nodular liquefying panniculitis
Introduction
Introduction to nodular liquefaction panniculitis Nodular liquefied panniculitis is also called pancreatic subcutaneous nodular fatty necrosis. Its clinical features are painful subcutaneous nodules with repeated redness, with a diameter of 0.5 to 5 cm. Skin lesions first occur in the calf and can spread to the skin throughout the body. Some nodules may contain aseptic viscous material after softening. Skin lesions may be accompanied by paroxysmal abdominal pain, polyarthritis (or joint pain), fever and eosinophilia. Spontaneous lesions Invagination without atrophy of the epidermis. Hansemann (1889) first discovered that nodular subcutaneous fat necrosis is associated with pancreatic disease. Blauvelt (1946) noted that calf nodular lesions can occur in acute pancreatitis. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: pancreatitis pancreatic cancer
Cause
Causes of nodular liquefaction panniculitis
(1) Causes of the disease
It is believed that the fat necrosis of this disease is caused by pancreatic lipase acting on subcutaneous neutral adipose tissue. Nodules and pancreatitis can occur when serum lipase suddenly rises. It is known that the lymphatic system is diffuse of pancreatic enzyme. The main route, but the systemic circulation system may play a major role in the operation of pancreatic enzymes.
(two) pathogenesis
1. Trypsin has vascular wall protein decomposition, which helps lipase to enter adipose tissue. Pancreatic tumor with nodular liquefaction panniculitis is a kind of alveolar adenocarcinoma that secretes a large amount of lipase. Lipase, this enzyme is elevated, especially when new nodules are formed.
2. Skin nodule biopsy, normal epidermis and dermis, pathological changes are limited to subcutaneous tissue, spotted, focal fat necrosis and almost normal appearance of fat lobules can appear alternately, fat cell membrane intact, and cellular The other components are weakly alkaline in hematoxylin-eosin staining, the membrane in the fat, and the nuclear staining is completely lost. These fat cells are called "phantom-like" cells with "shadow" cell walls, and the boundary between the lesion and the normal fat cells may appear. The inflammatory bands of various types of cells, namely normal and broken neutrophils, lymphocytes, eosinophils, tissue cells, foam cells and allogeneic cells, are infiltrated with a small basophilic edge at the edge of the necrotic area. Particle precipitation, it is believed that this basophilic particle precipitation is dystrophic calcification, and occasionally there is a bleeding area.
Prevention
Nodular liquefied panniculitis prevention
1. Remove infected lesions, pay attention to hygiene, strengthen physical exercise, and improve autoimmune function.
2. The law of life, work and rest, comfortable, avoid strong mental stimulation.
3. Strengthen nutrition, fasting and cold, pay attention to warming.
Complication
Nodular liquefied panniculitis complications Complications pancreatitis pancreatic cancer
Skin nodules can be accompanied by pancreatitis, and severe cases can be associated with pancreatic cancer.
Symptom
Nodular liquefaction lipid film symptoms common symptoms fatigue high fever abdominal pain bloating nausea shock jaundice insomnia cold sweat panniculitis
1. Skin lesions: purple or red, painful inflammatory subcutaneous nodules can be seen in any part of the calf, but it is more common in the upper part of the lower leg. The diameter of the nodules varies from a few millimeters to several centimeters, and some large lesions. There may be swelling around, the subcutaneous nodules adhere to the skin above it, but the touch can be moved. The mild cases can only have one attack, the nodules do not rupture, and after 2 or 3 weeks, the depression can remain lightly depressed. Sudden signs, this type of skin lesions are usually accompanied by abdominal pain in mild recurrent chronic pancreatitis, but some patients may be associated with fever and polyarticular pain or arthritis, more serious patients, except the face, the whole body Adipose tissue other than the skin is also often affected. Some large nodules are tender, and they appear to have an abscess-like change. The touch is fluctuating. If the nodule is spontaneously ruptured, it can ooze a white cheese-like or oily sticky substance. Several nodules can be merged into larger undulating plaques. Each nod can communicate with each other through several openings. The nodules are often accompanied by persistent high fever, general malaise, fatigue, poor appetite and insomnia. Physical symptoms.
2. Pancreatic lesions: patients with pancreatic cancer may have different degrees of abdominal pain, mostly dull pain, severe cases may be colic or knife-like pain, often sudden, more than 2 hours after the meal, gradually intensified, Most of them are located in the middle of the upper abdomen. The pain is mostly radiated to the lower back. A few can be radiated to the shoulders. Generally, it can last for 3 to 5 days. Most patients may have nausea and vomiting in the case of acute pancreatitis. In severe cases, they may be in vomit. Mixed with bile, a small number of patients may have jaundice, mostly due to biliary tract inflammation or pancreatic inflammation edema caused by the common bile duct, sometimes shock, patients with pale skin, cold sweat, weak pulse, blood pressure, etc., physical examination of the lower lung can be heard And respiratory sound reduction and wet voice, abdominal bulging, abdominal muscle tension, but no plate-shaped abdomen, upper abdominal pain and rebound pain, bowel sounds weakened, sometimes hypocalcemia, hand and foot snoring, more than half of patients Some patients may have superficial thrombophlebitis. In chronic pancreatitis, in addition to abdominal pain, there are still nausea, vomiting, loss of appetite, bloating and steatorrhea.
Examine
Examination of nodular liquefied panniculitis
1. Blood routine and erythrocyte sedimentation rate: Most patients have increased white blood cells, increased eosinophils, and markedly increased erythrocyte sedimentation rate.
2. Stool examination: more people with pancreatitis have increased fecal fat content.
3. Biochemical examination: blood calcium can be reduced, gamma globulin is elevated, serum amylase is increased, lipase is elevated, but pancreatitis is associated with increased pancreatic cancer, and BSP test is associated with pancreatic cancer. Alkaline phosphatase is elevated.
4. X-ray examination: Retrograde cholangiopancreatography, in the case of chronic pancreatitis, irregular glandular stenosis and dilatation, sometimes beaded, branching branches such as sticks, and pseudocyst formation (ie enlarged glandular branches) ), similar to cystic bronchiectasis, in pancreatic cancer, irregular pancreatic duct obstruction or obstruction, as well as distortion, displacement and other signs.
Percutaneous transhepatic cholangiography is recommended when necessary. Ultrasound and CT examination are helpful for the diagnosis of pancreatic lesions.
Diagnosis
Diagnosis and differentiation of nodular liquefied panniculitis
diagnosis
Bilateral calf recurrence of purple red painful subcutaneous nodules and fever, acute, chronic pancreatitis symptoms and signs, generally more than the disease, serum amylase or lipase increased, biopsy nodular fat tissue typical "Phantom-like" cells can be diagnosed, with pancreatic tumors, by retrograde cholangiopancreatography, serum amylase examination and CT examination, generally can be diagnosed.
Differential diagnosis
1. Nodular erythema: The disease involves the skin, no liquefaction pathological changes in the nodules, no local depression after the skin lesions subsided, serum amylase, lipase are normal, blood eosinophils are normal, no pancreatic inflammation.
2. Hard erythema: skin lesions occur in the bilateral calf flexion, no fever and pancreatitis, serum amylase is normal, histopathology is tuberculosis, anti-tuberculosis treatment is effective.
