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Arkhiv Patologii 2019Panniculitis is a heterogeneous group of diseases that are characterized by a subcutaneous adipose tissue (SAT) lesion and frequently occur with involvement of the...
UNLABELLED
Panniculitis is a heterogeneous group of diseases that are characterized by a subcutaneous adipose tissue (SAT) lesion and frequently occur with involvement of the musculoskeletal system and viscera in the process. This is a chronic multiple organ disease. The gold standard for its diagnosis is noted to be a morphological study. The paper presents the current classification of panniculitis.
OBJECTIVE
To study the morphological features of idiopathic lobular panniculitis (ILP) in accordance with the nature of the course and clinical forms of the disease.
SUBJECT AND METHODS
Biopsy specimens were studied in 62 patients with various clinical forms of ILP. Biopsy and surgical materials were investigated by light optical morphological methods. The results were statistically processed using a statistical analysis software Statistica Version 10 package for Windows ('StatSoft Inc.', USA). The differences were considered statistically significant at an error level of p<0.05. Methods, such as Pearson's c test (analysis of contingency tables), Student's t-test, Z-test for comparison of proportions, nonparametric tests, such as Mann-Whitney U-test, Kruskal-Wallis test, were used to assess the results.
RESULTS
The nature of the morphological parameters of the disease corresponded to the course of ILP. The acute course of the disease was characterized by the predominance of liponecrosis and inflammation concurrent with productive-destructive vasculitis. In the chronic course, there was a preponderance of lymphohistiocytic infiltrate with gigantic macrophages (lipophages) and granuloma-like structures. The above morphological changes were characteristic of the phagocytic morphological stage of node formation. The fibroplastic stage of panniculitis was absent in this study. The morphological features of the disease were shown depending on the form of idiopathic lobular panniculitis, which may be of diagnostic value in the differential diagnosis of panniculitis.
CONCLUSION
The pathologist must first of all pay attention to the preferential localization of pathological changes (in the SAT septa or slices), the presence or absence of vasculitis and the nature of the infiltrate. The skin in panniculitis is typically intact or has minimal changes following the pattern seen in reactive ones. Panniculitis shows an undulatory course, and therefore all signs of this disease are present in biopsy specimens; however, morphological signs of the acute inflammatory, lipophagic or fibroplastic stage of the disease predominate depending on the stage and activity of the process.
Topics: Biopsy; Granuloma; Humans; Panniculitis; Skin; Vasculitis
PubMed: 31317929
DOI: 10.17116/patol20198103137 -
International Journal of Dermatology Aug 2018Alpha-1 antitrypsin deficiency (AATD) may be associated with liver and lung disease and rarely causes panniculitis.
BACKGROUND
Alpha-1 antitrypsin deficiency (AATD) may be associated with liver and lung disease and rarely causes panniculitis.
OBJECTIVE
We evaluated the clinicopathologic and laboratory findings of AATD panniculitis in 10 patients.
METHODS
We conducted a retrospective review of all cases of AATD panniculitis at Mayo Clinic, Rochester, MN, from 1989 to 2016.
RESULTS
Ten patients with AATD panniculitis were included. Seven of ten were women. Clinical lesions were most commonly nodular (100%), erythematous (90%), ulcerated (90%), and painful (90%) subcutaneous nodules and plaques. Extracutaneous associations were rare. PiZZ phenotype was most commonly identified (50%). Histopathologically, lobular panniculitis (80%) with associated septal involvement (60%) and a predominant neutrophilic infiltrate (100%) were most common. Treatments varied; dapsone and alpha-1 proteinase inhibitor infusions were each used in five (50%) patients, respectively. In patients with greater than 6-month follow-up (n = 4), one patient continued to have disease activity despite treatment.
CONCLUSION
AATD panniculitis should be considered in the differential for a painful, ulcerative panniculitis with a predominantly neutrophilic histopathologic infiltrate. Diagnosis can be made with clinicopathologic correlation and genetic and laboratory evaluations. Serum AAT level and phenotype assists in diagnosing patients with suspected AATD panniculitis.
