1
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Kohanzadeh A, Sher A, Wind O, Liu Q, Srivastava P, Amin B, Mann R. Pancreatic Panniculitis: A Case Associated With Acute Pancreatic Allograft Rejection. Cureus 2024; 16:e52925. [PMID: 38274602 PMCID: PMC10810171 DOI: 10.7759/cureus.52925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 01/27/2024] Open
Abstract
We present a unique case of pancreatic panniculitis (PP) in a 42-year-old male with a history of pancreas-after-kidney (PAK) transplant. The patient developed PP due to acute pancreas allograft rejection. Clinical manifestations included fevers, myalgias, arthralgias, and tender erythematous subcutaneous nodules on the lower extremities. A recent hospital admission was noted for acute pancreas allograft rejection related to low tacrolimus levels. Rheumatological and infectious disease workups were negative. Skin nodule punch biopsy confirmed PP with lobular panniculitis, necrotic adipocytes, basophilic debris, and calcification. Pancreatic biopsy showed evidence of parenchymal acute cellular rejection. Lipase and amylase levels were elevated (1781 U/L and 881 U/L, respectively). Treatment involved pulse solumedrol and thymoglobulin for pancreatic rejection, alongside adjustments to immunosuppressive medications. This case highlights the rarity of PP in a PAK recipient and its association with acute pancreas allograft rejection. Importantly, it is the first reported case of PP occurring solely in the context of pancreas transplant rejection, without concurrent kidney damage or rejection. Prompt diagnosis and management led to the resolution of skin and systemic symptoms. In conclusion, this report presents a clinically relevant and unique case of PP resulting from acute pancreas allograft rejection in a PAK transplant recipient. The findings underscore the importance of early diagnosis and management for positive patient outcomes, serving as a reminder to consider underlying pancreatic pathology when encountering PP in transplant recipients.
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Affiliation(s)
- Avraham Kohanzadeh
- Internal Medicine, Albert Einstein College of Medicine, New York City, USA
| | - Ariel Sher
- Dermatology, New York Medical College, New York City, USA
| | - Olivia Wind
- Dermatology, Mount Sinai Hospital, New York City, USA
| | - Qiang Liu
- Pathology and Laboratory Medicine, Montefiore Medical Center, New York City, USA
| | | | - Bijal Amin
- Dermatopathology, Montefiore Medical Center, New York City, USA
| | - Ranon Mann
- Dermatology, Montefiore Medical Center, New York City, USA
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2
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Seguí M, Rodríguez-Jiménez P, Fraga J, Navas J, Ríos JJ, Revilla D, Santos-Briz Á, Lluch JJ, Fernández Figueras MT, Luque M, Llamas Velasco M. Pancreatic panniculitis revisited: A series of 34 patients. J Cutan Pathol 2023; 50:983-990. [PMID: 37605438 DOI: 10.1111/cup.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/02/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Pancreatic panniculitis is a rare form of panniculitis generally associated with acute or chronic pancreatitis, and less frequently with pancreatic carcinoma. Clinically, it presents with subcutaneous nodules usually located in the lower extremities, however, it presents an almost pathognomonic histopathological finding with enzymatic fat necrosis in the adipose tissue. METHODS In this retrospective case series of five hospitals, biopsy specimens of cutaneous lesions of pancreatic panniculitis were reviewed. Clinical information was obtained through medical records. RESULTS A total of 34 cases were included, 23 women and 11 men, aged between 31 and 92 years. The most common associated pancreatic disease was acute pancreatitis (23 cases) and its main triggering cause was gallstones (17 cases). In two patients it was related to chronic pancreatitis and six cases were associated with malignancy. Histopathological findings were always the key to diagnosis. In the biopsies reviewed, mostly lobular panniculitis with the characteristic necrosis of the adipocytes was observed. In addition, nine of the cases presented with Splendore-Hoeppli phenomenon. CONCLUSIONS We present the largest series of pancreatic panniculitis. Clinically, the female predominance and biliary lithiasis as the main cause of acute pancreatitis are to be emphasized. Histopathologically, a peripheral eosinophilic striated rim surrounding aggregates of ghost adipocytes consistent with Splendore-Hoeppli is an additional clue to its diagnosis.
