Panniculitis

Published on 05/03/2015 by admin

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Last modified 05/03/2015

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Panniculitis

Introduction

• Adipose tissue plays many active roles in the body beyond insulation, e.g. storing and releasing lipids, mediating inflammation, and modulating endocrinologic and reproductive systems.

• Panniculitis = inflammation of adipose tissue.

• Clinically and histopathologically, the adipose tissue has a limited repertoire of responses to insults and inflammation.

• Most often clinically presents as tender, inflamed, subcutaneous nodules or plaques; with the exception of erythema nodosum, ulceration with drainage may develop.

• There are various etiologies, and a clinical classification system is presented in Table 83.1.

Table 83.1

Clinical classification of the panniculitides.

^* The majority represent an underlying subcutaneous lymphoma.

• Diagnosis is challenging and involves consideration of (1) patient characteristics such as age, immune status, underlying diseases; (2) location of the lesions (Fig. 83.1); (3) the presence or absence of ulceration and/or drainage; and (4) histopathological findings.

Fig. 83.1 Most common locations for several forms of panniculitis.

• A biopsy is usually necessary to establish the diagnosis, and it is critical that the specimen include a generous portion of the subcutaneous (SC) fat.

• Excisional biopsies or narrow incisional biopsies that incorporate a broad expanse of SC fat are preferable to punch biopsies.

• Once the diagnosis of panniculitis is made, further evaluation for underlying etiology or associated conditions is necessary (Tables 83.2–83.4).

Table 83.2

The more common panniculitides.

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