Veterinary Dermatology 2005, 16, 413 419

Case report

Blackwell Publishing Ltd

Feline cutaneous and visceral necrotizing panniculitis and steatitis

associated with a pancreatic tumour
FABRIZIO FABBRINI*, PASCAL ANFRAY*, PAOLO VIACAVA, MICHELA GREGORI
and FRANCESCA ABRAMO
*Clinica Veterinaria Papiniano, via Papiniano 50, 20123 MI, Milan, Italy, Departments of Oncology and
Animal Pathology University of Pisa, Pisa (Italy)
(Received 15 February 2005; accepted 23 September 2005)

Abstract The association of pancreatic disorders with fat necrosis in domestic animals is rare. This report
concerns a case of cutaneous/subcutaneous necrotizing panniculitis and steatitis associated with a pancreatic
adenocarcinoma in an 11-year-old male Siamese cat. Clinical investigation revealed variably sized nodules on
the trunk, limbs and abdomen. Some of them were ulcerated; others showed a shiny yellow necrotic background
featuring irregular sinus tracts. The cat was euthanized at the owners request before a diagnosis could be made.
At necropsy, abundant oily material resembling mustard replaced the subcutaneous tissue and small yellow
nodules were disseminated in the omentum, mesentery and serosa of the abdomen. A multilobulated mass arising
from the anterior pancreatic head was found along with liver and lymph node metastasis. Histopathology showed
wide fistulous tracts draining necrotic fat from the subcutis toward the surface and multifocal areas of necrotic
adipocytes replacing the panniculus. Duct-like structures and tubules lined by neoplastic epithelial cells were
observed in the primary pancreatic tumour and in the metastatic sites. The aetiology of the fat necrosis was
possibly the result of systemic release of lipolytic pancreatic enzymes.

IN TRO D U CT ION
In veterinary literature, two feline cutaneous/subcutaneous
syndromes characterized by diffuse fat necrosis are
described. The first syndrome, feline pansteatitis, is the
more common and it represents a nutritional disorder
caused either by the consumption of great amounts of
unsaturated fatty acids and/or insufficient vitamin E
intake.16 The second syndrome is systemic lipodystrophy associated with pancreatitis.7 Other potential
aetiologies concerning fat necrosis include infectious
agents (bacterial, fungal and viral), physicochemical
factors (trauma, pressure, cold stress and foreign body
reactions), neoplasia, vasculopathy and immunemediated disorders.8 Nutritional pansteatitis has been
reported in cats whose diets contain canned red tuna,
sardines, herring and cod,3,5,9 but other kinds of food
should also be taken into account. Inactivation of
vitamin E by food processing or fat oxidation can also
be the cause of the disease. Moreover, two recently
published case records report a diet mostly based on
pigs brain, which induced pansteatitis.6 Affected cats
usually show subcutaneous nodules, pain on palpation,
fever, inappetence, depression and reluctance to move.

Correspondence: Prof Francesca Abramo, Department of Animal

Pathology, Viale delle Piagge, 2, I-56124 Pisa, Italy. E-mail:
abramo@vet.unipi.it
2005 European Society of Veterinary Dermatology

In the case of feline pansteatitis, lesions are limited to

the subcutis and abdominal cavity but there is no evidence
of pancreatic disease.
Extra-visceral manifestations of pancreatic disorders
are known in human medicine1015 but very few cases
are reported in animals.7,16 It has been suggested that
lipase released by the pancreas into blood or lymphatic
vessels is activated in distant sites, such as the skin.14,15
Pancreatitis or pancreatic carcinoma is usually
followed by lipolytic enzyme release. Although it is
known that pansteatitis is a common consequence of
pancreatic diseases, a single case of lipodystrophy
associated with pancreatitis in a cat7 and a few cases of
panniculitis in dogs affected with pancreatitis and
pancreatic hyperplasia/tumours1619 have been recognized so far. To the authors knowledge, this case
report represents the first in which feline cutaneous/
subcutaneous/visceral fat necrosis is associated with a
pancreatic tumour.

