Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
2015:81:3;282-283
doi: 10.4103/0378-6323.155578
PMID: 25900941

Pancreatic panniculitis

Sarita Kalwaniya1 , Pradeep Choudhary2 , Yashant Aswani3 , Suresh Jain1
1 Department of Dermatology, Venerology and Leprology, Government Medical College Kota, Rajasthan, India
2 Department of Radiodiagnosis, Government Medical College Kota, Rajasthan, India
3 Department of Radiodiagnosis, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Sarita Kalwaniya
Mirdha Nagar, Didwana Road, Kuchaman City,Nagaur, Rajasthan - 341 508
India
How to cite this article:
Kalwaniya S, Choudhary P, Aswani Y, Jain S. Pancreatic panniculitis. Indian J Dermatol Venereol Leprol 2015;81:282-283
Copyright: (C)2015 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

We read with a great deal of interest the article titled "Panniculitis-polyarthritis-pancreatitis syndrome" by Kashyap et al., which describe the rare association of panniculitis with pancreatic pathology. [1] However, we would like to make the following observations.

Panniculitis is an inflammation of the subcutaneous fat that can be associated with erythema nodosum, erythema induratum, Weber-Christian panniculitis, lupus panniculitis, alpha-1-antitrypsin deficiency and pancreatic disease including pancreatic neoplasms. Clinically, panniculitis presents with erythematous, ill-defined, reddish-brown, painful or painless nodules which appear on the arms, trunk, thighs, and breast. Chiari first described the association between pancreatic disease and subcutaneous fat necrosis in 1883. The subcutaneous nodules associated with pancreatic disease can precede, occur concurrently with or follow the pancreatic pathology. Pancreatic panniculitis can be associated with pancreatic malignant tumors (acinar cell carcinoma in 80% of the cases), and with acute or chronic pancreatitis. Distinctive laboratory values in pancreatic panniculitis include eosinophilia and elevated serum lipase levels. [2] Panniculitis in association with polyarthritis and eosinophilia is known as Schmid′s triad and shows a poor prognosis. [3]

The pathogenesis of pancreatic panniculitis is not unraveled but saponification of fat secondary to the action of liberated pancreatic lipase and elastase I is a postulated mechanism. Histopathologically, pancreatic panniculitis is characterized by lobular fat necrosis with anuclear adipocytes, called ghost cells, within a thick, shadowy wall with or without focal calcification and a mixed inflammatory infiltrate. [2]

In the article by Kashyap et al., it appears that authors are describing the association of panniculitis with alcohol-induced mass forming chronic pancreatitis. The final diagnosis is unclear since there is no mention about the histopathology of the mass. Although, both chronic pancreatitis- associated mass and carcinoma head pancreas may present with similar symptoms and signs, lack of calcification in the pancreatic parenchyma or within the mass, absence of atrophy of the parenchyma and smooth dilation of the pancreatic duct make chronic pancreatitis-associated mass less likely. [4]

In chronic pancreatitis, the dilated duct is typically irregular with strictures and contains calcification. [4] Moreover, the patient in the described case was known to have had a single episode of pancreatitis without any exocrine or endocrine insufficiency which itself negates the possibility of chronic pancreatitis.

Quite often, pancreatic tumor manifests itself as acute pancreatitis. [5] Such a clinical setting in an elderly person with imaging features of mass in the pancreatic head (that lacks features of chronic pancreatitis-associated mass as described above) should prompt endoscopic ultra sound (EUS)/endoscopic retrograde cholangio-pancreatography (ERCP)-guided biopsy before any surgery is contemplated.

The authors mention that the X-rays of the joint was normal but correlating with the description and clinical images provided in the article, the X-rays would at least reveal abnormal soft tissue swelling around the joint with displacement of fascial planes. The diagnosis of pancreatic panniculitis was established on biopsy. The biopsy was, however, followed by ultrasonography-guided aspiration. We wonder if there was any additional benefit of performing guided aspiration after biopsy, which is a gold standard for diagnosis. Similarly, if the authors thought the pancreatic mass to be malignant, serum measurement of CA 19-9 should have been done instead of carcinoembryonic antigen since the former has a specificity and sensitivity of 90% and is also widely used. [5] Furthermore, carcinoembryonic antigen can be increased in a numberof tumors other than pancreatic carcinoma. Lastly, the pancreatic duct has been erroneously labeled as common bile duct (CBD) in the provided images.

References
1.
Kashyap S, Shanker V, Kumari S, Rana L. Panniculitis-polyarthritis-pancreatitis syndrome. Indian J Dermatol Venereol Leprol 2014;80:352-4.
[Google Scholar]
2.
Moro M, Moletta L, Blandamura S, Sperti C. Acinar cell carcinoma of the pancreas associated with subcutaneous panniculitis. JOP 2011;12:292-6.
[Google Scholar]
3.
Agrawal PG, Khopkar US, Mahajan SA, Mishra SN. Triads in Dermatology. Indian J Dermatol 2013;58:346-51.
[Google Scholar]
4.
Sainani N, Catalano O, Sahani D. Pancreas. In: Haaga JR, Dogra VS, Forsting M, Gilkeson RC, Ha HK, Sundaram M, Editors. CT and MRI of the whole body. 5 th ed. Philadelphia: Mosby Elsevier; 2009. p. 1599-674.
[Google Scholar]
5.
Chua YJ, Cunningham D. Pancreatic cancer. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Editors. Harrison's principles of internal medicine. 17 th ed. United States of America: McGraw-Hill Companies, Inc: 2008. p. 586-9.
th ed. United States of America: McGraw-Hill Companies, Inc: 2008. p. 586-9.'>[Google Scholar]

Fulltext Views
611

PDF downloads
288
Show Sections