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Affiliation(s)
- Mireia Seguí
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Javier Fraga
- Department of Pathology, Hospital Universitario de La Princesa, Madrid, Spain
| | - José Navas
- Department of Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Juan José Ríos
- Department of Pathology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - David Revilla
- Department of Dermatology, Hospital Clínico Universitario, Salamanca, Spain
| | - Ángel Santos-Briz
- Department of Pathology, Hospital Clínico Universitario, Salamanca, Spain
| | - Juan José Lluch
- Department of Dermatology, Hospital Universitari Germans Tries y Pujol, Barcelona, Spain
| | - María Teresa Fernández Figueras
- Head of Surgical Pathology Area, Pathology Department, Sant Cugat del Valles, Hospital Universitari General de Catalunya, Spain
| | - Mar Luque
- Department of Dermatology, Hospital Clínic, Barcelona, Spain
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain
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3
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Yang FA, Cheng KS, Chou JW. Progressive nodule-like lesions on bilateral lower limbs. J Postgrad Med 2023; 69:50-52. [PMID: 36537394 PMCID: PMC9997608 DOI: 10.4103/jpgm.jpgm_136_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pancreatic panniculitis is a rare disease characterized by subcutaneous fat necrosis. It could be the result of an associated pancreatic tumor. Herein, we reported a 63-year-old man who presented with progressive bilateral lower limb edema accompanied with nodule-like lesions for 1 month. His serum lipase was 3,927 U/L (normal, 0-160 U/L). Histopathology of the skin specimen revealed lobular panniculitis, favoring a diagnosis of pancreatic panniculitis. Abdominal computed tomography (CT) scan with contrast showed a huge mass in his left upper quadrant. Endoscopic ultrasound showed a mixed echoic tumor, measuring 11.9 × 7.8 cm in dimensions, originating from the pancreatic tail. Biopsy performed via an endoscopic ultrasound showed a poorly differentiated acinar cell carcinoma. Because of the unresectable status of the tumor, the patient underwent chemotherapy with paclitaxel and gemcitabine. After chemotherapy, his skin lesions improved progressively. It is important to treat pancreatic panniculitis with its underlying pancreatic disease.
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Affiliation(s)
- F A Yang
- China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - K S Cheng
- China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - J W Chou
- China Medical University Hospital, China Medical University, Taichung, Taiwan
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4
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Kunovsky L, Dite P, Brezinova E, Sedlakova L, Trna J, Jabandziev P. Skin manifestations of pancreatic diseases. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:353-358. [PMID: 35938387 DOI: 10.5507/bp.2022.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022] Open
Abstract
Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the extra-pancreatic symptoms are also important. These include skin symptoms, such as pancreatic panniculitis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema, cutaneous signs of hemorrhage, as in persons with severe acute pancreatitis, or the finding of cutaneous metastases of pancreatic carcinoma, which may be a sign of advanced disease. The pancreas is therefore one of those organs for which diagnosis and therapy are often multidisciplinary. In this review article, we summarize current knowledge of the possible skin manifestations of pancreatic disorders.
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Affiliation(s)
- Lumir Kunovsky
- Department of Surgery, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Czech Republic.,Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Petr Dite
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Czech Republic.,Faculty of Medicine, University of Ostrava, Czech Republic
| | - Eva Brezinova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,1st Department of Dermatovenerology, St. Anne's University Hospital, Brno, Czech Republic
| | - Libuse Sedlakova
- Department of Dermatology, Military Hospital Brno, Czech Republic
| | - Jan Trna
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Petr Jabandziev
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Pediatrics, University Hospital Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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5
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Milani-Nejad N, Johnson AG, Chung CG. Nonpancreatic Pancreatic Panniculitis: An Incidental Finding in Individuals without Pancreatic Disease? A Case Series and Review of the Literature. J Clin Aesthet Dermatol 2021; 14:28-30. [PMID: 34055184 PMCID: PMC8142828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pancreatic panniculitis occurs in up to three percent of all patients with pancreatic disease. This cutaneous eruption, as implied by the name, is almost exclusively encountered in the context of pancreatic disorders, such as pancreatitis or pancreatic carcinoma. We report three cases in which histopathologic examination demonstrated hallmarks of pancreatic panniculitis occurring in patients without any history or evidence of pancreatic disorder. These nonpancreatic pancreatic panniculitis eruptions might be underreported in the literature.