C A S E R E P O RT
An 11-year-old male Siamese cat was presented with
a 3-month history of cutaneous nodules. The cat had
been regularly vaccinated, fed on commercial canned/
dry food and lived indoors with another cat. The owner
reported that a cutaneous nodule was first noticed on
the back and that the cat had been in good general
413

414

F Fabbrini et al.

health before the onset of the skin lesion. On the first

examination, the veterinary surgeon detected a single
skin nodule that was diagnosed as an abscess, probably
the consequence of a bite from the other cat in the
house. Treatment with topical chlorhexidine spot gel
had been initiated but this therapy did not lead to any
clinical improvement. Two weeks after the onset of the
first nodule, the owner observed the presence of a
second lesion on the abdomen. On clinical examination,
the veterinary surgeon diagnosed a haematoma caused
by trauma (the cat may have injured itself trying to
jump on a table). The cat was febrile and a dermatological examination revealed the presence of several other
nodules: one on the back, one on the abdomen and
other small ones all over the trunk. Treatment with
enrofloxacin (Baytril, Bayer, Milan, Italy) at 5 mg kg1
SID for 10 days was started. The owner found the oral
treatment difficult to administer, the cat became anorexic
and the therapy resulted in no clinical improvement.
On re-presentation to the veterinary surgeon, the cat
was still pyrexic and the nodules were still detectable.
Abdominal ultrasound examination identified two
abdominal masses, one on the liver and the other in the
pancreas, although this could not be clearly defined.
The cat responded to an 8-day course of amoxicillinclavulanate (Synulox, Pfizer, Rome, Italy) injected
subcutaneously and its clinical condition improved.
The cat began to eat and a decrease in the extent of the
cutaneous nodules was detected. After 1 month, relapse
of cutaneous nodules occurred, and the cat was referred
for a dermatological examination.
On physical examination the cat was pyrexic (40 C),
lethargic and depressed. Regional lymph nodes were
not palpable. Dermatological examination revealed
the presence of nodules of different sizes on the trunk,
limbs, dorsal and ventral abdomen (Fig. 1). Some
nodules showed a smooth or lumpy consistency, whereas
others were ulcerated. On the dorsal part of the
abdomen, the hair was matted by yellow-orange exudate
and the skin appeared yellowish and showed erythematous areas. After clipping, some of the nodules showed
a shiny yellow necrotic background, featuring irregular
sinus tracts (Fig. 2), whereas others discharged orangebrown oily exudates.
The differential diagnoses included unusual/atypical
bacterial infections (actinomycosis, actinobacillosis,
mycobacteriosis, nocardiosis), deep mycotic infections,
panniculitis and pansteatitis.
A complete blood count and biochemistry profile
were performed (Tables 1 and 2). Fungal and bacterial
cultures were performed from the nodules and failed
to reveal any evidence of a bacterial or fungal aetiology.
Cytological evaluation of air-dried Diff-Quik-stained
impression smears and fine-needle aspirates from
cutaneous nodules were performed. Neutrophils and
macrophages were the main inflammatory cells
present, along with free extracellular bacteria and some
amorphous necrotic material in the background. Tests
for feline leukaemia virus infection and feline immunodeficiency virus were negative.

Figure 1. Cat, ventral view, nodules of different size in the dorsal

part of the abdomen and axilla. The hair is matted by yellow-orange
exudate.

Figure 2. Cat, abdomen, a wide ulcerated nodule with a yellow

necrotic background featuring irregular sinus tracts.

On the first day of admission, while waiting for

bacterial and fungal culture results, intravenous lactated
Ringers solution at 15 mL kg1 h1 along with mercaptopropionyl glycine (Thiola, Coop.Farmaceutica,
Milan, Italy) at 100 mg i.v. s.i.d. and ceftriazone
(Rocefin, Roche, Milan, Italy) at 25 mg kg1 i.v. b.i.d.
were administered. However, because of the progressive worsening of the general condition over 2 days,
euthanasia was performed at the owners request.
At necropsy, the first skin incision in the abdominal
region showed abundant oily exudates replacing the

2005 European Society of Veterinary Dermatology, Veterinary Dermatology, 16, 413 419

Necrotizing panniculitis and steatitis associated with pancreatic tumour

415

Table 1. CBC results

Haematological profile

Mean

Reference

Erythrocytes (106 L1)

White blood cells (103 L1)
Band neutrophils (cell L1)
Segmented neutrophils (cell L1)
Lymphocytes (cells L1)
Monocytes (cells L1)
Eosinophils (cells L1)
Basophils (cells L1)
Platelets (103 L1)
Haemoglobin concentration (g dL1)
Packed cell volume (%)
Mean cell volume (fl)

3.81
20:04
6120
12:24
1:02
204
612
0
205
5:06
0:47
22:09

6.0 10.1
6.3 19.6
0 300
3.000 13.400
2000 7.200
0 1.000
300 1.700
0 100
156 626
8.114.2
0.4 1.4
8.6 18.9

Figure 4. Necropsy, abdominal cavity. A firm, grey, multi-lobulated

mass arising from the anterior pancreatic head (arrow). Small,
yellowish, noncoalescing necrotic nodules are visible in the serosa of
the abdominal wall (arrowhead).

