Pancreatic Neuroendocrine Tumor Presenting with Arthritis and Panniculitis

Hyung Rae Kim; Jae-Sung Ahn; Jin-Hee Noh; Hee-jeong Jeon; Ji Seon Oh; Seung Won Choi; Doo-Ho Lim

doi:10.4078/jrd.2017.24.5.313

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Kim, Ahn, Noh, Jeon, Oh, Choi, and Lim: Pancreatic Neuroendocrine Tumor Presenting with Arthritis and Panniculitis

Case Report

J Rheum Dis 2017;24(5):313-317.

Published online: 31 October 2017

DOI: https://doi.org/10.4078/jrd.2017.24.5.313

Pancreatic Neuroendocrine Tumor Presenting with Arthritis and Panniculitis

Hyung Rae Kim¹, Jae-Sung Ahn¹, Jin-Hee Noh¹, Hee-jeong Jeon¹, Ji Seon Oh², Seung Won Choi¹, Doo-Ho Lim¹

¹Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

²Division of Rheumatology, Department of Internal Medicine, National Medical Center, Seoul, Korea

Corresponding to: Doo-Ho Lim, Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan 44033, Korea. E-mail: dlaengh@hanmail.net

Received 14 March 201717 May 2017 Accepted 18 May 2017

This is a Open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pancreatic neoplasm is complicated and can be preceded by extra-pancreatic manifestations, such as cutaneous and musculoskeletal symptoms. Awareness of these associations is important for timely diagnosis and appropriate treatment. We report a case of pancreatic neuroendocrine tumor (NET) presenting with arthritis and panniculitis. The patient had a two month history of right knee pain and subcutaneous nodules in both legs. Synovial fluid analysis from the right knee joint revealed a mildly increased white blood cell count without crystallization. A skin biopsy of a subcutaneous nodule revealed lobular panniculitis. The initial treatment with empirical antibiotics did not alleviate the symptoms; however, the right knee arthritis and skin nodules improved with steroid treatment. On the eighth day of hospitalization, the patient complained of abdominal discomfort. Abdominopelvic computed tomography scanning revealed a 14-cm sized pancreatic mass with peritoneal metastasis. Percutaneous needle biopsy confirmed the diagnosis of pancreatic NET.

Keywords: Pancreatic neoplasms, Neuroendocrine tumors, Arthritis, Panniculitis

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Figure 1.

(A) A subcutaneous lesion is present on the posterior surface of the right leg, indicating panniculitis. (B) Punch biopsy revealing lobular panniculitis with fat necrosis (H&E, x40, arrow).

Figure 2.

(A) Aspirated right knee joint fluid showing turbid appearance. (B) Right knee magnetic resonance imaging showing fluid collection and multifocal enhancement around the knee joint.

Figure 3.

Abdominopelvic computed tomography revealing a 14-cm circumscribed well-mar-ginated heterogenous solid mass (arrow) in left upper quadrant mesocolic space. Coronal view (A), Transverse view (B).

Figure 4.

Microphotograph of synaptophysin immunohistochemistry shows small synaptophysin positive (brown color) monotonous tumor cells arranged in the acini and trabeculae (Immunohistochemistry, x400).

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