential diagnosis of pancreatic panniculitis. The diagnosis, pathology, and treatment of pancreatic panniculitis are reviewed herein.
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Affiliation(s)
- Anna C. Evans
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, UPMC Presbyterian, Pittsburgh, Pennsylvania
- Address correspondence to: Anna C. Evans, MD, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, UPMC Presbyterian, Mezzanine Level, 200 Lothrop Street, Pittsburgh, PA 15213, E-mail:
| | - Aatur D. Singhi
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Herbert J. Zeh
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Nathan Bahary
- Department of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Randall E. Brand
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, UPMC Presbyterian, Pittsburgh, Pennsylvania
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27
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Agarwal S, Nelson JE, Stevens SR, Gilliam AC. An Unusual Case of Cutaneous Pancreatic Fat Necrosis. J Cutan Med Surg 2016. [DOI: 10.1177/120347540200600103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Cutaneous pancreatic fat necrosis is a pathognomonic sign for pancreatic disease and usually presents as subcutaneous nodules in the pretibial region. Objective: A case of cutaneous pancreatic fat necrosis is presented in which the clinical presentation of diffuse erythema was unusual. This disease is discussed and its possible etiologies are reviewed. Methods: A MEDLINE search for cases of cutaneous pancreatic fat necrosis presenting as diffuse erythema without nodules was conducted. Results: Diffuse erythema is an unusual presentation of cutaneous pancreatic fat necrosis. Conclusion: This may be the first case of cutaneous pancreatic fat necrosis presenting as diffuse erythema.
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Affiliation(s)
- Smita Agarwal
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jennell E. Nelson
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Seth R. Stevens
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anita C. Gilliam
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
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28
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Menzies S, McMenamin M, Barnes L, O'Toole D. Pancreatic panniculitis preceding acute pancreatitis and subsequent detection of an intraductal papillary mucinous neoplasm: A case report. JAAD Case Rep 2016; 2:244-6. [PMID: 27408933 PMCID: PMC4927540 DOI: 10.1016/j.jdcr.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Mairin McMenamin
- Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - Louise Barnes
- Department of Dermatology, St James's Hospital, Dublin, Ireland
| | - Dermot O'Toole
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
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29
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Zundler S, Erber R, Agaimy A, Hartmann A, Kiesewetter F, Strobel D, Neurath MF, Wildner D. Pancreatic panniculitis in a patient with pancreatic-type acinar cell carcinoma of the liver--case report and review of literature. BMC Cancer 2016; 16:130. [PMID: 26895632 PMCID: PMC4761203 DOI: 10.1186/s12885-016-2184-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
Background Pancreatic panniculitis is a rare condition, which has only been described in relation with pancreatic diseases up to now. It is characterized by necrotizing subcutaneous inflammation and is thought to be triggered by adipocyte necrosis due to systemic release of pancreatic enzymes with consecutive infiltration of neutrophils. We present the first case of a patient with pancreatic panniculitis caused by pancreatic-type primary acinar cell carcinoma (ACC) of the liver and without underlying pancreatic disease. Case presentation A 73-year old Caucasian female patient was referred to our department with painful cutaneous nodules persisting for eight weeks and with marked lipasemia (~15000 U/l; normal range <60 U/l). Four weeks prior, several liver lesions had been detected. Empiric treatment with steroids did not show any effect. A biopsy of the skin nodules revealed “pancreatic” panniculitis, while abdominal imaging with ultrasound, computed tomography and magnetic resonance imaging detected no abnormal pancreatic findings. Ultrasound-guided biopsy of the liver lesions showed infiltrates of an ACC. The patient died soon thereafter. Autopsy failed to reveal any other primary for the ACC, so that a pancreatic-type ACC of the liver was diagnosed by exclusion. One hundred thirty cases of pancreatic panniculitis published within the last 20 years are reviewed. ACC of the pancreas is the most common underlying neoplastic condition. Patients with associated neoplasm are significantly older, take longer to be diagnosed and have higher lipase levels than patients with underlying pancreatitis. Extrapancreatic pancreatic-type ACC is very rare, but shows the same biological features as ACC of the pancreas. It is believed to develop from metaplastic or ectopic pancreatic tissue. Up to now, no pancreatic panniculitis in extrapancreatic ACC has been described. Conclusion Pancreatic panniculitis should always be included in the differential diagnosis of lipolytic panniculitic lesions. It can be regarded as a facultative paraneoplastic phenomenon. When suspected, a thorough work-up for identification of the underlying disease is mandatory and extrapancreatic lesions (e.g. liver) should also be considered. While administration of octreotide or steroids can sometimes alleviate symptoms, immediate treatment of the associated condition is the only effective management option.