Figure 3. Necropsy, first skin incision in the abdominal region.

Large amount of oily exudate is replacing the subcutaneous tissue,
the yellow-greenish colour resembling mustard.

subcutaneous tissue. The yellow-greenish colour of the

exudates resembled mustard (Fig. 3). Other small-sized
mustard-coloured nodules were disseminated in the
subcutaneous tissue and coalesced into larger, apparently liquified areas. Smaller yellow-greenish, 0.51 cm
in diameter, noncoalescing necrotic nodules were seen
in the omentum, mesentery, serosa of the abdomen
wall and pericardium. A multilobulated, 4 cm-wide
mass was detected in the anterior pancreatic head. The
lesion was firm, grey and showed a nodular appearance
(Fig. 4). Two metastatic masses were found protruding
from the liver surface. The mesenteric lymph node was
noticeably enlarged.
Tissue specimens from skin, subcutis, pancreas, liver
and peritoneum were fixed in 10% buffered formalin
solution (pH 7.4) and routinely processed. Sections
were cut and stained with haematoxylin and eosin,
periodic acid-Schiff (PAS) and Ziehl-Neelsen.
Histological examination of the skin at low-power
magnification showed wide fistulous tracts draining
necrotic fat from the subcutis towards the surface.
Wide crusts containing neutrophils, nuclear debris and
necrotic fat covered the skin surface. At higher-power
magnification, the panniculus was almost replaced by
multifocal areas of necrotic adipocytes with irregular,
granular, basophilic material often deposited in the

Figure 5. Histopathology from the subcutis of the abdomen.

Multifocal areas of necrotic adipocytes characterized by basophilic
material often deposited at the periphery of the cytoplasm (asterisk).
Pycnotic neutrophils and macrophages infiltrate the subcutis (E & E,
bar = 50 m).

peripheral cytoplasm. These ghost-like fat cells were

characterized by radially arranged needle-shaped clefts.
A dense, mostly neutrophilic and macrophagic infiltration was present at the periphery of the fat necrosis
area (Fig. 5). Necrotic areas were PAS-negative and
weakly acid-fast-positive and ceroid pigment was not
detected. The pancreatic tumour was a moderately
differentiated ductal adenocarcinoma predominantly
formed by duct-like structures and tubules variable in
size and shape. Neoplastic ducts and tubules were lined
by epithelial cells with moderate nuclear polymorphism
and frequent mitoses. Solid tumour cell sheets and nests
and focal necrotic areas were also observed. Stromal
reaction was scanty. The same histological and cytological features were observed in the liver metastasis.
Immunohistochemistry was negative for the endocrine
markers chromogranin, insulin, glucagon, somatostatin
and gastrin.

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F Fabbrini et al.
Table 2. Biochemistry profile

Figure 6. Cryostat skin specimen stained with oil red 0. Normal fat
containing skin structures such as cornified layer (arrow) and
sebocytes (arrowhead) stain strongly red. Round-shaped structures
in the crusted surface are also stained by oil red 0 (asterisk) (Oil Red
0, bar = 100 m).

Figure 7. Cryostat subcutis specimen stained with oil red 0. Roundshaped, radially arranged structures are present in the deep
panniculus (oil red 0, bar = 50 m).