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Affiliation(s)
- Nima Milani-Nejad
- Dr. Milani-Nejad is with the Department of Dermatology at the University of California in Los Angeles, California
- Dr. Chung is with the Division of Dermatology in the Department of Internal Medicine as well as the Department of Pathology at The Ohio State Wexner Medical Center in Columbus, Ohio
- Dr. Johnson is with the Division of Hematology at The Ohio State University Wexner Medical Center in Columbus, Ohio
| | - Amy G Johnson
- Dr. Milani-Nejad is with the Department of Dermatology at the University of California in Los Angeles, California
- Dr. Chung is with the Division of Dermatology in the Department of Internal Medicine as well as the Department of Pathology at The Ohio State Wexner Medical Center in Columbus, Ohio
- Dr. Johnson is with the Division of Hematology at The Ohio State University Wexner Medical Center in Columbus, Ohio
| | - Catherine G Chung
- Dr. Milani-Nejad is with the Department of Dermatology at the University of California in Los Angeles, California
- Dr. Chung is with the Division of Dermatology in the Department of Internal Medicine as well as the Department of Pathology at The Ohio State Wexner Medical Center in Columbus, Ohio
- Dr. Johnson is with the Division of Hematology at The Ohio State University Wexner Medical Center in Columbus, Ohio
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6
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Garrido PM, Pimenta R, Viana I, Kutzner H, Filipe P, Soares-Almeida L. Cutaneous mucormycosis mimicking pancreatic panniculitis. J Cutan Pathol 2021; 48:1007-1009. [PMID: 33470453 DOI: 10.1111/cup.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/05/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Pedro Miguel Garrido
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Rita Pimenta
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Isabel Viana
- Dermatology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, Portugal
| | - Heinz Kutzner
- Dermatopathologie Friedrichshafen, Friedrichshafen, Germany
| | - Paulo Filipe
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal.,Dermatology Universitary Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Dermatology Research Unit, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Luís Soares-Almeida
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal.,Dermatology Universitary Clinic, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Dermatology Research Unit, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
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7
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Kasamatsu H, Oyama N, Hasegawa M, Oku Y, Inoue G, Kimura M, Kanno M, Kawakami T, Ohta H, Yoneshima M. Fatal case of pancreatic panniculitis caused by occult neuroendocrine tumor in the corresponding organ: A case report and review of the published work. J Dermatol 2020; 48:237-241. [PMID: 33073392 DOI: 10.1111/1346-8138.15646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/31/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
Pancreatic panniculitis (PP) is a rare clinical variant of subcutaneous fat necrosis, developing in patients with a variety of pancreatic diseases such as acute or chronic pancreatitis, tumors and cysts. The tumor-associated PP represents a noteworthy skin manifestation of underlying internal malignancies, also known as dermadrome. Among causative pancreatic tumors, acinar cell carcinoma is the most frequent malignancy; however, little is known about how the origin of tumor cells and progression stage of pancreatic tumors potentially contribute to the establishment of panniculitis. Here, we present a 69-year-old Japanese male case of clinically aggressive PP on the bilateral legs, whose skin lesions developed prior to the diagnosis of occult pancreatic tumor and liver metastasis. Moreover, the immunopathology of the pancreatic lesion revealed neuroendocrine tumor (NET), a rare pathological variant. Skin lesions immediately spread to the upper limbs with extensive ulcerations and necrosis, accompanied by high levels of serum lipase and elastase, but not with other pancreatic enzymes. He died 2 months after the initial development of the skin lesion due to rapid deterioration of general condition. We reviewed 14 cases, including ours, of PP with NET in the pancreas thus far reported, to identify the clinicopathological characteristics regarding to what extent this rare complication could reflect the clinical course of pancreatic tumors and overall prognosis. Our published work review found that the disease has a significant male predominance (male : female, 13:1) and cases with occult pancreatic tumors died within 4 months after the development of their skin lesions. Our case was the poorest prognostic outcome. This report emphasizes that dermatologists should recognize PP with NET, reflecting a fatal prognosis, and to make a prompt diagnosis.
