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Pancreatic panniculitis as the first presentation of pancreatic ductal adenocarcinoma |
Wei-Fang Zhu, Shan Fang, Jian-Jun Qiao ∗ |
Department of Dermatology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
∗ Corresponding author.
E-mail address: qiaojianjun@zju.edu.cn (J.-J. Qiao). |
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Abstract Pancreatic panniculitis, also known as pancreatic fat necrosis or enzymatic panniculitis, is a rare type of panniculitis that occurs in 0.3%−3% of patients with pancreatic disease such as acute or chronic pancreatitis and pancreatic carcinoma, especially acinar cell carcinoma [ 1 , 2 ]. The clinical manifestations are nonspecific erythema tender nodules, which need to be distinguished from other types of panniculitis. Subcutaneous fat necrosis may present before the diagnosis of pancreatic disease in up to 45% of patients [2] . In addition, nearly half of pancreatic panniculitis is associated with malignancy and is considered a marker of poor prognosis [3] . Therefore, these nodules serve as an early and valuable marker for discovering related pancreatic diseases which leads to skin biopsy, serum pancreatic enzyme, tumor marker detection, and imaging examination. We herein report a case of pancreatic panniculitis in both lower limbs presented in the context of pancreatic ductal adenocarcinoma (PDAC) with distant metastasis, and the skin lesions subsided after FOLFIRINOX (a combination of 5- fluorouracil, leucovorin, irinotecan, and oxaliplatin) chemotherapy.
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