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Affiliation(s)
- Sebastian Zundler
- Department of Medicine 1, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Ramona Erber
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | | | - Deike Strobel
- Department of Medicine 1, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Markus F Neurath
- Department of Medicine 1, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Dane Wildner
- Department of Medicine 1, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
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30
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Polyarthritis and pancreatic panniculitis associated with pancreatic carcinoma: review of the literature. J Clin Rheumatol 2015; 20:433-6. [PMID: 25417680 DOI: 10.1097/rhu.0000000000000181] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pancreatic disorders, such as chronic or acute pancreatitis, and carcinoma may be infrequently accompanied or preceded by panniculitis or polyarthritis. This triad is known in the literature as the pancreatitis, panniculitis, and polyarthritis syndrome. Although the pancreatic disease of pancreatitis, panniculitis, and polyarthritis syndrome usually includes pancreatitis, here we review the literature with report of 1 additional case of polyarthritis and panniculitis occurring in the presence of pancreatic carcinoma. Given that the diagnosis is often difficult when abdominal symptoms are absent, knowledge of the association between panniculitis and polyarthritis with pancreatic disease may lead to a prompt diagnosis and management. The histopathology of the skin lesions can be a valuable clue for focusing attention to a pancreatic disease.
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31
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Loverdos I, Swan MC, Shekherdimian S, Al-Rasheed AA, Schneider R, Fish JS, Ngan BY, Adeli K, Lowe ME, Singh VP, Sevilla WMA, Langer JC, Gonska T. A case of pancreatitis, panniculitis and polyarthritis syndrome: Elucidating the pathophysiologic mechanisms of a rare condition. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015; 3:223-226. [PMID: 27182490 PMCID: PMC4864014 DOI: 10.1016/j.epsc.2015.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Pancreatitis-Panniculitis-Polyarthritis (PPP) syndrome is rare and its physiopathology unclear. A 6-year old boy suffered of traumatic pancreatitis complicated by PPP syndrome. Extensive investigations demonstrated high levels of pancreatic lipase and fatty acids in the affected peripheral tissues. These findings support the sequence of peripheral lipolysis and fatty acid accumulation inducing tissue inflammation.
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Affiliation(s)
- Ines Loverdos
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Marc C Swan
- Division of Plastic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Shant Shekherdimian
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Abdulrahman A Al-Rasheed
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Rayfel Schneider
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Joel S Fish
- Division of Plastic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Bo-Yee Ngan
- Division of Pathology, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Khosrow Adeli
- Division of Clinical Biochemistry, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mark E Lowe
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vijay P Singh
- Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - Wednesday Marie A Sevilla
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jacob C Langer
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tanja Gonska
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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32
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Callata-Carhuapoma HR, Pato Cour E, Garcia-Paredes B, Fernandez RM, Mendoza Fernandez ML, Fernandez AM, De La Rosa CA, Sotelo Lezama MJ, Cabezas-Camarero S, Sastre Varela J. Pancreatic acinar cell carcinoma with bilateral ovarian metastases, panniculitis and polyarthritis treated with FOLFIRINOX chemotherapy regimen. A case report and review of the literature. Pancreatology 2015; 15:440-4. [PMID: 25959244 DOI: 10.1016/j.pan.2015.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 02/08/2023]
Abstract
Pancreatic acinar cell carcinoma (PACC) is a rare pancreatic tumor, with an estimated frequency of less than 1% of pancreatic malignancies. There are no prospective studies to guide diagnostic or therapeutic algorithms. We report the case of a 36 year-old woman, diagnosed of a pancreatic tumor with liver and peritoneal metastases that was initially managed as a neuroendocrine tumor with temozolomide and capecitabine. After two cycles a severely painful arthritis developed in her left ankle with panniculitis and extensive fat necrosis, and CT scan demonstrated progressive disease. Pathology of the primary was reassessed establishing the diagnosis of PACC. The patient started treatment with FOLFIRINOX regimen, achieving clinical benefit and disease stabilization. We also briefly reviewed the literature on this rare subtype of pancreatic tumor.
