Subcutaneous Fat Necrosis/Panniculitis and Polyarthritis Associated With Acinar Cell Carcinoma of the Pancreas: A Rare Presentation ofPancreatitis, Panniculitis and Polyarthritis Syndrome
September 2010 | Volume 9 | Issue 9 | Case Reports | 1145 | Copyright © September 2010
Jessica Borowicz DO PGY-3, Megan Morrison BS, Daniel Hogan MD, Richard Miller DO FAOC
An 82-year-old man presented with a two-week history of three painful, inflamed nodules on his lower extremities with symmetric
arthritis of multiple joints. He was under the care of hospice for end-stage acinar cell carcinoma of the pancreas. His serum amylase
and lipase levels were markedly elevated. An incisional biopsy revealed lobular inflammation of subcutaneous fat, focal fat necrosis
with saponification/ghost cells and scattered foreign-body type giant cells consistent with pancreatic fat necrosis/pancreatic panniculitis.
This is hypothesized to be initiated by autodigestion of subcutaneous fat secondary to systemic spillage of excess digestive
pancreatic enzymes. Enzymes such as amylase, lipase and trypsin are increased in the bloodstream and can affect remote tissues,
such as the subcutaneous fat and articular surfaces of joints. This report, along with the patient’s clinical findings, was consistent with
PPP syndrome: pancreatic disease, polyarthritis and panniculitis. Although the pancreatic disease of PPP syndrome usually includes
pancreatitis, this case represents a report of polyarthritis and panniculitis occurring in the presence of pancreatic carcinoma.