Ann Dermatol.  2011 May;23(2):225-228. 10.5021/ad.2011.23.2.225.

Pancreatic Panniculitis Associated with Acinar Cell Carcinoma of the Pancreas: A Case Report

• Zheng ZJ
• Gong J
• Xiang GM
• Mai G
• Liu XB

• KMID: 2156669
• DOI: http://doi.org/10.5021/ad.2011.23.2.225

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.

Keyword

Acinar cell carcinoma of pancreas; Erythema nodosum; Pancreatic panniculitis; Subcutaneous fat necrosis

MeSH Terms

Acinar Cells
Arthralgia
Biopsy
Carcinoma, Acinar Cell
Colectomy
Dermatology
Erythema Nodosum
Extremities
Hospitalization
Humans
Joints
Knee
Lipase
Middle Aged
Necrosis
Pancreas
Pancreatectomy
Pancreatic Diseases
Panniculitis
Skin
Splenectomy
Subcutaneous Fat
Weight Loss
Lipase

Figure

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  Fig. 1 Erythematous and violaceous nodules on the extremities.

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  Fig. 2 The skin biopsy showing pancreatic panniculitis with colliquative necrosis of adipocytes, ghost-like cells, an inflammatory infiltration and lipid-laden, foamy histiocytes (H&E, ×200).

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  Fig. 3 Computed tomography scan showed a large mass with central necrosis in the body and tail of the pancreas.

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  Fig. 4 The histological section of the pancreatic acinar cell carcinoma shows the acinar structure and a solid pattern with uniform nuclei (H&E, ×400).

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  Fig. 5 On the follow up at two months, the skin lesions regressed with subcutaneous pigmentation on the swollen left knee (arrows).

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