To better define the histochemical nature of the

amorphous material observed in the panniculus, 5-mm3
representative portions of formalin-fixed skin specimens
were washed in tap water, deep-frozen in cold (80 C)
isopentane (Riedel-de Han, Sigma-Aldrich, Germany)
and cryostat-sectioned specimens were stained with oil
red 0. Normal fat containing cutaneous structures such
as the cornified layer, sebocytes and adipocytes showed
a strong red positivity (Fig. 6). Round-shaped, radially
arranged structures in the deep panniculus, sinus tracts
and crusted surface were also less intensely stained
by oil red 0 (Fig. 7). A cytological specimen performed
by touch imprint was also stained with oil red 0 and
revealed red-stained, round-shaped structures with the
same dimensions as those found in the deep panniculus.
Based on gross and microscopical alterations, the
postmortem diagnosis was cutaneous/subcutaneous
and visceral necrotizing panniculitis and steatitis
associated with pancreatic tumour.

Blood chemistry analysis

Mean

Reference

CPK (IU L1)

AST (IU L1)
ALT (IU L1)
ALP (IU L1)
GGT (IU L1)
Total bilirubin (mg dL1)
Total protein (g dL1)
Albumin (g dL1)
Globulin (g dL1)
A:G ratio (g dL1)
Cholesterol (mg dL1)
Triglycerides (mg dL1)
Urea nitrogen (mg dL1)

400
239
160
34
2.9
1:56
3.1
1.2
1.9
0.63
32
54
40

0 130
0 40
0 50
0 70
0 5
0 0.2
5.8 8.0
2.5 4.0
2.8 5.5
0.4 1.3
70 150
40 100
20 65

D IS C U S S IO N
In human beings, any skin condition featuring recurrent
inflammation with fat necrosis in the subcutis is called
WeberChristian disease. This condition was first
described by Pfeifer20 in 1892 who recognized it, further
depicted by Weber in 1925,21 and lastly by Christian22
in 1928 who emphasized the presence of fever as part
of the syndrome. Currently, WeberChristian disease is
a form of panniculitis characterized by recurrent fever
episodes accompanied by the eruption of single or
multiple erythematous subcutaneous nodules.23 Today,
the aetiology of this disease is still unknown and its
typical clinical features are often described in the
literature under various synonyms: mesenteric lipodystrophy, mesenteric panniculitis, nodular nonsuppurative
panniculitis, nonsuppurative relapsing panniculitis,
relapsing panniculitis and subcutaneous nodular fat
necrosis and pancreatitis. These feature clinical entities
that often overlap. Many authors believe that to better
define this disease, a specific diagnosis should be made
only on the basis of pathogenesis and/or aetiology.
Yellow fat disease, pansteatitis and some of the terms
listed previously have been adapted to animals1,7,8,16 and
the current nomenclature in the veterinary literature is
confusing.
Fat necrosis naturally occurs in many species such as
pigs, rats,24 chinchillas,25 foxes, ferrets,26 wild rabbits,27
lions,28 minks,29 wild hares,30 fishes,31 herons,32 hawks,33
dogs,8 but mostly in cats.14,6,7
In almost all of these species, the disease is mostly
related to dietary fat intake and inadequate vitamin E
supply, whereas in dogs, the aetiology is uncertain. In
three canine cases, an immune-mediated disorder was
hypothesized, but pancreatitis and pancreatic tumours
have been recognized in other cases.8,1619 Fat necrosis
following pancreatitis is rarely found in cats.7
When the cat in this case report was presented for
dermatological examination, its general health was
severely compromised. During the time required to
obtain bacterial and fungal culture results, infective
causes could not be ruled out. Only negative bacterial
and fungal cultures allow a diagnosis of idiopathic