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33
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Beveridge M, Pei S, Tsoukas MM. Pancreatic panniculitis in a pancreas-kidney transplant patient resolved after immunosuppression increase: Case report and review of literature. JAAD Case Rep 2015; 1:101-5. [PMID: 27051698 PMCID: PMC4802559 DOI: 10.1016/j.jdcr.2015.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mara Beveridge
- University of Chicago, Department of Medicine, Section of Dermatology, Chicago, Illinois
| | - Susan Pei
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Maria M Tsoukas
- University of Illinois at Chicago, Department of Dermatology, Chicago, Illinois
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34
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Neves Z, Segura Ú, Valente A, Pacheco MH, Malhado J. Panniculitis - A Rare Manifestation of Acute Pancreatitis. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:117-120. [PMID: 28868388 PMCID: PMC5580174 DOI: 10.1016/j.jpge.2015.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/31/2015] [Indexed: 01/27/2023]
Abstract
Pancreatic panniculitis is a rare skin disorder that occurs in 2-3% of pancreatic diseases, mostly associated with acute or chronic pancreatitis. Its pathophysiology is still unclear, but the release of pancreatic enzymes in circulation can be responsible for this disorder. The typical histological features are adipocyte necrosis with neutrophils infiltrate and typical "ghost cells". Its treatment, clinical course and prognosis are usually related with the pancreatic disease. We present a case of a 39-year-old man who presented with fever, abdominal pain, nausea and vomiting after a copious alcohol ingestion. Acute alcohol-induced pancreatitis was diagnosed. 9 days after admission he developed tender erythematous subcutaneous nodules, whose biopsy was consistent with pancreatic panniculitis. There was clinical and laboratory improvement with supportive treatment as well as skin nodules regression. Although pancreatic panniculitis is a rare condition, physicians must be aware of it to avoid delay in the diagnosis.
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Affiliation(s)
- Zélia Neves
- Medicine Department 7.1, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Úrsula Segura
- Medicine Department 7.1, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - André Valente
- Medicine Department 7.1, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - M Helena Pacheco
- Medicine Department 7.1, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - José Malhado
- Medicine Department 7.1, Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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35
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Gregory MH, Henderson A, Klostermeyer K, Esmadi M, Yousef M, Ewing D, Braudis KM, Katta N. Recurrent pancreatitis, rash, and diarrhea: Crohn's disease. Am J Med 2015; 128:133-6. [PMID: 25448173 DOI: 10.1016/j.amjmed.2014.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 10/14/2014] [Accepted: 10/15/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Mohammad Esmadi
- Department of Medicine, University of Missouri School of Medicine, Columbia
| | - Mohamed Yousef
- Department of Medicine, University of Missouri School of Medicine, Columbia
| | - David Ewing
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia
| | - Kara M Braudis
- Department of Dermatology, University of Missouri School of Medicine, Columbia
| | - Natraj Katta
- Department of Medicine, University of Missouri School of Medicine, Columbia.
