title: Pancreatic carcinoma with polyarthritis, fat necrosis, and high serum lipase and trypsin activity.
abstract: A 46 year old white man presented with subcutaneous and intramedullary fat necrosis, destructive polyarthritis, and osteolytic bone lesions, complicating a poorly differentiated adenocarcinoma of the tail of the pancreas with metastases in the liver and omentum. There was a 100-fold increase in serum lipase and trypsin activity. His condition deteriorated rapidly, was characterised by rapid tumour growth, formation of ascites, a 20 kg weight loss, extensive subcutaneous fat necrosis, and fistula formation in the left calf. Treatment with 5-fluorouracil 300 mg/m2 on days 1-5 and doxorubicin 50 mg/m2 and cisplatin 100 mg/m2 on day 1, every three weeks, was well tolerated and resulted in rapid clinical improvement. After three courses of treatment a partial remission was seen and after seven courses further improvement occurred with a return to normal of serum lipase and trypsin activity. One year after starting chemotherapy the tumour relapsed but responded again to chemotherapy (epirubicin 40 mg/m2 and carboplatin 300 mg/m2 on day 1, every three weeks).
authors.affiliation: Department of Internal Medicine, Nijmegen University Hospital, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: van Klaveren
authors.forename: P H
authors.initials: PH
authors.lastname: de Mulder
authors.forename: A M
authors.initials: AM
authors.lastname: Boerbooms
authors.forename: C A
authors.initials: CA
authors.lastname: van de Kaa
authors.forename: U J
authors.initials: UJ
authors.lastname: van Haelst
authors.forename: D J
authors.initials: DJ
authors.lastname: Wagener
authors.forename: J C
authors.initials: JC
authors.lastname: Hafkenscheid
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000201:enzymology; D001168:Arthritis / Q000150:complications*; D005218:Fat Necrosis / Q000150:complications*; D006801:Humans; D008049:Lipase / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000201:enzymology; D014357:Trypsin / Q000097:blood*
chemical_list: D008049:Lipase; D014357:Trypsin