Pancreatic panniculitis revisited: A series of 34 patients

Author:

Seguí Mireia1ORCID,Rodríguez‐Jiménez Pedro1,Fraga Javier2,Navas José3,Ríos Juan José4ORCID,Revilla David5,Santos‐Briz Ángel6ORCID,Lluch Juan José7ORCID,Fernández Figueras María Teresa8,Luque Mar9,Llamas Velasco Mar1ORCID

Affiliation:

1. Department of Dermatology Hospital Universitario de La Princesa Madrid Spain

2. Department of Pathology Hospital Universitario de La Princesa Madrid Spain

3. Department of Dermatology Hospital Universitario Virgen Macarena Sevilla Spain

4. Department of Pathology Hospital Universitario Virgen Macarena Sevilla Spain

5. Department of Dermatology Hospital Clínico Universitario Salamanca Spain

6. Department of Pathology Hospital Clínico Universitario Salamanca Spain

7. Department of Dermatology Hospital Universitari Germans Tries y Pujol Barcelona Spain

8. Head of Surgical Pathology Area, Pathology Department Sant Cugat del Valles Hospital Universitari General de Catalunya Spain

9. Department of Dermatology Hospital Clínic Barcelona Spain

Abstract

AbstractBackgroundPancreatic 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.MethodsIn this retrospective case series of five hospitals, biopsy specimens of cutaneous lesions of pancreatic panniculitis were reviewed. Clinical information was obtained through medical records.ResultsA 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.ConclusionsWe 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.

Publisher

Wiley

Subject

Dermatology,Histology,Pathology and Forensic Medicine

Reference28 articles.

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2. Panniculitis. Part II. Mostly lobular panniculitis

3. Pancreatic Panniculitis

4. Chronic relapsing pancreatitis with pseudocyst erosion into the portal vein and disseminated fat necrosis;Lee SH;Am J Gastroenterol,1985

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