Topics: Adolescent; Adult; Anti-Infective Agents; Dapsone; Female; Humans; Male; Middle Aged; Neutrophils; Panniculitis; Phenotype; Retrospective Studies; Skin Ulcer; Treatment Outcome; Trypsin Inhibitors; Young Adult; alpha 1-Antitrypsin; alpha 1-Antitrypsin Deficiency
PubMed: 29707779
DOI: 10.1111/ijd.14012 -
Journal Der Deutschen Dermatologischen... May 2019
Review
Topics: Arthritis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pancreatitis; Panniculitis; Syndrome
PubMed: 30994265
DOI: 10.1111/ddg.13839 -
The Turkish Journal of Pediatrics 2019Açarı C, Ünsal E, Hakgüder G, Soylu A, Özer E. Pediatric mesenteric panniculitis: three cases and a review of the literature. Turk J Pediatr 2019; 61: 798-803.... (Review)
Review
Açarı C, Ünsal E, Hakgüder G, Soylu A, Özer E. Pediatric mesenteric panniculitis: three cases and a review of the literature. Turk J Pediatr 2019; 61: 798-803. Mesenteric panniculitis is an inflammatory and fibrotic process in the mesenteric adipose tissue with unknown etiology. It is rarely seen in general, particularly in children. Etiology is unknown, and pathophysiology is not clear. Factors that trigger the disease are malignancy, tuberculosis, trauma, medications and past surgical interventions. There is no pediatric case series in the literature except single case reports. This paper consists of 3 cases: The first case is a 5-month-old girl, the youngest patient in the literature, who was referred to a pediatric surgeon with vomiting and abdominal distention. She had diffused intraabdominal fluid and mesenteric panniculitis documented by perioperative biopsy. The second case had acute abdominal pain with perforated appendicitis, who eventually had mesenteric panniculitis in the evaluation of the pathological specimen. The last case had a diagnosis of polyarticular juvenile idiopathic arthritis (JIA), successfully treated with etanercept, and has been in remission for 2 years. Interestingly, in one of her routine visits, she had pallor, anemia and renal failure. Bilateral hydronephrosis was detected. Magnetic resonance imaging (MRI) of the abdomen revealed retroperitoneal fibrosis, and mesenteric panniculitis was the histopathological diagnosis.
Topics: Abdominal Pain; Biopsy; Child; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Panniculitis, Peritoneal; Vomiting
PubMed: 32105017
DOI: 10.24953/turkjped.2019.05.024 -
Journal of the European Academy of... Oct 2022
Topics: Cytokines; Humans; Immune Checkpoint Inhibitors; Panniculitis
PubMed: 35686625
DOI: 10.1111/jdv.18312 -
Revista Espanola de Medicina Nuclear E... 2021
Topics: Fluorodeoxyglucose F18; Humans; Lymphoma, B-Cell; Panniculitis; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography
PubMed: 34218889
DOI: 10.1016/j.remnie.2020.09.008 -
BMJ Case Reports Oct 2018A previously healthy 74-year-old woman was admitted with vespertine fever, tremors, shivers and loss of appetite within the previous month. Blood tests revealed an...
A previously healthy 74-year-old woman was admitted with vespertine fever, tremors, shivers and loss of appetite within the previous month. Blood tests revealed an elevated C reactive protein serum level. Serologies for infection were negative. Blood cultures grew no organisms. Colonoscopy revealed normal findings. CT showed typical findings of mesenteric panniculitis with infiltration of mesenteric fat that was circumscribed by hyperattenuating capsule and contained enlarged homogenous lymph nodes. The histopathological analysis from mesenterium revealed non-specific signs of chronic inflammation. On institution of prednisolone, the clinical symptoms subsided, and we replaced it with azathioprine after 1 month. After 12 months of therapy, the patient remained asymptomatic, normalised the serological inflammatory markers and repeat CT revealed normal mesenteric fat.