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Affiliation(s)
- Hiroshi Kasamatsu
- Department of Dermatology, Municipal Tsuruga Hospital, Tsuruga, Japan.,Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Japan
| | - Noritaka Oyama
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Japan
| | - Yohei Oku
- Department of Gastroenterology, Municipal Tsuruga Hospital, Tsuruga, Japan
| | - Genki Inoue
- Department of Gastroenterology, Municipal Tsuruga Hospital, Tsuruga, Japan
| | - Makiko Kimura
- Department of Gastroenterology, Municipal Tsuruga Hospital, Tsuruga, Japan
| | - Masataka Kanno
- Department of Gastroenterology, Municipal Tsuruga Hospital, Tsuruga, Japan
| | - Takumi Kawakami
- Department of Gastroenterology, Municipal Tsuruga Hospital, Tsuruga, Japan
| | - Hajime Ohta
- Department of Gastroenterology, Municipal Tsuruga Hospital, Tsuruga, Japan
| | - Manabu Yoneshima
- Department of Gastroenterology, Municipal Tsuruga Hospital, Tsuruga, Japan
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8
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Miulescu R, Balaban DV, Sandru F, Jinga M. Cutaneous Manifestations in Pancreatic Diseases-A Review. J Clin Med 2020; 9:E2611. [PMID: 32806580 PMCID: PMC7464368 DOI: 10.3390/jcm9082611] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023] Open
Abstract
Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an important role both as a diagnostic clue for the pancreatic disease itself and serving as a prognostic factor for the severity of the condition. Recognition of these cutaneous signs is, however, far from being satisfactory, all the more as some of them are relatively rare. In the current review, we discuss skin involvement in pancreatic diseases, referring to pancreatic panniculitis, cutaneous hemorrhagic manifestations, skin metastasis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema and cutaneous fistula. We highlight the clinical characteristics, treatment and prognostic value of these lesions. Better awareness among medical specialties other than dermatology is needed for detection of the skin clues associated with pancreatic pathology.
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Affiliation(s)
- Raluca Miulescu
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; (R.M.); (F.S.)
| | - Daniel Vasile Balaban
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Florica Sandru
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; (R.M.); (F.S.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
| | - Mariana Jinga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
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9
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Nizam W, Shah AA, Rajack F, Ramdath A, Naab T, Williams M. Lipase hypersecretion syndrome: A rare cutaneous manifestation of advanced pancreatic acinar cell carcinoma. Clin Case Rep 2020; 8:905-910. [PMID: 32477543 PMCID: PMC7250977 DOI: 10.1002/ccr3.2785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 01/07/2023] Open
Abstract
Careful recognition of cutaneous lesions in patients with malignancies may aid in avoiding additional morbidity during end of life care.
