SHM Converge Scientific Abstract ePoster Gallery-Pancreatic Panniculitis as Rare Manifestation of Non-Hodgkin Lymphoma

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This case report describes a 54-year-old woman with no major prior medical history who presented with 6 weeks of progressive abdominal and leg swelling, dyspnea, jaundice, and weight loss. Exam showed tense ascites, bilateral edema, and tender erythematous nodules on the shins. Initial imaging and labs suggested an advanced intra-abdominal malignancy with cholestatic liver injury, elevated LDH, elevated lipase, and tumor markers CA-125 and CA19-9. CT showed extensive peritoneal carcinomatosis, bulky retroperitoneal and mesenteric adenopathy, biliary ductal dilation, and major compression of the portal vein and IVC.<br /><br />Because the skin lesions worsened and the primary cancer was unclear, dermatology performed a punch biopsy of a shin nodule. Histology showed fat necrosis with mixed inflammation and saponification, consistent with pancreatic panniculitis; infectious stains and vasculitis studies were negative. A retroperitoneal lymph node biopsy then revealed B-cell lymphoma, later confirmed as double-hit diffuse large B-cell lymphoma (DLBCL), germinal center type.<br /><br />The report highlights pancreatic panniculitis, a rare form of subcutaneous fat necrosis most commonly linked to pancreatitis or pancreatic tumors, but occasionally seen with nonpancreatic malignancies. In this patient, the panniculitis likely reflected pancreatic inflammation caused by extensive lymphoma involvement rather than a primary pancreatic cancer. Her liver tests and symptoms improved after corticosteroids and R-CHOP chemotherapy, and she was discharged for outpatient hematology-oncology follow-up.<br /><br />The key teaching point is that painful nodular skin lesions can provide an early clue to an occult malignancy. Recognizing pancreatic panniculitis on physical exam and confirming it with biopsy may accelerate diagnosis and treatment in otherwise challenging cases.

Asset Subtitle

Ruth Wang

Meta Tag

Author List Chase Jeffrey J. Webber DO FACP, Claire Lo, Ruth Wang, Snehal Bindra, Uswah Siddiqi MBBS

Category Clinical Vignettes

Concept Pancreatic Panniculitis

Concept Malignancy

Concept Diffuse Large B-Cell Lymphoma

Concept Biopsy

Concept Cutaneous Manifestation

Distinguished Non-Finalist

Presenter Organization Vanderbilt University Medical Center

Presenting Author Ruth Wang

Track Adult

Keywords

pancreatic panniculitis

diffuse large B-cell lymphoma

double-hit lymphoma

peritoneal carcinomatosis

subcutaneous fat necrosis

cholestatic liver injury

retroperitoneal adenopathy

R-CHOP chemotherapy

skin biopsy

occult malignancy

Pancreatic Panniculitis

Malignancy

Diffuse Large B-Cell Lymphoma

Biopsy

Cutaneous Manifestation