Pancreatic panniculitis as a first sign of liver carcinoma.

Sir, Pancreatic panniculitis (PP) is a rare disease that is caused by the massive release of pancreatic enzymes into the bloodstream and results in cytosteatonecrosis of the hypodermis. PP is clinically characterized by painful or asymptomatic nodules of the legs that closely resemble erythema nodosum or infectious panniculitis (1). The nodules may sometimes spontaneously ulcerate and drain brownish gelatinous sterile material. From a histopathologic point of view, PP is a mainly lobular panniculitis with intense, characteristic necrosis of adipocytes. We report on a case of PP with a dramatic presentation of massive cancer of the liver.