Nodular Fat Necrosis and Pancreatic Diseases

Szymanski, Frederick J.

doi:10.1001/archderm.1961.01580080054006

Cited by 86 publications

(34 citation statements)

References 3 publications

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“…pancreatic fat necrosis) in that the clinical appearance is that of an ill-defined mass and histologically that of a well-circumscribed nodule. 9 A comprehensive literature review of the clinicopathological presentation of 49 reported cases of fat necrosis revealed that: (i) it is mostly prevalent in females (31 versus 18 males); (ii) the age range of all cases was 9-77 years with an average of 40.9 years; and (iii) there was a clear difference between the mean age of males and females (29.9 versus 47.8 years, respectively). The most commonly affected sites were in the lower extremities, with a history of previous trauma evident in only 13 cases.…”

Section: Fat Necrosismentioning

confidence: 99%

Subcutaneous thigh fat necrosis as a result of tourniquet control during total knee arthroplasty

Tamvakopoulos¹,

Toms²,

Glasgow³

2005

Ann R Coll Surg Engl

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A n 83-year-old female underwent a left total knee arthroplasty (replacement) as treatment for knee pain secondary to osteoarthrosis. The patient attended a routine pre-operative assessment a fortnight prior to an elective admission; she had no other past medical history and was found to be fit to proceed to surgery. She underwent an uncomplicated procedure under a combined spinal epidural anaesthetic implanting a Genesis II Total Knee Replacement prosthesis. A pneumatic tourniquet was used around the left thigh to achieve a bloodless field. A layer of cotton wool padding (velband) was applied over the left thigh and the tourniquet was applied over the padding. The limb was elevated and exsanguinated using a rubber limb exsanguinor and the tourniquet was then inflated to a pressure of 350 mmHg for a period of 90 min until the knee capsule and wound were ready to be closed in layers.Adequate haemostasis was achieved using diathermy and the knee capsule was closed over two drains. The subcutaneous tissue and skin were then closed, and the wound was dressed and padded with a compression dressing. Prior to leaving the operating theatre, the patient pressure points were checked as per routine protocol, and there was no evidence of an injury.The patient made an uncomplicated, early postoperative recovery and was discharged home 6 days later when she was able to mobilise safely with crutches. She was due to be followed up as an out-patient 6 weeks following her operation.She was reviewed a week later in clinic at her general practitioner's request because of the raised concern of a reported painful lump felt in her thigh suspected to be a superficial abscess. The clinical appearance was that of a soft, lobulated, mobile mass with a poorly defined edge covered by an area of indurated skin.Ultrasound examination was performed with a high resolution 7-12 MHz linear array probe (ATL HDI 5000, Philips Medical Systems, Andover, MA, USA). This demonstrated a relatively echogenic mass within the subcutaneous fat, with no discrete fluid collection and Subcutaneous thigh fat necrosis as a result of tourniquet control during total knee arthroplasty George S Tamvakopoulos 1 , Andoni P Toms 2 , Malcolm Glasgow

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Section: Fat Necrosismentioning

confidence: 99%

Subcutaneous thigh fat necrosis as a result of tourniquet control during total knee arthroplasty

Tamvakopoulos¹,

Toms²,

Glasgow³

2005

Ann R Coll Surg Engl

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“…The percutaneous biopsy specimens from the right knee of patient CL showed the characteristic histopathologic findings of disseminated fat necrosis (2). There were necrotic fat cells with shadowy walls, disrupted fat cells, and an infiltrate that included lymphocytes, lipid laden histiocytes, and foreign body giant cells.…”

Section: Discussionmentioning

confidence: 97%

“…The diagnosis is established by the characteristic histopathology: foci of necrotic fat cells with disrupted shadowy walls and a surrounding zone of acute or chronic inflammation (2). The joint pain experienced by patients with this entity has generally been attributed to a periarthritis; fat necrosis has been noted only in periarticular tissues (3)(4)(5)(6)(7)(8)(9).…”

