Skin inflammatory (nontumor)
Pancreatic panniculitis

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 22 October 2018, last major update August 2011

Copyright: (c) 2002-2018,, Inc.

PubMed Search: Pancreatic fat necrosis

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Cite this page: Hamodat, M. Pancreatic panniculitis. website. Accessed January 22nd, 2019.
Definition / general
  • Due to acute pancreatitis or pancreatic carcinoma
  • Lesions may be widespread, may drain chalky material
  • Associated with elevated serum amylase and lipase
  • Males are affected more than females
Clinical features
  • Tender violaceous and erythematosus nodules, usually in trunk, buttocks and lower extremities
  • Also joint involvement, pleural effusion, ascitis and pericardial effusion
  • Peripheral blood eosinophilia is quite common
Microscopic (histologic) description
  • Changes are lobular in distribution and characterized by ghost cells, which are anucleate cells composed of amorphous granular debris and a rim of eosinophilia; also stippled basophilia due to calcification
  • Usually neutrophils around foci of fat necrosis and hemorrhage
  • Uninvolved surrounding fat is heavily infiltrated by acute and chronic inflammatory cells including large numbers of macrophages, many with foamy cytoplasm due to ingested lipid, and occasional multinucleated giant cells
  • No evidence of vasculitis
  • Birefringent crystals have been described in the mesenteric fat and within affected joints, but not in subcutaneous fat
Microscopic (histologic) images

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Courtesy of Angel Fernandez-Flores, M.D., Ph.D.