A patient with a pancreatic disease may develop foci of panniculitis and fat necrosis.


Conditions where described:

(1) acute or traumatic pancreatitis

(2) pancreatic carcinoma, especially acinic cell carcinoma

(3) pancreatic pseudocyst (which is usually secondary to pancreatitis)


Clinical features:

(1) The lesions may be focal or widespread.

(2) The lesions are erythematous or reddish-brown edematous nodules.

(3) The lesions may ulcerate and drain a viscous, chalky or brownish material.

(4) If periarticular fat is affected then the patient may develop an arthralgia.


Laboratory findings:

(1) Serum levels of lipase and amylase are usually elevated.


Histologic features:

(1) Affected lipocytes lose their nuclei and may show:

(1a) a thickened eosinophilic membrane with cytoplasmic pallor ("ghost cells")

(1b) a deep basophilia due to calcium deposition.

(1c) liquefaction and necrosis

(2) Extracellular granular calcium deposits may be present.

(3) Early lesions show a mixed lobular and septal inflammation. Areas of necrosis may be surrounded by a mixed inflammatory cell infiltrate.

(4) Late lesions may be surrounded by a granulomatous infiltrate. Healing involves fibrosis and atrophy.


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