Skin Metastases: The Visible Face of a Disastrous Unusual Finding

ttp://dx.doi.org/10.1016/j.jpge.2015.12.002 341-4545/© 2015 Sociedade Portuguesa de Gastrenterologia. Published C BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4 ore commonly from the head of the pancreas. Clinical ymptoms are usually non-specific. In contrast to ductal denocarcinoma, ACC rarely obstructs the common bile uct because it generally compresses and does not infilrate into adjacent structures, so jaundice is infrequent 12%). It has a unique ability to produce pancreatic enzymes. araneoplastic syndrome may be the only presenting sympom in 15% of patients. Lipase hypersecretion syndrome haracterized by subcutaneous fat necrosis, polyarthralgia nd peripheral eosinophilia is a type of paraneoplastic synrome associated with it. Skin nodules in this syndrome re commonly seen on the lower extremities and often istaken for metastatic disease.1--3 Surgical resection is he best treatment for localized ACC but this is a highly ggressive tumor. Approximately 50% of the cases presented ith metastasis at diagnosis. More than 70% the patients ho undergo surgical resection are eventually confirmed o show recurrent disease.2,3 Chemotherapy and radiotheapy are therapeutic options when ACC is unresectable or ecurs after resection, but no effective treatment strateies have been established. Although recent studies have larified the characteristics of ACC it still has not been fully 4,5 nderstood. We report a rare case of ACC with widespread metastases n a 35-year-old woman who presented with subcutaeous nodules as the initial symptom without evidence of