Tica Irina, Niculescu Costin, Mocanu Liliana, Iliescu Mădălina Gabriela, Tica Vlad Iustin, Niculescu Zizi
Department of Surgery, Faculty of Medicine, "Ovidius" University of Constanţa; Ist Department of Obstetrics and Gynecology, Emergency County Hospital, Constanţa, Romania;
Rom J Morphol Embryol. 2019;60(4):1343-1347.
Pancreatic panniculitis represents a rare dermatological manifestation mainly due to a pancreatic disorder, but other etiologies are possible. Even rarer, it can occur prior to the clinical signs of the underlying disease, and its presence must orientate the investigations especially towards pancreas, liver and neuroendocrine system. We report a rare case of a 47-year-old male patient who presented to the Emergency Unit complaining about a two weeks-long-persistent pain in the upper abdomen and biliary vomiting. The medical history included alcohol abuse. Several days prior to the onset of these symptoms, the patient has noticed the occurrence of a nodular inflammatory lesion of 5∕3 cm on the right calf (this makes the case even rarer). Based on clinical aspect and high levels of pancreatic enzymes, acute pancreatitis was diagnosed. Contrast-enhanced abdominal computed tomography (CT) revealed a cystic pancreatic mass and dilated intrahepatic biliary ducts. Abdominal magnetic resonance imaging (MRI) revealed a cystic tumor of the pancreatic head and thrombosis of the portal vein, which increased the suspicion of pancreatic adenocarcinoma. Biopsy was performed from the calf nodular lesion, with the diagnosis of panniculitis. This case, besides its rarity, supports the clinical important value of a pancreatic workup in case of histologically proved panniculitis, even without pancreatic related symptoms.
胰腺性脂膜炎是一种罕见的皮肤病学表现，主要由胰腺疾病引起，但也可能有其他病因。更罕见的是，它可在潜在疾病的临床症状出现之前发生，其存在必须引导检查，特别是针对胰腺、肝脏和神经内分泌系统的检查。我们报告一例罕见病例，一名47岁男性患者因上腹部持续两周的疼痛和胆汁性呕吐就诊于急诊科。病史包括酗酒。在这些症状出现前几天，患者注意到右小腿出现一个5∕3厘米的结节性炎性病变（这使得该病例更为罕见）。根据临床症状和高水平的胰腺酶，诊断为急性胰腺炎。腹部增强计算机断层扫描（CT）显示胰腺有一个囊性肿块和肝内胆管扩张。腹部磁共振成像（MRI）显示胰头部有一个囊性肿瘤和门静脉血栓形成，这增加了胰腺腺癌的怀疑。对小腿结节性病变进行了活检，诊断为脂膜炎。该病例除了罕见之外，还支持在组织学证实为脂膜炎的情况下，即使没有胰腺相关症状，进行胰腺检查的临床重要价值。