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36
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Chan MP. Neutrophilic panniculitis: algorithmic approach to a heterogeneous group of disorders. Arch Pathol Lab Med 2014; 138:1337-43. [PMID: 25268197 DOI: 10.5858/arpa.2014-0270-cc] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Neutrophilic panniculitis encompasses an etiologically and morphologically heterogeneous group of disorders. Correct histopathologic diagnosis is important in identifying certain systemic diseases and guiding appropriate treatment. OBJECTIVE To review the clinical and histopathologic features of different types of neutrophilic panniculitis, and to provide a diagnostic algorithm for these disorders. DATA SOURCES A review of the literature with emphasis on the distinguishing features of different entities was performed. CONCLUSIONS Evaluation for neutrophilic panniculitis entails paying close attention to the pattern of inflammation, the type of fat necrosis present, any evidence of vascular damage, and other relevant histopathologic features. An algorithmic approach integrating all histopathologic, clinical, and laboratory findings is required for correct diagnosis.
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Affiliation(s)
- May P Chan
- From the Department of Pathology, University of Michigan, Ann Arbor
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37
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Arenbergerova M, Alexandrova P, Gkalpakiotis S, Gkalpakiotis D, Svanda J, Sticova E, Kujal P, Srp A, Arenberger P. [Pancreatic panniculitis with multiple osteolytic lesions]. Hautarzt 2014; 66:114-6. [PMID: 25325989 DOI: 10.1007/s00105-014-3514-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 62-year-old man with a history of chronic alcohol abuse presented with severe pancreatic panniculitis associated with an acute exacerbation of chronic pancreatitis.
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Affiliation(s)
- M Arenbergerova
- Dermatologische Klinik der Dritten medizinischen Fakultät der Karls-Universität, Ruská 87, 100 34, Prag 10, Tschechische Republik,
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38
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Endoscopic Retrograde Cholangiopancreatography as a Risk Factor for Pancreatic Panniculitis in a Post-Liver Transplant Patient. ACG Case Rep J 2014; 2:36-8. [PMID: 26157900 PMCID: PMC4435344 DOI: 10.14309/crj.2014.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 08/19/2014] [Indexed: 11/23/2022] Open
Abstract
Post endoscopic retrograde cholangiopancreatography (ERCP) pancreatic panniculitis is a rare condition caused by fat necrosis following release of pancreatic enzymes into the bloodstream. No previous reports of pancreatic panniculitis have been reported in post-liver transplant subjects undergoing ERCP. We present a 63-year-old cryptogenic cirrhotic female post-cadaveric liver transplant who underwent ERCP for suspected biliary stricture and subsequently developed pancreatic panniculitis.
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39
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Holt BA, Hawes R, Varadarajulu S. Hemosuccus pancreaticus caused by superior mesenteric artery fistula presenting as pancreatic panniculitis and anemia. Clin Gastroenterol Hepatol 2014; 12:e97-8. [PMID: 24681082 DOI: 10.1016/j.cgh.2014.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Bronte A Holt
- Florida Hospital Center for Interventional Endoscopy, Orlando, Florida
| | - Robert Hawes
- Florida Hospital Center for Interventional Endoscopy, Orlando, Florida
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40
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Sotoude H, Mozafari R, Mohebbi Z, Mirfazaelian H. "Pancreatic panniculitis". Am J Emerg Med 2014; 32:944.e1-2. [PMID: 24602897 DOI: 10.1016/j.ajem.2014.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 01/15/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- Hamed Sotoude
- Department of Emergency Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Rambod Mozafari
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mohebbi
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Mirfazaelian
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
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41
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Dinis-Oliveira RJ, Magalhães T, Moreira R, Proença JB, Pontes H, Santos A, Duarte JA, Carvalho F. Clinical and forensic signs related to ethanol abuse: a mechanistic approach. Toxicol Mech Methods 2013; 24:81-110. [PMID: 24274640 DOI: 10.3109/15376516.2013.869782] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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42
