Pancreatic Panniculitis — RACP Adult Medicine MCQ

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HardGeneral Internal MedicinePancreatic PanniculitisRACP Adult Medicine

A 50-year-old man develops painful subcutaneous nodules on his shins. He has been recently diagnosed with pancreatic cancer. Biopsy of the nodules shows fat necrosis with ghost cells. What is this paraneoplastic phenomenon?

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Correct answer: D — Polyarteritis nodosa

Pancreatic panniculitis is a rare paraneoplastic syndrome associated with pancreatic disease (cancer, pancreatitis). It presents as tender subcutaneous nodules with pathognomonic histology showing lobular panniculitis with fat necrosis and ghost cells (anucleated adipocytes with thickened membranes due to saponification). It is caused by systemic release of pancreatic lipase, amylase, and trypsin. Polyarthritis (periarticular fat necrosis) may cooccur. Treatment is directed at the underlying pancreatic disease.

Reference: eTG – 2025 – Dermatology