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Case Reports
. 2018 Jan 4;18(1):1.
doi: 10.1186/s12876-017-0727-1.

Pancreatic panniculitis: the "bright" side of the moon in solid cancer patients

Elena Guanziroli  1 , Antonella Colombo  2 , Antonella Coggi  3 , Raffaele Gianotti  2 , Angelo Valerio Marzano  2
Affiliations
Case Reports

Pancreatic panniculitis: the "bright" side of the moon in solid cancer patients

Elena Guanziroli et al. BMC Gastroenterol. .

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.

Keywords: Pancreatic cancer; Pancreatic panniculitis; Subcutaneous fat necrosis.

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Conflict of interest statement

Authors’ information

EG is a resident in Dermatology at the University of Milan, AC1 is a dermatologist, AC2 and RG are dermatologists and pathologists. All of the authors currently work in Italy. AVM is a dermatologist and a former professor at the University of Milan.

Ethics approval and consent to participate

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Oral informed consent was obtained from the patients for publication of this case report and any accompanying images.

Consent for publication

During lifetime, patients consented orally to the use of their history and all the related images and information for scientific purposes. After the patients’ death the patients’ next of kin gave written consent for the publication of the cases.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient 1: multiple erythematous-brownish subcutaneous nodules on the legs (panel a); one of them shows an ulcerated surface (panel b). Patient 2: erythematous-violaceous subcutaneous nodules surrounded by a purpuric halo on the lower extremities (panel c)
Fig. 2
Fig. 2
Predominant lobular panniculitis with focal fat necrosis (Panel a). Liquefaction phenomena of adipocytes, ghost-like cells and calcium deposits in a predominant neutrofilic inflammatory infiltrate (Panel b, c)
See this image and copyright information in PMC

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