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Affiliation(s)
- Wasay Nizam
- Department of SurgeryHoward University College of MedicineWashingtonDCUSA
| | - Adil A. Shah
- Department of SurgeryHoward University College of MedicineWashingtonDCUSA
| | - Fareed Rajack
- Department of PathologyHoward University College of MedicineWashingtonDCUSA
| | - Asa Ramdath
- Department of SurgeryHoward University College of MedicineWashingtonDCUSA
| | - Tammey Naab
- Department of PathologyHoward University College of MedicineWashingtonDCUSA
| | - Mallory Williams
- Department of SurgeryHoward University College of MedicineWashingtonDCUSA
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10
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Goyal A, Jain M, Rehberg K, Goodman W, Gertner E. Pancreatic panniculitis in active systemic lupus erythematosus. J Cutan Pathol 2019; 46:688-690. [PMID: 31081550 DOI: 10.1111/cup.13493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 11/30/2022]
Abstract
This report documents the case of a 64-year-old African-American female with new end-stage renal disease (ESRD), diagnosed with systemic lupus erythematosus (SLE) on renal biopsy and serologies including a positive ANA (>1:2560), positive anti-Sm antibodies, low titer anti-RNP antibodies, high titer anti-Ro antibodies, anti-dsDNA antibodies, lupus anticoagulant, and hypocomplementemia. She was also noted to have tender nodules on the bilateral shins. Excisional biopsy of one of the nodules showed marked fat necrosis with "ghost cells" and patchy basophilic granular debris consistent with pancreatic panniculitis. Further examination for pancreatic pathology showed an elevated lipase of 585 U/L (reference range 8-78 U/L) and amylase of 214 U/L (reference range 25-125 U/L). However, computed tomography imaging showed no evidence of pancreatitis or pancreatic tumors. This is very similar to another case recently reported in the literature. Similarities of these two cases (African-American females with lupus nephritis on dialysis) may represent a particular subset of SLE patients at increased risk for pancreatic panniculitis.
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Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Meera Jain
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kim Rehberg
- Division of Rheumatology, University of Minnesota, Minneapolis, Minnesota
| | - Warren Goodman
- Department of Pathology, Regions Hospital and HealthPartners Medical Group, St Paul, Minnesota
| | - Elie Gertner
- Division of Rheumatology, University of Minnesota, Minneapolis, Minnesota.,Section of Rheumatology, Regions Hospital, St Paul, Minnesota
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11
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Montes de Oca MK, Jamison RA. Pancreatic panniculitis as the initial presentation of intrahepatic cholangiocarcinoma. JAAD Case Rep 2018; 4:528-530. [PMID: 30023419 PMCID: PMC6047103 DOI: 10.1016/j.jdcr.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mary Katherine Montes de Oca
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina
- Samford University, Birmingham, Alabama
| | - Richard Andrew Jamison
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina
- Division of Dermatology, Greenville Health System, Greenville, South Carolina
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12
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Abstract
RATIONALE Pancreatic pseudocyst can present single or multiple, inside or outside the pancreas. Pancreatic panniculitis is a rare skin lesion in pancreatic disease patients. The purpose of this study is to report a case of chronic pancreatitis coexisting with multiple pseudocysts and pancreatic panniculitis. PATIENT CONCERNS A 46-year-old man with chronic pancreatitis presented multiple small cystic lesions inside the head of the pancreas and two large cystic lesions adjacent to the tail of the pancreas. The patient also developed subcutaneous nodules involving upper and lower limbs, hands, and lower abdomen bilaterally. DIAGNOSIS The patient was diagnosed with pancreatic pseudocyst and pancreatic panniculitis resulted from chronic pancreatitis. INTERVENTIONS Bile duct stent and pancreatic duct stent placement was performed endoscopicly. OUTCOMES Panniculitis faded three weeks later and the pancreatic pseudocysts disappeared six weeks later. LESSONS Clinicians should be aware of the manifestation of multiple pancreatic pseudocyst and pancreatic panniculitis, and endoscopic transpapillary drainage may be a effective way in this scenario.
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13
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Fernández-Sartorio C, Combalia A, Ferrando J, Alsina M, Iranzo P, Estrach T, Hernández-Ruiz E, Mascaró JM. Pancreatic panniculitis: A case series from a tertiary university hospital in Spain. Australas J Dermatol 2018; 59:e269-e272. [PMID: 29741276 DOI: 10.1111/ajd.12842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/28/2018] [Indexed: 12/14/2022]
Abstract
Pancreatic panniculitis is a rare type that only occurs in 2-3% of all patients with pancreatic diseases. It is usually described in association with benign pancreatic disease and less commonly in association with pancreatic carcinoma. We describe a case of pancreatic panniculitis as the first manifestation of underlying ampullary adenocarcinoma and a new case of pancreatitis, panniculitis and polyarthritis (PPP-Syndrome). Pancreatic panniculitis may be the cutaneous manifestation of pancreatic allograft rejection after simultaneous pancreas-kidney transplantation.