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Souza FHDMD, Siqueira EBD, Mesquita L, Fabricio LZ, Tuon FF. Pancreatic panniculitis as the first manifestation of visceral disease--case report. An Bras Dermatol 2012; 86:S125-8. [PMID: 22068791 DOI: 10.1590/s0365-05962011000700033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 04/26/2011] [Indexed: 11/22/2022] Open
Abstract
Pancreatic panniculitis is a rare pathological condition affecting 2-3% of patients with pancreatic disease. In 40% of cases the condition precedes manifestations of pancreatic disease. We report the case of a 71-year-old female who presented with an erythematous tender node which had appeared one month previously, progressing to ulceration and yellowish exudation. No abdominal symptoms. Biopsy revealed fat necrosis and vacuolated macrophages represented by amorphous amphophilic areas. Laboratory examination and CT scan revealed chronic pancreatitis. It is assumed that release of pancreatic enzymes such as trypsin may enhance the permeability of the microcirculation leading to lipase and amylase causing the subcutaneous fat necrosis observed in the lesions. Histology showed "ghost cells" and, firstly, septal panniculitis, followed later by lobular panniculitis. Treatment focused on resolution of the underlying pancreatic disease.
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43
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Simon M, Bioulac-Sage P, Trillaud H, Blanc JF. FOLFOX regimen in pancreatic acinar cell carcinoma: case report and review of the literature. Acta Oncol 2012; 51:403-5. [PMID: 21961498 DOI: 10.3109/0284186x.2011.617388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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44
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Marengo MF, Suarez-Almazor ME, Lu H. Neoplastic and Paraneoplastic Synovitis. Rheum Dis Clin North Am 2011; 37:551-72. [DOI: 10.1016/j.rdc.2011.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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45
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Abstract
Pancreatic panniculitis is an uncommon cause of panniculitis. It is associated with acute or chronic pancreatic disease. 1½ year old boy was referred for erythematous tender nodules involving both legs and associated with abdominal distention, fever, and vomiting. Dermatological examination revealed multiple erythematous tender nodules distributed over front and back of legs. Blood chemistry showed raised serum amylase (430 IU/ 1). Ultrasonography showed a pseudopancreatic cyst. Multislice CT scan was suggestive of a pseudopancreatic cyst. A skin biopsy showed typical features of pancreatic panniculitis which included lobular panniculitis with lipocyte degeneration with few Ghost cells.
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46
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Pancreatic panniculitis after endoscopic retrograde cholangiopancreatography. J Am Acad Dermatol 2011; 64:e72-4. [PMID: 21496686 DOI: 10.1016/j.jaad.2010.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 03/01/2010] [Accepted: 03/28/2010] [Indexed: 11/24/2022]
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47
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Zheng ZJ, Gong J, Xiang GM, Mai G, Liu XB. Pancreatic panniculitis associated with acinar cell carcinoma of the pancreas: a case report. Ann Dermatol 2011; 23:225-8. [PMID: 21747626 DOI: 10.5021/ad.2011.23.2.225] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 06/04/2010] [Accepted: 06/04/2010] [Indexed: 02/05/2023] Open
Abstract
Pancreatic panniculitis is a rare type of disorder associated with pancreatic diseases. We describe here a case of 54-year-old man who was admitted to the Department of Dermatology with the diagnosis of erythema nodosum. The patient presented with a 9-month history of painful erythematous nodules on the extremities, joint pain and swelling, and weight loss. A highly elevated level of pancreatic lipase was found on the laboratory examinations. The biopsy specimens from the skin lesions showed subcutaneous fat necrosis. Abdominal computed tomography (CT) revealed a large mass with central necrosis in the body and tail of the pancreas. Distal pancreatectomy, splenectomy and partial transverse colectomy were successfully performed on day 17 of the hospitalization. The histopathologic findings supported the diagnosis of acinar cell carcinoma of the pancreas (ACCP). Postoperatively, the level of serum lipase returned to normal, and the skin lesions and joint manifestations gradually regressed. However, the swelling did not significantly resolve in the left knee. In view of the non-specific clinical presentation of this disease, clinicians should be alert and have a high index of suspicion for pancreatic panniculitis.
