Pancreatic Panniculitis Associated with Acinar Cell Pancreatic Carcinoma

Abstract

Background: Pancreatic panniculitis is a rare entity, occurring in less than 2% of patients with pancreatic disorders. Skin manifestations may precede the diagnosis of a pancreatic disease by many months. When treatable, correction of the underlying pancreatic disorder may lead to prompt resolution of the panniculitis.Objective: We present the case of a 74-year-old-man with a history of chronic pancreatitis who presented with an acute onset of tender, nonulcerating nodules. The clinical and histologic features of pancreatic panniculitis are discussed, with a brief review of the differential diagnosis and clinical approach to panniculitis.Conclusions: Pancreatic panniculitis is a recognizable clinical entity with characteristic histologic features that may resolve with treatment of the underlying pancreatic disorder. The algorithm-based clinical approach to panniculitis presented in this study is a practical tool designed to guide clinicians in ordering investigations and determining the appropriate management for patients presenting with subcutaneous nodules.Anté cé dents: La panniculite pancré atique est une condition rare qui survient chez moins de 2 % des patients souffrant d'un trouble du pancré as. Les manifestations cutané es peuvent pré cé der de plusieurs mois le diagnostic d'une maladie du pancré as. Le traitement de la maladie du pancré as sous-jacente, lorsque cette maladie est traitable, peut mener à une prompte gué rison de la panniculite.Objectif: Pré senter le cas d'un homme de 74 ans ayant des anté cé dents de pancré atite chronique qui pré sente une manifestation de nodules douloureux et non ulcé reux. Les caracté ristiques cliniques et histologiques de la panniculite pancré atique sont exposé es, avec un survol rapide du diagnostic diffé rentiel et de l'approche clinique de la panniculite.Conclusions: La panniculite pancré atique est une condition repé rable qui pré sente des caracté ristiques histologiques pré cises et qui peut gué rir à la suite du traitement de la maladie du pancré as sous-jacente. L'approche clinique se fondant sur un algorithme pré senté dans cette é tude repré sente un outil pratique visant à guider les cliniciens dans leur investigation et dans le choix du moyen de gestion approprié des malades pré sentant des nodules sous-cutané s.

Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome: MRI features of intraosseous fat necrosis involving the feet and knees

“…The underlying pancreatic disease is either acute or chronic pancreatitis [1]. Previous reports have shown that a pancreatic mass, such as a pseudopapillary pancreatic tumor, a malignancy (composed of acinar cell types), or a pancreatic pseudocyst, can also cause PPP syndrome [4][5][6][18][19][20]. Our patient had acute pancreatitis, subcutaneous fat necrosis, and polyarthritis, including medullary fat necrosis.…”

“…However, polyarthritis more rarely presents as a complication of pancreatic disease. Therefore, PPP syndrome is extremely rare and presents as a clinical triad of pancreatitis, panniculitis, and polyarthritis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The underlying pancreatic disease is either acute or chronic pancreatitis [1].…”

“…This triad is referred to pancreatitis, panniculitis, and polyarthritis (PPP) syndrome in the literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Despite the rarity of PPP syndrome, it is important to understand and be familiar with its indicators because of the possibility of misdiagnosis or a delayed diagnosis due to absent or mild abdominal symptoms [1,4,7,12,16,17].…”

Pancreatic panniculitis – a cutaneous manifestation of acute pancreatitis

“…1 The later increase the permeability of the microcirculation within lymphatic vessels, allowing other enzymes to enter into fat lobules. Lipase or amylase hydrolize neutral fat resulting in glycerol and free fatty acids accumulation leading to fat necrosis and inflammation.…”

“…1 Its pathogenesis is still not well understood but the release of pancreatic enzymes in the setting of pancreatic injury may play an important role, leading to fat necrosis in subcutaneous tissue and elsewhere. 2 Pancreatic panniculitis typically presents with tender, edematous and erythematous to redbrown subcutaneous nodules that spontaneously ulcerate and exsude an oily brown substance that results from liquefaction necrosis of adipocytes.…”