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Affiliation(s)
| | - Andrea Combalia
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Joan Ferrando
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Mercè Alsina
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Iranzo
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Teresa Estrach
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | - José M Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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14
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Abstract
BACKGROUND Pancreatic panniculitis is a rare cause of subcutaneous fat necrosis secondary to elevated serum levels of pancreatic enzymes. It is most often associated with pancreatic acinar cell carcinoma, but has also been seen in patients with pancreatitis. CASE REPORT We present a case of a 64 year old Caucasian man without symptoms of pancreatitis who presents with pancreatic panniculitis manifesting in multiple subcutaneous ulcerating nodules of the bilateral lower extremities, discovered to have a previously unreported etiology for this condition. He had no evidence of pancreatitis or malignancy, but instead a pancreatic-portal fistula resulting in panniculitis. CONCLUSION Peripancreatic vascular lesions must also be considered in the differential diagnosis of pancreatic panniculitis. The diagnosis, pathology, and treatment of pancreatic panniculitis are reviewed herein.
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Affiliation(s)
- A C Evans
- Division of Gastroenterology and Hepatology, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213
| | - A D Singhi
- Department of Pathology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Scaife Hall A616.2, Pittsburgh, PA 15213
| | - H J Zeh
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 414, Pittsburgh, PA 15232
| | - N Bahary
- Department of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213
| | - R E Brand
- Division of Gastroenterology and Hepatology, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213
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Yoshihiro T, Nio K, Tsuchihashi K, Ariyama H, Kohashi K, Tsuruta N, Hanamura F, Inadomi K, Ito M, Sagara K, Okumura Y, Nakano M, Arita S, Kusaba H, Oda Y, Akashi K, Baba E. Pancreatic acinar cell carcinoma presenting with panniculitis, successfully treated with FOLFIRINOX: A case report. Mol Clin Oncol 2017; 6:866-870. [PMID: 28588779 PMCID: PMC5451886 DOI: 10.3892/mco.2017.1240] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/29/2017] [Indexed: 12/14/2022] Open
Abstract
Pancreatic acinar cell carcinoma (PACC) is a rare tumor of the exocrine pancreas, representing only 1% of all pancreatic malignancies. A 50-year-old man presented with edema of the thumb joints bilaterally, followed by an appearance of masses in the bilateral lower extremities and fever (38°C). The masses were diagnosed as panniculitis by skin biopsy, and multiple intraperitoneal masses were incidentally detected on pelvic magnetic resonance imaging performed to investigate the leg abnormalities. The patient was referred to the Kyushu University Hospital for further investigation, and fluorodeoxyglucose-positron emission tomography/computed tomography (CT) revealed high-uptake tumors in the pancreatic tail, in the periphery of the liver, and in the pelvis. Laboratory examinations revealed high serum concentrations of pancreatic exocrine enzymes, such as lipase, trypsin, elastase 1 and pancreatic phospholipase A2. Histological examination of a bioptic specimen obtained from a hepatic lesion revealed proliferation of atypical cells arranged in a tubular or glandular pattern. Immunohistochemical staining revealed that the atypical cells were positive for cytokeratin (CK)7, CK19 and lipase, but negative for CK20 and thyroid transcription factor-1, leading to a final diagnosis of acinar cell carcinoma of the pancreatic tail (T4bN0M1, stage IV according to the 7th edition of the TNM Classification of Malignant Tumors). Combined chemotherapy with oxaliplatin, irinotecan and fluorouracil (FOLFIRINOX) was administered and fever was soon alleviated. The serum levels of lipase also declined and panniculitis completely resolved. As of the start of the 8th course of chemotherapy, the levels of the pancreatic exocrine enzymes were within normal ranges and CT revealed partial response. Therefore, the severe lipase hypersecretion syndrome was well controlled by the FOLFIRINOX regimen and shrinkage of the mass was also achieved. Thus, the FOLFIRINOX regimen may represent an effective treatment option for advanced PACC.
