非胰腺疾病引起胰腺性脂膜炎1例

Pancreatic Panniculitis Caused by Non-Pancreatic Diseases:A Case Report

目的分析非胰腺疾病引起胰腺性脂膜炎病理和临床特点,探讨发病机制,完善脂膜炎临床诊断思路。方法对1例确诊肝脏内分泌肿瘤(但胰腺正常)引起的胰腺性脂膜炎病例进行分析,并对既往报告的非胰腺疾病引起胰腺性脂膜炎病例进行临床和病理特点总结。结果非胰腺疾病和胰腺疾病引起的胰腺性脂膜炎在病理上具有共同的特点:均为小叶脂膜炎,局灶性坏死脂肪细胞、鬼影细胞和坏死脂肪细胞胞浆内的嗜碱性沉积物,坏死的脂肪细胞周围可见中性粒细胞和组织细胞浸润。非胰腺疾病引起的胰腺性脂膜炎患者死亡率高,内分泌肿瘤可能引起胰腺性脂膜炎。结论血清胰脂肪酶和/或淀粉酶代谢异常可能是非胰腺疾病患者出现胰腺性脂膜炎的原因,非胰腺疾病引起胰腺性脂膜炎不容忽视。

Objective To analyze the pathologic and clinical characteristics of pancreatic panniculitis caused by non-pancreatic diseases,explore the pathogenesis of pancreatic panniculitis,and improve the clinical diagnosis of panniculitis.Methods A case of pancreatic panniculitis caused by a hepatic endocrine tumor with a normal pancreas was analyzed and complemented with a summary of the previous cases of pancreatic panniculitis caused by non-pancreatic diseases.Results Pancreatic panniculitis caused by non-pancreatic diseases and pancreatic diseases had the same pathological characteristics:lobular panniculitis,with focal necrotic adipocytes,ghost cells,basophilic deposits in the cytoplasm of necrotic adipocytes,and infiltration of neutrophils and histiocytes around necrotic adipocytes.The mortality rate of pancreatic panniculitis caused by non-pancreatic diseases was high.Pancreatic panniculitis may be caused by non-pancreatic diseases,especially endocrine tumors.Conclusion Abnormal metabolism of serum pancreatic lipase and/or amylase is involved in the pathogenesis of pancreatic panniculitis caused by non-pancreatic diseases.Pancreatic panniculitis caused by non-pancreatic disorders should not be ignored.