Case Number : Case 30 Posted By: Guest

Phillip McKee - Overseas consultations (USA) Wrote:

The final diagnosis is pancreatic fat necrosis. See you all tomorrow.

Submitted on 21/07/2010 21:25
________________________________________
Jonathan S. - UK () Wrote:

With a neutrophilic panniculitis you would also include alpha 1 anti-trypsin deficiency and exclude infection

Submitted on 21/07/2010 18:41
________________________________________
Wayne Grayson - (Johannesburg, South Africa) Wrote:

My knee-jerk diagnosis is pancreatic fat necrosis/panniculitis.

Submitted on 21/07/2010 16:53
________________________________________
Phillip McKee - Overseas consultations (USA) Wrote:

I believe that the self assessment course is having some fine tuning done and should go online fairly soon.

Submitted on 21/07/2010 15:35
________________________________________
Phillip McKee - Overseas consultations (USA) Wrote:

Good morning all. Again you are doing well. Very occasionally deep fungal infections may mimic pancreatic fat necrosis. Again, clinicopathological correlation is essential.

Submitted on 21/07/2010 15:33
________________________________________
Rodrigo Restrepo - UPB (Colombia) Wrote:

Steatonecrosis

Submitted on 21/07/2010 14:15
________________________________________
Marwa Fawzi - Dermatology Department,Faculty of Medicine, Cairo university. (Egypt) Wrote:

Subcutaneous fat necrosis associated with pancreatic disease

Submitted on 21/07/2010 13:29
________________________________________
Richard Carr - Warwick (UK) Wrote:

Agree pancreatic fat necrosis without the typical basophilia. You might want to polarise the section as you nearly always see crystals on polarising microscopy in pancreatic fat necrosis (I remember Charlie Keen, who was in Lewisham, teaching me this as he wrote a paper on it in relation to pancreatitis but I am not sure it has been reported in the skin although I have photographed it myself on a previous cutaneous case!)

Submitted on 21/07/2010 12:17
________________________________________
Naglaa Nabil El Mongy - Cairo university (Egypt) Wrote:

Lbular panniculitis with fat necrosis, foamy histiocytes, neutophilic infiltrate, Smudgy saponification and Ghost cells. So, pancreatic panniculitis is very acceptable to me.

Submitted on 21/07/2010 09:42
________________________________________
Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Characteristic fat necrrosis with ghost like outline of remaining fat cells (to the right of the necrotic fat cells)and surrounded with neutrophils and nuclear dust and many foamy macrophages (lipophages). I agree with Marcela that it is not that bluish; the pale basophilic hue of calcium deposition in the zone of necrosis and the basophilic rim of calcium deposition around the necrotic area is not that evident. However, the ghost like cells points to Pancreatin Enzymatic Paniculitis. I dont thik it could be alpha 1 atitrpsi def panniculitis because in this condition I should see masses of neutrophils and some fat necrosis and no ghost cells are seen. Thank you Dr McKee ad as Eman said I am waiting for the online course.

Submitted on 21/07/2010 07:43
________________________________________
Eman El-Nabarawy - Dermatology Department,Faculty of Medicine, Cairo university. (Egypt) Wrote:

Pancreatic enzyme panniculitis.Beautiful picture.Thanks Dr Mckee.Waiting for the online course to subscribe.

Submitted on 21/07/2010 05:02
________________________________________
Marcela Saeb Lima - MSL Dermatopato (Mexico City) Wrote:

Although it is not that bluish it could be pancreatic panniculitis... with neutrophils and foamy histiocytes..

Submitted on 21/07/2010 02:16
________________________________________
Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Lobular panniculitis with fat necrosis and neutrophilic infiltrante.. infectious panniculitis? pancreatic panniculitis?

Submitted on 21/07/2010 00:33
________________________________________