Possible origin of pancreatic fat necrosis as a septal panniculitis

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We describe pancreatic subcutaneous fat necrosis in a man with alcoholism and pancreatitis. The initial specimen, from a 2-day-old lesion, showed a septal inflammatory infiltrate in the subcutis. A second specimen, from a 5-day-old lesion, showed the lobular pattern of enzymatic fat necrosis diagnostic for pancreatic panniculitis. We suggest that the histologic appearance of subcutaneous pancreatic fat necrosis evolves from an early septal reaction to a fully developed lobular panniculitis.

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    Fibrosis and lipoatrophy are seen in the final stage, when the process is resolved. In the very early stage of pancreatic panniculitis, a septal pattern has been described.10,11 This septal pattern is characterized by lymphoplasmacytic infiltrate within the fibrous septa surrounding the subcutaneous fat lobules.

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    The nodules often heal leaving hypopigmentation and lipoatrophy.43 In early-stage lesions of pancreatic panniculitis, a septal lymphoplasmacytic panniculitis has been described,44,45 but fat saponification of adipocyte contents combined with secondary pannicular inflammation results in a mostly lobular panniculitis. A predominantly neutrophilic infiltrate is seen surrounding the areas of fat necrosis.

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a

From The Section of Dermatology, Division of Rheumatology, Department of Medicine

b

From The Department of Pathology, University of Calgary

c

From The Kasper Medical Laboratories Inc.

d

From The Tom Baker Cancer Centre, Calgary, Alberta, Canada.

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