title: Pancreatic panniculitis: a cutaneous presentation as an initial clue to the diagnosis of pancreatic cancer.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Pancreatic panniculitis is associated with pancreatic cancer and represents an important clue to the diagnosis.
authors: Department of Medicine, Faculty ofMedicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Saoraya
authors: S
authors: Lueangarun
authors: Panitta
authors: P
authors: Sittinamsuwan
authors: Bussakorn
authors: B
authors: Mahakkanukrauh
authors: Penvadee
authors: P
authors: Pattanaprichakul
authors: Supot
authors: S
authors: Pongprasobchai
mesh_terms: D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D001706:Biopsy; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D005218:Fat Necrosis / Q000150:complications / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007868:Leg Dermatoses / Q000209:etiology / Q000473:pathology*; D008049:Lipase / Q000097:blood; D009336:Necrosis / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D015434:Panniculitis / Q000209:etiology* / Q000473:pathology; D012867:Skin / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D008049:Lipase; D000681:Amylases