Pancreatic Panniculitis in an 88-Year-Old Man with Neuroendocrine Carcinoma

Abstract

Pancreatic panniculitis is a rare complication that occurs in 0.3–3% of patients with pancreatic diseases. Most of the cases reported to date were associated with adenocarcinoma and acute or chronic pancreatitis. We here present an 88-year-old man who was admitted to our institution with a nonfunctional neuroendocrine carcinoma of the pancreas. He subsequently developed pancreatic panniculitis and arthritis. Treatment with octreotide did not have an effect neither on progression of the carcinoma nor on development of new skin lesions. Two months after the diagnosis of pancreatic panniculitis had been made, the patient died from progressing carcinoma. A review of the literature shows that there is no congruent hypothesis for the pathogenesis of pancreatic panniculitis. Vascular damage seems to induce lipolysis by pancreatic enzymes. This eventually leads to fat necrosis. The diversity of disorders that can go along with pancreatic panniculitis suggests an unspecific damage of pancreatic tissue as a first step in the chain of events.

Pancreatic Neuroendocrine Tumor Presenting with Arthritis and Panniculitis

“…Two cases were insulinoma [7,8] and the other two were identified as nonfunctional NET [9,10]. Like in our patient, cases from previous reports visited the hospital presenting panniculitis with constitutional symptom such as weight loss, anorexia or fatigue.…”

“…Therefore, it is suggested that there are mechanisms other than pancreatic carcinoma that cause pancreatic panniculitis. In previous reports, Schwartz and Fleishman [8], Preiss et al [9], and Berkovic and Hallermann [10] described a relatively large mass; 12 cm, 11×13-cm and 5-cm sized NET, respectively. One possible mechanism of pancreatic panniculitis associated with pancreatic NET is that the large mass may cause obstruction of the pancreatic ducts and thus temporarily increase the exocrine enzyme levels, resulting in pancreatic panniculitis.…”

Pancreatic Panniculitis Associated with Acinar Cell Carcinoma of the Pancreas: A Case Report

“…The delay of 9 months for the diagnosis and treatment worsened the prognosis of this condition. Rarely, other types of pancreatic carcinoma are associated with panniculitis, including islet cell carcinoma 17 , neuroendocrine carcinoma 4,18 and acinar cell cystadenocarcinoma 5 .…”

“…The somatostatin analogue octreotide, which inhibits secretion of pancreatic enzymes, can be useful to resolve the skin lesions and arthropathy 19 . However, Preiss and his collegues 18 demonstrated it was ineffective in an 88-year-old man with neuroendocrine carcinoma and whose somatostatin receptor scintigraphy was negative. It has also been demonstrated that corticosteroid, non-steroid anti-inflammatory drugs, and immunosuppressants could effectively not control the symptoms 5,11 .…”

Pancreatitis, panniculitis, polyarthritis syndrome successfully treated with EUS-guided cyst-gastrostomy

“…3 Histologically, the lesions are characterized by lobular panniculitis without evidence of vasculitis. 2,6,7 Adipocytes that have undergone coagulative necrosis are termed ghost adipocytes because they have lost their nuclei. 2 Treatment of pancreatic panniculitis is supportive and directed at the underlying pancreatic disease.…”