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Affiliation(s)
- Tomoyasu Yoshihiro
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Kenta Nio
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Kenji Tsuchihashi
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Hiroshi Ariyama
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Kenichi Kohashi
- Department of Anatomical Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Nobuhiro Tsuruta
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Fumiyasu Hanamura
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Kyoko Inadomi
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Mamoru Ito
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Kosuke Sagara
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Yuta Okumura
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Michitaka Nakano
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Shuji Arita
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hitoshi Kusaba
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomical Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Koichi Akashi
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan
| | - Eishi Baba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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Zhang G, Cao Z, Yang G, Wu W, Zhang T, Zhao Y. Pancreatic panniculitis associated with pancreatic carcinoma: A case report. Medicine (Baltimore) 2016; 95:e4374. [PMID: 27495045 PMCID: PMC4979799 DOI: 10.1097/md.0000000000004374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Pancreatic panniculitis is a very rare complication of pancreatic cancer, most often accompanying rare acinar cell carcinoma. We herein report a case of pancreatic panniculitis that was associated with pancreatic mucinous adenocarcinoma. PATIENT INFORMATION A 57-year-old male was referred to our hospital for weight loss. A physical examination revealed subcutaneous nodules on his lower extremities. The blood test showed abnormal increases in amylase, lipase, and carbohydrate antigen 19-9 levels. A computed tomography scan detected a hypodense 2 × 1.5 cm solid mass with an unclear margin in the head of the pancreas. The biopsy of subcutaneous nodules on the lower extremities was conducted and revealed lobular panniculitis. Pancreatic cancer and pancreatic panniculitis were strongly suspected. After the administration of octreotide acetate and the Whipple procedure, the serous amylase and lipase levels returned to normal, and the pancreatic panniculitis had almost resolved by 4 weeks later. CONCLUSION Pancreatic panniculitis is a rare complication of pancreatic cancer. However, in the presence of a pancreatic mass, as in this case, clinicians should be aware that panniculitis may be the sentinel of pancreatic carcinoma.
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Affiliation(s)
| | | | | | | | - Taiping Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Menzies S, McMenamin M, Barnes L, O'Toole D. Pancreatic panniculitis preceding acute pancreatitis and subsequent detection of an intraductal papillary mucinous neoplasm: A case report. JAAD Case Rep 2016; 2:244-6. [PMID: 27408933 PMCID: PMC4927540 DOI: 10.1016/j.jdcr.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Mairin McMenamin
- Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - Louise Barnes
- Department of Dermatology, St James's Hospital, Dublin, Ireland
| | - Dermot O'Toole
- Department of Gastroenterology, St James's Hospital, Dublin, Ireland
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18
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Affiliation(s)
- Satish K Nayak
- Registrar in Gastroenterology, Apollo Hospital, Chennai, India
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Beveridge M, Pei S, Tsoukas MM. Pancreatic panniculitis in a pancreas-kidney transplant patient resolved after immunosuppression increase: Case report and review of literature. JAAD Case Rep 2015; 1:101-5. [PMID: 27051698 PMCID: PMC4802559 DOI: 10.1016/j.jdcr.2015.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mara Beveridge
- University of Chicago, Department of Medicine, Section of Dermatology, Chicago, Illinois
| | - Susan Pei
- University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Maria M Tsoukas
- University of Illinois at Chicago, Department of Dermatology, Chicago, Illinois
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Bush JW, Himes E, Liu D, Fraga GR. Splendore-Hoeppli reaction and muscular arteritis in pancreatic panniculitis. J Cutan Pathol 2015; 42:77-81. [PMID: 25690642 DOI: 10.1111/cup.12466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- James W Bush
- University of Kansas Hospital, Department of Pathology and Laboratory Medicine, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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