Solitary increased tibial uptake of 99mTc-diphosphonate unmasking pancreatic tumor-related medullary fat necrosis

Paycha, Frédéric; Russ, Gilles; Bellivet, Christian; Vulpillat, M.

doi:10.1007/bf00251685

Cited by 4 publications

(1 citation statement)

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“…The radiological findings usually show numerous osteolytic lesions predominantly in the extremities [19]. In some cases these can be missing, and only in radionuclide bone scanning a diffuse increase of tracer uptake may be present [20]. The bone lesions are believed to develop by excessive fat necrosis in the marrow where high activities of lipase have been found.…”

Section: Discussionmentioning

confidence: 99%

Carcinoma of the Pancreas with Neuroendocrine Differentiation and Nodular Panniculitis

Berkovic¹,

Hallermann²

2003

Oncol Res Treat

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Background: On rare occasions tumours of the pancreas produce high amounts of pancreatic lipase. The enzyme activity in the blood and in different tissues causes a syndrome called nodular panniculitis by focal necrosis of lipids and a concomittant inflammatory reaction. Case Report: A 72-year-old man was admitted to the dermatology clinic with the diagnosis of erythema nodosum. The patient had been well until 3 months earlier when painful red nodes developed on the skin of both shanks. He complained of profuse night sweating and a weight loss of 10 kg within that time but did not have fever. He also had noticed a painful swelling of his right index finger, left middle finger and the third toe on his left foot. Biopsy of the nodes revealed a focal necrosis of fatty tissue. Laboratory examinations showed a highly elevated concentration of serum pancreatic lipase. Further investigations showed a tumour in the pancreas and several osteolytic lesions. Tumour biopsy revealed a neuroendocrine carcinoma. After tumour resection serum lipase level immediately fell to almost normal values, and all skin and bone manifestations disappeared quickly. Conclusion: Due to its clinical appearance the panniculitis syndrome is most often mistaken for either erythema nodosum or rheumatoid arthritis. A resection of the tumour after correct diagnosis should always be considered because the widespread manifestations in the skin and bones do not represent distant metastasis and have a very good chance to dissolve completely.

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Section: Discussionmentioning

confidence: 99%