Abstract

A 52-year-old woman had a 3-month history of multiple red-brown, tender subcutaneous nodules confined to the lower extremities and associated with a 15-kg weight loss. A skin incisional biopsy specimen revealed lymphocytic panniculitis with necrosis of fat cells, some appearing as ghostlike cells, consistent with pancreatic panniculitis. The serum lipase level was 2910 U/L. Computed tomography of the abdomen showed what appeared to be a tumor thrombus in the portal vein. On the basis of additional laboratory test results and fine-needle aspiration of the mass, the likely primary source for the malignancy was determined to be the pancreas, with secondary spread into the portal venous system. The patient underwent palliative chemotherapy and died within 3 months. This rare form of panniculitis typically presents as tender, dull red lower extremity nodules that may ulcerate.1Dahl PR Su WP Cullimore KC Dicken CH Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (155) Google Scholar The characteristic histological finding is the “ghost cell,” representing a necrotic, partially calcified adipocyte.1Dahl PR Su WP Cullimore KC Dicken CH Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (155) Google Scholar, 2Ball NJ Adams SP Marx LH Enta T Possible origin of pancreatic fat necrosis as a septal panniculitis.J Am Acad Dermatol. 1996; 34: 362-364Abstract Full Text PDF PubMed Google Scholar Pancreatitis and pancreatic carcinoma are the most frequently encountered precipitating conditions for pancreatic panniculitis.1Dahl PR Su WP Cullimore KC Dicken CH Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (155) Google Scholar Several other factors have been implicated as causes, including pancreatic pseudocysts, congenital anomalies of the pancreas, and blunt abdominal trauma.1Dahl PR Su WP Cullimore KC Dicken CH Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (155) Google Scholar, 2Ball NJ Adams SP Marx LH Enta T Possible origin of pancreatic fat necrosis as a septal panniculitis.J Am Acad Dermatol. 1996; 34: 362-364Abstract Full Text PDF PubMed Google Scholar When possible, correction of the underlying abnormality may lead to resolution of the panniculitis.1Dahl PR Su WP Cullimore KC Dicken CH Pancreatic panniculitis.J Am Acad Dermatol. 1995; 33: 413-417Abstract Full Text PDF PubMed Scopus (155) Google Scholar

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