Nodular liquefactive panniculitis

　　First, Etiology

　　It is currently believed that the fat necrosis in this disease is caused by the action of pancreatic lipase on subcutaneous neutral fat tissue. Nodules and pancreatitis may occur when the serum lipase suddenly increases, and it is known that the lymphatic system is the main pathway for the diffusion of pancreatic enzymes, but the systemic circulation system may play a major role in the transport of pancreatic enzymes.

　　Second, Pathogenesis

　　1, Trypsin has the function of proteolyzing vascular wall proteins, which helps lipase enter fat tissue. The pancreatic tumor associated with nodular liquefactive panniculitis is an acinar adenocarcinoma that secretes a large amount of lipase. Continuous measurement of the patient's serum lipase can show that this enzyme level increases, especially when new nodules form.

　　1, The biopsy of skin nodules showed that the epidermis and dermis were normal, and the pathological changes were limited to the subcutaneous tissue, presenting as macular involvement. Focal fat necrosis and nearly normal fat lobules may alternate. The cell membrane of fat cells is intact, while other components of the cells appear slightly alkaline in hematoxylin and eosin staining. The intercellular septum and nucleus staining of the fat cells are completely lost. These fat cells are called 'phantom-like' cells with 'shadowy' cell walls. An inflammatory zone containing various types of cells may appear at the junction between the lesion and normal fat cells, with normal and broken neutrophils, lymphocytes, eosinophils, histiocytes, foam cells, and foreign cells infiltrating in a strip. Small alkaline granules may be seen at the edge of the necrotic area, and some believe that these alkaline granules are malnutrition calcification. Occasionally, hemorrhagic areas may be seen.

　　1, Pancreatitis:It is a disease caused by the autodigestive action of trypsin on the pancreas. The pancreas may have edema, congestion, or hemorrhage, and necrosis. Clinically, symptoms such as abdominal pain, bloating, nausea, vomiting, and fever may occur.

　　2, Pancreas includes:There are two types of functions, endocrine and exocrine, which correspond to two types of cells. Both types of cells can undergo cancer, and cancer originating from endocrine cells is called neuroendocrine cancer.

　　1. Skin lesions:Purple-red, painful inflammatory subcutaneous nodules can appear at any part of both lower legs, but they are more common in the skin above the medial malleolus of the lower leg. The diameter of the nodules ranges from a few millimeters to several centimeters. Some larger skin lesions may have swelling around them. The subcutaneous nodules are adherent to the skin above them but can be moved when touched. In mild cases, there may be only one attack, and the nodules do not break open, but sink in 2 to 3 weeks later, leaving slight pigmented scars. This type of skin lesion usually accompanies abdominal pain that occurs with mild recurrent chronic pancreatitis. However, some patients may have fever and polyarthritis or arthritis. In severe cases, other fat tissues outside the face and the whole body may also be involved. Some large nodules may be significantly tender, resembling abscesses with a fluctuating sensation when touched. If the nodules break open spontaneously, they can exude a white, cheesy, or oily, thick substance. Several nodules may coalesce into larger fluctuant plaques, and the nodules can communicate with each other through several openings. The occurrence of nodules is often accompanied by persistent high fever, malaise, fatigue, poor appetite, and insomnia, among other systemic symptoms.

　　2. Pancreatic lesions:Patients with accompanying pancreatic cancer may have varying degrees of abdominal pain, usually dull pain, which can be severe, presenting as colicky or cutting pain. It often occurs suddenly, usually within 2 hours after meals, gradually intensifying, and most often located in the upper middle abdomen. The pain often radiates to the back and waist, with a few cases radiating to the shoulder. Generally, it can last for 3 to 5 days. Most patients may experience nausea and vomiting during acute pancreatitis, with severe cases having bile mixed in the vomit. A few patients may have jaundice, usually due to biliary inflammation or pancreatic inflammation and edema compressing the common bile duct. Sometimes, shock may occur, with symptoms such as pale skin, cold sweat, weak pulse, and decreased blood pressure. Physical examination may reveal decreased respiratory sounds and moist rales in the lower lungs, abdominal distension, and tense abdominal muscles without rigidity. There may be tenderness and rebound pain in the upper abdomen, decreased bowel sounds, and sometimes hypocalcemia. Some patients may have tetany, and more than half of the patients may have liver enlargement. Some patients may develop superficial thrombophlebitis. In chronic pancreatitis, in addition to abdominal pain, symptoms such as nausea, vomiting, anorexia, abdominal distension, and steatorrhea may also be present.

