Miksch RC, Schiergens TS, Weniger M, Ilmer M, Kazmierczak PM, Guba MO, Angele MK, Werner J, D'Haese JG. Pancreatic panniculitis and elevated serum lipase in metastasized acinar cell carcinoma of the pancreas: A case report and review of literature. World J Clin Cases 2020; 8(21): 5304-5312 [PMID: PMC7674712 DOI: 10.12998/wjcc.v8.i21.5304]
Corresponding Author of This Article
Jan G D'Haese, MD, Assistant Professor, Surgeon, Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany. jan.dhaese@med.uni-muenchen.de
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 6, 2020; 8(21): 5304-5312 Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5304
Pancreatic panniculitis and elevated serum lipase in metastasized acinar cell carcinoma of the pancreas: A case report and review of literature
Rainer Christoph Miksch, Tobias S Schiergens, Maximilian Weniger, Matthias Ilmer, Philipp M Kazmierczak, Markus O Guba, Martin K Angele, Jens Werner, Jan G D'Haese
Rainer Christoph Miksch, Tobias S Schiergens, Maximilian Weniger, Matthias Ilmer, Markus O Guba, Martin K Angele, Jens Werner, Jan G D'Haese, Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany
Philipp M Kazmierczak, Department of Radiology, Ludwig-Maximilians-University Munich, Munich 81377, Germany
Author contributions: Miksch RC, Schiergens TS and D'Haese JG designed the report; Miksch RC, Weniger M, Ilmer M and Kazmierczak PM collected the patient’s clinical data; Miksch RC, Kazmierczak PM, Guba MO, Angele MK and Werner J analyzed the data; Miksch RC wrote the paper; Guba MO, Angele MK, Werner J and D'Haese JG made important intellectual contributions and edited and revised the manuscript; Miksch RC and Schiergens TS contributed equally to the report, created the figures, and performed the systematic review.
Informed consent statement: Consent was obtained from the patient for publication of the case and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jan G D'Haese, MD, Assistant Professor, Surgeon, Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Munich 81377, Bavaria, Germany. jan.dhaese@med.uni-muenchen.de
Received: June 28, 2020 Peer-review started: June 28, 2020 First decision: July 24, 2020 Revised: July 28, 2020 Accepted: September 29, 2020 Article in press: September 29, 2020 Published online: November 6, 2020 Processing time: 130 Days and 14.7 Hours
Abstract
BACKGROUND
Pancreatic panniculitis is an extremely rare condition associated with different underlying pancreatic disorders and characterized by subcutaneous fat necrosis induced by elevated serum lipase levels. These lesions usually affect the lower extremities and may precede abdominal symptoms of pancreatic disease. Acinar cell carcinoma (ACC) of the pancreas is a rare pancreatic neoplasm, accounting for only 1%-2% of pancreatic tumors in adults.
CASE SUMMARY
We present the case of a 72-year-old man with ACC of the pancreatic head and synchronous liver metastases. Both the primary tumor and liver metastases were resected. Serum lipase was elevated before surgery and decreased to normal postoperatively. Rising serum lipase levels at follow-up led to the diagnosis of hepatic recurrence. This disease progression was then accompanied by pancreatic panniculitis, with subcutaneous fat necrosis and acute arthritis. To the best of our knowledge, only 4 cases have been reported in the literature and each showed a similar association of serum lipase levels with pancreatic panniculitis and progression of ACC.
CONCLUSION
Clinical symptoms and progression of ACC may correlate with serum lipase levels, suggesting potential usefulness as a follow-up biomarker.
Core Tip: This case report highlights the aggressive progress of metastasized pancreatic acinar cell carcinoma in a male patient. The included systematic review lends support to the possibility that increased serum lipase levels with simultaneous pancreatic panniculitis should prompt suspicion for acinar cell carcinoma and lead to further diagnostic steps.
