J Rheum Dis.  2017 Oct;24(5):313-317. 10.4078/jrd.2017.24.5.313.

Pancreatic Neuroendocrine Tumor Presenting with Arthritis and Panniculitis

• Kim HR
• Ahn JS
• Noh JH
• Jeon HJ
• Oh JS
• Choi SW
• Lim DH

• KMID: 2394348
• DOI: http://doi.org/10.4078/jrd.2017.24.5.313

Abstract

Pancreatic neoplasm is complicated and can be preceded by extra-pancreatic manifestations, such as cutaneous and musculoskeletal symptoms. Awareness of these associations is important for timely diagnosis and appropriate treatment. We report a case of pancreatic neuroendocrine tumor (NET) presenting with arthritis and panniculitis. The patient had a two month history of right knee pain and subcutaneous nodules in both legs. Synovial fluid analysis from the right knee joint revealed a mildly increased white blood cell count without crystallization. A skin biopsy of a subcutaneous nodule revealed lobular panniculitis. The initial treatment with empirical antibiotics did not alleviate the symptoms; however, the right knee arthritis and skin nodules improved with steroid treatment. On the eighth day of hospitalization, the patient complained of abdominal discomfort. Abdominopelvic computed tomography scanning revealed a 14-cm sized pancreatic mass with peritoneal metastasis. Percutaneous needle biopsy confirmed the diagnosis of pancreatic NET.

Keyword

Pancreatic neoplasms; Neuroendocrine tumors; Arthritis; Panniculitis

MeSH Terms

Anti-Bacterial Agents
Arthritis*
Biopsy
Biopsy, Needle
Crystallization
Diagnosis
Hospitalization
Humans
Knee
Knee Joint
Leg
Leukocyte Count
Neoplasm Metastasis
Neuroendocrine Tumors*
Pancreatic Neoplasms
Panniculitis*
Skin
Synovial Fluid
Anti-Bacterial Agents

Figure

• 

  Figure 1. (A) A subcutaneous lesion is present on the posterior surface of the right leg, indicating panniculitis. (B) Punch biopsy revealing lobular panniculitis with fat necrosis (H&E, x40, arrow).

• 

  Figure 2. (A) Aspirated right knee joint fluid showing turbid appearance. (B) Right knee magnetic resonance imaging showing fluid collection and multifocal enhancement around the knee joint.

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  Figure 3. Abdominopelvic computed tomography revealing a 14-cm circumscribed well-mar-ginated heterogenous solid mass (arrow) in left upper quadrant mesocolic space. Coronal view (A), Transverse view (B).

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  Figure 4. Microphotograph of synaptophysin immunohistochemistry shows small synaptophysin positive (brown color) monotonous tumor cells arranged in the acini and trabeculae (Immunohistochemistry, x400).

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