　　1. Remove infection foci:Pay attention to hygiene, strengthen physical exercise, and improve the body's immune function.

　　2. Regular lifestyle:Combine work and rest, maintain a pleasant mood, and avoid strong mental stimulation.

　　3. Enhance nutrition:Avoid cold and raw foods, and pay attention to warmth and nourishment.

　　1. Routine blood tests and erythrocyte sedimentation rate:During the attack, most patients have an increase in white blood cells, eosinophils, and a significant increase in erythrocyte sedimentation rate.

　　2. Stool examination:Those with accompanying pancreatitis often have increased fecal fat content.

　　3. Biochemical examination:Serum calcium can be reduced, gamma globulin elevated, with increased serum amylase and lipase, but the elevation in those with pancreatitis is more pronounced than in those with pancreatic cancer. BSP test and alkaline phosphatase levels are also elevated in those with pancreatic cancer.

　　4. X-ray examination:Retrograde cholangiopancreatography shows irregular stenosis and dilatation of the ducts in chronic pancreatitis, sometimes呈念珠状, the branching ends are expanded like sticks, and pseudo-cysts may form (i.e., dilated duct branches), similar to cystic bronchiectasis. In pancreatic cancer, irregular stenosis or obstruction of the pancreatic ducts, as well as twisting and displacement, can be seen.

　　Lipodermatitis Food Therapy Formula:

　　1. Ginger Chicken:Use one male chicken that has just crowed, 100-250g of ginger, cut into small pieces, and stir-fry and stew it in a pot without adding oil or salt.

　　2. Deer Antler Chicken:Use one male chicken of the year, 3-6g of deer antler, cook it in a pot without adding oil or salt. Eat the meat and drink the soup, finish it in two days. It can be eaten every 1 week or half a month according to the situation. Do not use it in summer or in patients with joint redness and pain.

　　3. Red Bean Porridge:30g of red beans, 15g of white rice, and appropriate amounts of sugar. First cook the red beans until they are cooked, then add the white rice to make porridge and add sugar, which can remove damp-heat.

　　4. Job's Tears Porridge:30g of Job's tears, a small amount of starch, sugar, and appropriate amounts of osmanthus. First cook the Job's tears, when the rice is soft, add a small amount of starch, then add sugar and osmanthus. It can be used as breakfast, and it can clear damp-heat, invigorate the spleen and relieve stiffness.

　　I. Treatment

　　1. General treatment When high fever, joint symptoms, and skin lesions occur in acute attacks, antipyretic and analgesic drugs can be used, aspirin 1.5-3g, taken orally in three divided doses, or phenylbutazone 0.3-0.6g per day, taken orally in three divided doses, or diclofenac (Fetorin) 75-150mg/d, taken orally in three divided doses, to relieve joint symptoms and reduce fever. If necessary, hydrocortisone 100-200mg can be added to 500ml of 5% glucose for intravenous drip, 1 time/d, for several days in a row.

　　2. Treatment of concurrent pancreatitis Once acute pancreatitis occurs,对症 treatment should be fully carried out, antipyretic and analgesic drugs can be used to reduce fever, and in severe abdominal pain, analgesic drugs such as morphine can be appropriately used, correction of water and electrolyte imbalance and acid-base disorder. After the acute stage is over, consider surgical resection of the tumor, and appropriate chemotherapy after surgery.

　　II. Prognosis

　　Poor prognosis in patients with concurrent pancreatic cancer, which can deteriorate and lead to death quickly. In patients with concurrent pancreatitis, the prognosis is better, but recurrence is easy.