Topics: Aged; Diagnosis, Differential; Fever; Humans; Male; Mesentery; Panniculitis, Peritoneal; Tomography, X-Ray Computed
PubMed: 30317189
DOI: 10.1136/bcr-2017-223977 -
Archives of Iranian Medicine Sep 2014
Topics: Humans; Knee; Male; Middle Aged; Panniculitis; Skin; Staphylococcal Skin Infections; Thigh
PubMed: 25204486
DOI: No ID Found -
European Journal of Dermatology : EJD Apr 2023BRAF and MEK inhibitors have changed the landscape of treatment for advanced melanoma. Among their side effects, panniculitis has been hypothesized to be associated with...
BACKGROUND
BRAF and MEK inhibitors have changed the landscape of treatment for advanced melanoma. Among their side effects, panniculitis has been hypothesized to be associated with better survival.
OBJECTIVES
In this study, we aimed to explore the association between the occurrence of panniculitis during targeted therapy and outcome of metastatic melanoma.
MATERIALS & METHODS
This was a retrospective single-centre comparative study from 2014 to 2019. An English literature review was also conducted to further our understanding of the mechanism(s) involved and identify characteristics of this association, in order to support better management.
RESULTS
Ten patients who developed panniculitis during treatment were matched to 26 controls based on potential confounders at treatment introduction. The prevalence of panniculitis was 5.3%. Median progression-free survival (PFS) for all patients was 8.5 months (range: 3.0-94.0). The median PFS for the group with panniculitis was 10.5 months (7.0-undefined) and 7.0 months (6.0-32.0) for controls (p=0.39). According to the scientific literature, panniculitis occurring during targeted therapy affects mainly young people, predominantly women, with variable delay to onset (with half reported cases occurring in the first month). In addition, panniculitis usually only affects the lower limbs or is associated with other clinical signs (fever, arthralgia), without histological specificity. Discontinuation of targeted therapy is not required as spontaneous remission is usually experienced. Symptomatic treatment may be administered but systemic corticosteroids have not been proven to be effective.
CONCLUSION
In contrast to the belief that there is a link between panniculitis and clinical response to targeted therapy according to the literature, our results show that there is no significant association between the two.
Topics: Humans; Female; Adolescent; Male; Retrospective Studies; Remission, Spontaneous; Melanoma; Arthralgia; Panniculitis
PubMed: 37431115
DOI: 10.1684/ejd.2023.4467 -
Autoimmunity Reviews Apr 2023Involvement of subcutaneous tissue in idiopathic inflammatory myopathies (IIM) is poorly known. (Review)
Review
INTRODUCTION
Involvement of subcutaneous tissue in idiopathic inflammatory myopathies (IIM) is poorly known.
METHODS
We conducted a systematic review of the literature regarding panniculitis and lipodystrophy/lipoatrophy in juvenile and adult IIM via PubMed/Medline, Embase and Scopus databases. Three local observations are included in this review. Epidemiological, clinical, paraclinical and therapeutic data were collected.
RESULTS
Panniculitis appears to be more common in adults than in juveniles. It was mainly localised in the upper and lower limbs. Panniculitis improved in most cases with steroids and panniculitis and myositis had a similar course in 83.3% and 72.2% of cases in juveniles and adults, respectively. Lipodystrophy appeared to be more frequent in juveniles and was only observed in dermatomyositis in both juveniles and adults. Lipodystrophy was mainly partial in juveniles and adults. The median time from myositis to the diagnosis of lipodystrophy was 6 years [0-35] and 2.5 years [0-10] in juveniles and adults, respectively. Lipodystrophy was associated with anti-TIF1 gamma auto-antibody positivity, a polycyclic/chronic course of myositis and the occurrence of calcinosis and might be an indicator of poor disease control.
CONCLUSION
Adipose tissue involvement, particularly lipodystrophy, occurs almost exclusively in dermatomyositis. The insidious onset and lack of awareness of the diagnosis may underestimate its prevalence. Larger studies are needed to identify possible risk factors in these patients, to better potential underlying pathophysiological process, in order to discuss potential therapeutic targets.
Topics: Adult; Humans; Dermatomyositis; Subcutaneous Tissue; Autoantibodies; Myositis; Panniculitis; Lipodystrophy
PubMed: 36736986
DOI: 10.1016/j.autrev.2023.103284