Pancreatic panniculitis as the sole manifestation of pancreatic ductal adenocarcinoma: a case report.
6 affiliations
- 1Department of Dermatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. [email protected].
- 2Université Claude Bernard Lyon 1, 5 Place d'Arsonval, Lyon, 69003, France. [email protected].
- 3Université Claude Bernard Lyon 1, 5 Place d'Arsonval, Lyon, 69003, France.
- 4Department of Gastroenterology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
- 5Department of Dermatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
- 6CIRI, Centre International de Recherche en Infectiologie, Epidermal immunity & Allergy, INSERM, U1111, Univ Lyon, Université de Lyon, Ecole Normale Supérieure de Lyon, CNRS, UMR 5308, Lyon, France.
Abstract
Background
Pancreatic panniculitis is a rare form of lobular panniculitis characterized by subcutaneous fat necrosis occurring at cutaneous sites distant from the pancreas. It is most often associated with pancreatitis, while pancreatic malignancies - dominated by acinar cell carcinoma - represent a minority of cases. Recognizing this cutaneous manifestation is important, as it may be the primary and sole manifestation of an underlying pancreatic neoplasm.Case presentation
A 79-year-old female presented with a one-month history of painful subcutaneous nodules of the lower limbs without abdominal pain, weight loss, or other symptoms. Laboratory workup revealed elevated serum lipase levels (> 1000 U/L). Skin biopsy showed lobular panniculitis with characteristic "ghost cells", consistent with pancreatic panniculitis. Abdominal imaging identified a 14-mm mass in the head of the pancreas and endoscopic ultrasound-guided fine-needle aspiration suggested a well-differentiated adenocarcinoma. Given the resectable nature of the tumor and a favorable geriatric assessment, the patient underwent total pancreatectomy, which confirmed a 25-mm well-differentiated pancreatic ductal adenocarcinoma staged pT2N2R0, followed by adjuvant chemotherapy with mFOLFIRINOX. The cutaneous lesions resolved within the first postoperative week.Conclusions
Pancreatic panniculitis can be the sole manifestation of an underlying pancreatic malignancy; therefore, clinicians should consider this rare but important association. Serum lipase measurement should be included in the workup of any unexplained panniculitis, and pancreatic imaging should be promptly performed in case of high levels. Early recognition can lead to timely diagnosis and effective treatment.
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BibTeX
@article{garcia2026pancreatic,
title = {{Pancreatic panniculitis as the sole manifestation of pancreatic ductal adenocarcinoma: a case report.}},
author = {Aline Garcia and Valentine Faye and Denis Jullien and Claire Billioud and Liza Benzoni},
journal = {BMC gastroenterology},
year = {2026},
month = aug,
doi = {10.1186/s12876-026-05174-w},
url = {https://europepmc.org/article/MED/42958068},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pancreatic panniculitis as the sole manifestation of pancreatic ductal adenocarcinoma: a case report.
AU - Aline Garcia
AU - Valentine Faye
AU - Denis Jullien
AU - Claire Billioud
AU - Liza Benzoni
PY - 2026
DA - 2026/08/01
JO - BMC gastroenterology
DO - 10.1186/s12876-026-05174-w
UR - https://europepmc.org/article/MED/42958068
AB - Background Pancreatic panniculitis is a rare form of lobular panniculitis characterized by subcutaneous fat necrosis occurring at cutaneous sites distant from the pancreas. It is most often associated with pancreatitis, while pancreatic malignancies - dominated by acinar cell carcinoma - represent a minority of cases. Recognizing this cutaneous manifestation is important, as it may be the primary and sole manifestation of an underlying pancreatic neoplasm.Case presentation A 79-year-old female presented with a one-month history of painful subcutaneous nodules of the lower limbs without abdominal pain, weight loss, or other symptoms. Laboratory workup revealed elevated serum lipase levels (> 1000 U/L). Skin biopsy showed lobular panniculitis with characteristic "ghost cells", consistent with pancreatic panniculitis. Abdominal imaging identified a 14-mm mass in the head of the pancreas and endoscopic ultrasound-guided fine-needle aspiration suggested a well-differentiated adenocarcinoma. Given the resectable nature of the tumor and a favorable geriatric assessment, the patient underwent total pancreatectomy, which confirmed a 25-mm well-differentiated pancreatic ductal adenocarcinoma staged pT2N2R0, followed by adjuvant chemotherapy with mFOLFIRINOX. The cutaneous lesions resolved within the first postoperative week.Conclusions Pancreatic panniculitis can be the sole manifestation of an underlying pancreatic malignancy; therefore, clinicians should consider this rare but important association. Serum lipase measurement should be included in the workup of any unexplained panniculitis, and pancreatic imaging should be promptly performed in case of high levels. Early recognition can lead to timely diagnosis and effective treatment.
SN - 1471-230X
ER -