Pancreatic Panniculitis: A Cutaneous Presentation as an Initial Clue to the Diagnosis of Pancreatic Cancer
Saoraya Lueangarun MD*, Panitta Sittinamsuwan MD**, Bussakorn Mahakkanukrauh MD**, Penvadee Pattanaprichakul MD***, Supot Pongprasobchai MD*
Affiliation : * Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Pancreatic panniculitis is a rare complication of pancreatic diseases, including pancreatic carcinoma. It is
clinically manifested by erythematous subcutaneous nodules typically located on the legs which can occur before or at the
onset of pancreatic disease.
Case Report: An 81-year-old woman presented with painful subcutaneous nodules at both shins, recurrent epigastric
pain, anorexia and significant weight loss. Physical examination revealed mild pallor, palpable epigastric mass and multiple
tender erythematous subcutaneous nodules discrete to both lower extremities. The skin biopsy showed lobular panniculitis
with marked subcutaneous fat necrosis and ghost adipocytes compatible with pancreatic panniculitis that was an important
clue for further investigations. Elevations of serum amylase and serum lipase were then noted. Computed tomography of the
abdomen revealed pancreatic cancer with duodenal involvement and multiple liver metastases.
Conclusion : Pancreatic panniculitis is associated with pancreatic cancer and represents an important clue to the diagnosis.
Keywords : Pancreatic panniculitis, Pancreatic cancer
