Synovial Fat Necrosis Associated with Ischemic Pancreatic Disease

Authors

  • Nathan M. Smukler MD,

    Corresponding author
    1. Professor of Medicine, Jefferson Medical College
    2. Jefferson Medical College, Philadelphia, Pennsylvania and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
    • Jefferson Medical College, 1015 Walnut Street, Room 613, Philadelphia PA 19107
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  • H. Ralph Schumacher MD,

    1. Associate Professor of Medicine, University of Pennsylvania School of Medicine
    2. Jefferson Medical College, Philadelphia, Pennsylvania and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
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  • Eliseo Pascual MD,

    1. Rheumatology Fellow, University of Pennsylvania School of Medicine
    2. Jefferson Medical College, Philadelphia, Pennsylvania and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
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  • Sylvan Brown MD,

    1. Rheumatology Fellow, Jefferson Medical College
    2. Jefferson Medical College, Philadelphia, Pennsylvania and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
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  • William E. Ryan MD,

    1. Trenton, New Jersey
    2. Jefferson Medical College, Philadelphia, Pennsylvania and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
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  • M. Reza Sadeghian MD

    1. Rheumatology Fellow, Jefferson Medical College.
    2. Jefferson Medical College, Philadelphia, Pennsylvania and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
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Abstract

A 59-year-old man with ischemic pancreatic disease, polyarthritis, and cutaneous nodules has shown histopathologic findings indicative of disseminated fat necrosis in a percutaneous biopsy specimen from the right knee. The histopathologic findings in the synovium included necrotic fat cells, distorted fat cells and adjacent lymphocytes, lipid laden histiocytes, and giant cells. In prior histopathologic studies of the joint involvement associated with this disorder, fat cell necrosis has been found only in the periarticular tissues, and the synovium has appeared normal or showed nonspecific inflammation. However, the present study shows that the synovial membrane may also be the site of fat necrosis and an associated inflammatory reaction; thus patients with this disorder may manifest arthritis in addition to periarthritis.

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