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Affiliation(s)
- Zhen Jiang Zheng
- Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
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48
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Makni A, Chebbi F, Ayadi S, Rebai W, Daghfous A, Mlika M, Fterich F, Bedioui H, Ksantini R, Jouini M, Kacem M, Khir N, Safta ZB. Acinar cell carcinoma of the pancreas: a rare tumor with a particular clinical and paraclinical presentation. Clin Res Hepatol Gastroenterol 2011; 35:414-7. [PMID: 21316330 DOI: 10.1016/j.clinre.2010.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 11/16/2010] [Accepted: 11/23/2010] [Indexed: 02/04/2023]
Abstract
Acinar cell carcinoma (ACC) of the pancreas is a rare tumor with an extremely low incidence rate. While the number of reported patients with ACC is relatively small, a long-term survival rate has been noted in patients with neuroendocrine differentiation. A 39-year-old woman visited our emergency department for upper gastrointestinal bleeding. Endoscopy indicated extrinsic compression of the posterior body of the stomach, together with a large, 10-cm, central ulcer covered with necrotic tissue. Abdominal computed tomography (CT) indicated a lesion that involved the whole of the pancreas, with a fistula in the stomach, which was suspected of being a degenerative intraductal papillary mucinous tumor of the pancreas. Magnetic resonance imaging (MRI) of the pancreas was performed, and the results further strengthened our suspicions by demonstrating the presence of cystic lesions and tumor buds. A total duodenopancreatectomy, including total splenectomy and gastrectomy, was performed, along with two independent Roux-en-Y anastomoses (one esojejunal and one hepaticojejunal). The tumor also had a wide opening in the stomach. The patient's postoperative course was marked by partial thrombosis of the portal vein, which was treated medically. Histopathological examination provided evidence of pancreatic ACC. The diagnosis of ACC should be considered in the presence of cutaneous lesions, which were absent in the case of our patient, and colonoscopy is also highly desirable because of the various forms associated with familial adenomatous polyposis. The prognosis, which includes a 5-year survival rate of 45%, in the population with an R0 resection is better than that for ductular adenocarcinoma, thus prompting the more aggressive management of this type of tumor.
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Affiliation(s)
- Amin Makni
- Service de chirurgie générale A, hôpital La Rabta, Jabbari 1007, Tunis, Tunisia.
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49
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Jacobson-Dunlop E, Takiguchi R, White CR, White KP. Fatal Pancreatitis Presenting as Pancreatic Panniculitis without Enzyme Elevation. J Cutan Pathol 2011. [DOI: 10.1111/j.1600-0560.2011.01725_2.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Lyon MJ. Metabolic panniculitis: alpha-1 antitrypsin deficiency panniculitis and pancreatic panniculitis. Dermatol Ther 2010; 23:368-74. [PMID: 20666824 DOI: 10.1111/j.1529-8019.2010.01337.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Panniculitis can be the initial presentation of both alpha-1 antitrypsin deficiency and pancreatic disease. They can both present with abscess-like draining nodules, but may present like other forms of panniculitis with erythematous nodules. It is important to consider these in the differential diagnosis of patients presenting with panniculitis. Alpha-1 antitrypsin deficiency is a relatively common disorder mainly affecting the lungs and liver. It frequently goes undiagnosed, yet critical interventions can be made to minimize disease progression. Panniculitis associated with alpha-1 antitrypsin deficiency can be difficult to treat. Pancreatic panniculitis occurs in less than 3% of patients with underlying pancreatic disease and is often associated with arthritis. Diagnosis and treatment of the underlying pancreatic disease is imperative.
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Affiliation(s)
- Milena J Lyon
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA.
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