mentioning

confidence: 99%

Synovial Fat Necrosis Associated with Ischemic Pancreatic Disease

Smukler

Schumacher

Pascual

et al. 1979

Arthritis & Rheumatism

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A 59-year-old man with ischemic pancreatic disease, polyarthritis, and cutaneous nodules has shown histopathologic findings indicative of disseminated fat necrosis in a percutaneous biopsy specimen from the right knee. The histopathologic findings in the synovium included necrotic fat cells, distorted fat cells and adjacent lymphocytes, lipid laden histiocytes, and giant cells. In prior histopathologic studies of the joint involvement associated with this disorder, fat cell necrosis has been found only in the periarticular tissues, and the synovium has appeared normal or showed nonspecific inflammation. However, the present study shows that the synovial membrane may also be the site of fat necrosis and an associated inflammatory reaction; thus patients with this disorder may manifest arthritis in addition to periarthritis.Disseminated fat necrosis is a rare complication of pancreatic disease marked by cutaneous nodules, joint pain, and increased serum amylase and lipase (1). The diagnosis is established by the characteristic histopathology: foci of necrotic fat cells with disrupted shadowy walls and a surrounding zone of acute or chronic inflammation (2). The joint pain experienced by patients with this entity has generally been attributed to a periarthritis; fat necrosis has been noted only in periarticular tissues (3-9). However, we have recently observed fat cell necrosis in the synovial membrane from the right knee of a 59-year-old man who had ischemic pancreatitis secondary to atherosclerosis of the abdominal arteries. CASE REPORTCL, a 59-year-old white man, developed an illness characterized by episodes of fever, arthritis, and cutaneous nodules in 1972. These recurrent attacks would persist for days or weeks and recur irregularly. The joint disease was polyarticular with a predilection for the metacarpophalangeals of the hands, knees, and ankles. The involved joints were swollen, erythematous, and unresponsive to treatment with aspirin, indomethacin, and phenylbutazone. The cutaneous nodules were erythematous and developed most frequently over the arms, abdomen, and legs.Findings that suggested t h e skin a n d joint involvement were related to pancreatic disease were noted during hospitalization for a severe episode of arthritis in January 1975. A biopsy specimen from a cutaneous nodule showed foci of necrotic fat cells, and the serum amylase and the serum lipase were elevated. Studies to detect a pancreatic neoplasm were initiated as there were no symptoms suggestive of acute pancreatitis or abdominal trauma. An upper gastrointestinal series, barium enema, cholecystogram, intravenous cholangiogram, and isotope scan of the pancreas were not helpful; abdominal arteriography was planned. However, during the course of these evaluations, the patient's joints had shown moderate improvement, and he refused this critical study.

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“…Surrounding these groups of 'ghost cells' is a polymorphous inflammatory cell infiltrate that may consist of neutrophils, lymphocytes, macrophages and foreign-body giant cells (3). Fine, basophilic, granular areas of calcification may be seen within or surrounding the necrotic adipocytes (17).…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Panniculitis Associated with Allograft Pancreatitis and Rejection in a Simultaneous Pancreas–Kidney Transplant Recipient

Pike¹,

Rice²,

Sánchez

et al. 2006

American Journal of Transplantation

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Pancreatic panniculitis is an uncommon condition that can occur in association with pancreatic disease. We present a case of pancreatic panniculitis in a female pancreas-kidney transplant recipient 5 months posttransplant. The patient was on standard immunosuppressive medications and had acute rejection of her renal allograft. The diagnosis of allograft pancreatitis and rejection presenting with pancreatic panniculitis was supported clinically, histopathologically and by laboratory and imaging data. This is the fourth case of pancreatic panniculitis occurring in a transplant recipient and the first in a simultaneous pancreas-kidney transplant recipient. It is also the first case associated with allograft rejection. Clinicians should be aware that pancreatic panniculitis may be a manifestation of underlying allograft pancreatic disease.

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Nodular Fat Necrosis and Pancreatic Diseases

Cited by 86 publications

References 3 publications

Subcutaneous thigh fat necrosis as a result of tourniquet control during total knee arthroplasty

Subcutaneous thigh fat necrosis as a result of tourniquet control during total knee arthroplasty

Synovial Fat Necrosis Associated with Ischemic Pancreatic Disease

Pancreatic Panniculitis Associated with Allograft Pancreatitis and Rejection in a Simultaneous Pancreas–Kidney Transplant Recipient

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