Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Oct 5;16(1):356.
doi: 10.1186/s13256-022-03595-1.

Painful lower limb nodules as first symptom of resectable pancreatic acinar cell cancer: a case report

S M Haenen  1   2 , J A M G Tol  3   4 , S C J van Steen  5   4 , O R Busch  3   4 , A Farine Sarasqueta  6   4 , S Roshani  6   4 , A Wolkerstorfer  7 , M M D van der Linden  7 , J W Wilmink  8   4 , H C Post  8   4 , M G Besselink  9   10
Affiliations
Case Reports

Painful lower limb nodules as first symptom of resectable pancreatic acinar cell cancer: a case report

S M Haenen et al. J Med Case Rep. .

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.

Keywords: Acinar cell carcinoma; Case report; Cutaneous nodules; Pancreatic panniculitis.

PubMed Disclaimer

Conflict of interest statement

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Figures

Fig. 1
Fig. 1
Cutaneous nodules on both legs during presentation
Fig. 2
Fig. 2
Skin biopsy showing the subcutis with local saponification of fat
Fig. 3
Fig. 3
Mass located in the left pancreas, in contact with the stomach
See this image and copyright information in PMC

References

    1. Chiari H. Uber die sogenannte fettnekrose. Prag Med Wochenschr. 1883;8:255–256.
    1. Poelman SM, Nguyen K. Pancreatic panniculitis associated with acinar cell pancreatic carcinoma. J Cutan Med Surg. 2008;12(1):38–42. doi: 10.2310/7750.2007.00032. - DOI - PubMed
    1. Miksch RC, Schiergens TS, Weniger M, et al. Pancreatic panniculitis and elevated serum lipase in metastasized acinar cell carcinoma of the pancreas: a case report and review of literature. World J Clin Cases. 2020;8(21):5304–5312. doi: 10.12998/wjcc.v8.i21.5304. - DOI - PMC - PubMed
    1. Bagazgoitia L, Alonso T, Rios-Beceta L, et al. Pancreatic panniculitis: an atypical clinical presentation. Eur J Dermatol. 2009;19(2):191–192. doi: 10.1684/ejd.2008.0616. - DOI - PubMed
    1. Guanziroli E, Colombo A, Coggi A, et al. Pancreatic panniculitis: the “bright” side of the moon in solid cancer patients. BMC gastroenterol. 2018;18(1):1–4. doi: 10.1186/s12876-017-0727-1. - DOI - PMC - PubMed

Publication types