Pancreatic panniculitis and elevated serum lipase in metastasized acinar cell carcinoma of the pancreas: A case report and review of literature

Figure 1 T2-weighted magnetic resonance images showing acinar cell carcinoma of the pancreatic head with synchronous liver metastases before surgery. The patient’s presurgical bloodwork showed lipase of 5580 U/L, amylase of 172 U/L, C-reactive protein of 3.3 mg/dL, and leukocytes of 5 G/L. A: Primary tumor localized in the processus uncinatus; B and C: T2-weighted HASTE cor showing prepapillary tumor (arrow) infiltrating the common hepatic duct, which is extended; D: Hepatic metastasis in liver segment VI (arrow).

Figure 2 Computed tomography at 9 mo after surgery showing hepatic progression of the disease. The patient’s bloodwork showed lipase of 2384 U/L, amylase of 61 U/L, C-reactive protein of 13.1 mg/dL, and leukocytes of 4.98 G/L. A and B: Multifocal filiae of the liver with hypovascular metastases (arrows), and tumor infiltration of the abdominal wall dorsally of the liver. Of note, compared with pancreatic ductal adenocarcinoma[48], the tumor density of the acinar cell carcinoma in the non-contrast phase and time attenuation curve pattern are different but both tumor entities tend to be hypodense in the contrast-enhanced phases; C: Portal venous phase of recurrent metastasis with solid and cystic properties (liver segment VII).

Figure 3 Progressive panniculitis with fat necrosis in the lower extremities at 10 mo after surgery. The patient’s bloodwork showed lipase of 8414 U/L, amylase of 82 U/L, C-reactive protein of 5.2 mg/dL, and leukocytes of 5.41 G/L. A-C: Erythema suspicious for panniculitis occurred in both legs.

Figure 4 X-ray at 12 mo after surgery showing acute arthritis of the left elbow with epicondylitis (arrow). The patient’s bloodwork showed lipase of 13410 U/L, amylase of 22 U/L, C-reactive protein of 22.3 mg/dL, and leukocytes of 10.2 G/L.

Figure 5 Dynamics of serum lipase levels starting before surgery and during follow-up. The maximal concentration of lipase was 19940 U/L, of C-reactive protein was 22.9 mg/dL, and leukocytes was 11.2 G/L. The carcinoembryonic antigen (CEA) an CA19-9 tumor marker levels were collected during follow-up as well: CEA 1.5 ng/mL and CA19-9 13.3 U/mL (first surgery), CEA 1.7 ng/mL and CA19-9 10.2 U/mL (6 mo after primary surgery), CEA 1.7 ng/mL and CA19-9 9.9 U/mL (9 mo after primary surgery).