2005 European Society of Veterinary Dermatology, Veterinary Dermatology, 16, 413 419

Necrotizing panniculitis and steatitis associated with pancreatic tumour

panniculitis or a pancreatic disorder, prompting glucocorticoid therapy. Pansteatitis caused by consumption
of great amounts of unsaturated fatty acids or vitamin
E deficiency was, however, considered unlikely, as
the cat was not fed on a fish-based diet. Moreover,
pansteatitis caused by lipase release represents a very
rare disease in cats, and feline pancreatic lipase immunoreactivity testing in the subject was not performed
because the test was not available at the time the case
was seen. Only recently, purification and partial characterization of feline classical pancreatic lipase has
been performed.34 Marked hyperlipaemia was found in
six dogs with aberrant pancreatic lipase production
by pancreatic adenocarcinoma, endocrine carcinoma
and hepatic carcinoma. In none of these dogs did
hyperlipaemia lead to subcutaneous fat necrosis.35 The
authors did not give any explanation about failure of
hyperlipaemia to induce steatitis/panniculitis in these
dogs. Quick blood clearing of lipase, lipase levels not
high enough to produce fat necrosis or genetic susceptibility to panniculitis might be considered as possible
factors for the previously mentioned condition.
Pancreatic tumours occur relatively frequently in dogs
and less often in cats. They feature an invasive behaviour
by implanting into the peritoneum. Liver metastasis
usually occurs, either in the shape of small or large
nodules. They appear in the very early phases of
carcinogenesis so the success of surgery is decreased
by delays in diagnosis.36,37 In human beings, acinar
pancreatic carcinoma is found in a small number of
patients affected by pancreatic tumours, but more than
half of those affected by subcutaneous fat necrosis
suffer from this form of pancreatic carcinoma.10,12,13
In our case, the histopathological pattern was not
compatible with an acinar-type pancreatic tumour.
Recently, a human form of nodular panniculitis, associated with liver metastasis of a pancreatic carcinoma
and high levels of serum lipase, has been described as a
paraneoplastic syndrome.38 We would avoid this term
for the condition described in our case, as lipase is
normally found in pancreatic acini and ducts. In fact,
by definition, paraneoplastic syndromes are caused by
ectopic production of hormones, hormone-like polypeptides, growth factors, metabolic intermediates and
other factors.39
Oil red stain is not commonly used in routine histopathology, but is valuable in detecting fat from frozen
sections. Fat dissolves from formalin-fixed sections, but
freezing of samples after formalin fixation appeared to
be satisfactory in this case. The same stain was also
satisfactorily used on cytology samples.
In conclusion, this case described fat necrosis associated with a pancreatic tumour in a cat. The authors
believe that the terms steatonecrosis and lipodystrophy
could also be adopted as synonyms of necrotizing panniculitis and steatitis to emphasize that the aetiology is
fat necrosis possibly the result of the systemic release of
lipolytic enzymes rather than of inflammation, which
represents a secondary outcome. Whatever the underlying cause is, the pathological finding is fat necrosis

417

without any relation to a specific aetiology.40 In fact,

adipocyte necrosis is followed by lipid content release,
undergoing hydrolysis; the released glycerol and fatty
acids have proinflammatory properties recruiting neutrophils and macrophages into the damaged fat tissue.

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Rsum Lassociation de maladies pancratiques avec une ncrose des tissus graisseux est rare chez les animaux.
Cet article rapporte un cas de panniculite ncrosante sous-cutane/cutane et dune statite associe un adnocarcinome pancratique chez un Siamois mle de 11 ans. Lexamen clinique a montr de nodules de taille varie
sur le tronc, les membres et labdomen. Certains taient ulcrs, dautres prsentaient un aspect jauntre et des
fistules. Le chat a t euthanasi la demande de ses propritaires avant quun diagnostic ne soit fait. A lautopsie,
un matriel huileux abondant ressemblant de la moutarde remplaait le tissu sous-cutan et des nodules jaunes
taient dissmins dans lomentum, le msentre et les sreuses abdominales. Une masse multilobule a t
observe sur le pancras, ainsi que des mtastases sur le foie et les ganglions. Lexamen histopathologique a
montr des fistules ncrotiques adipeuses remplaant le tissu sous-cutan. La tumeur pancratique tait
compose de structures en canaux et de tubules entoures de cellules noplasiques pithliales. Ltiologie de la
ncrose adipeuse tait peut tre lie la libration systmique denzymes pancratiques lipolytiques.
Resumen La asociacin de enfermedades pancreticas con necrosis de tejido graso en animales domsticos es
poco comn. Este articulo se refiere a un caso de paniculitis necrotizante del cutis y subcutis, as como esteatitis,
asociados con un adenocarcinoma de pncreas en un gato macho Siams de 11 aos. La investigacin clnica
desvel ndulos de varios tamaos en el tronco, extremidades y abdomen. Algunos de estos ndulos estaban
ulcerados, y otros mostraban un fondo amarillento necrtico con tractos sinusoidales irregulares. El animal fue
sacrificado a peticin del dueo antes de poder emitir un diagnstico. En la necropsia observamos abundante
material oleoso similar a mostaza ocupando la zona del tejido subcutneo, as como ndulos pequeos amarillentos diseminados en el omento, mesenterio y serosa del abdomen. Una formacin multilobulada se originaba
en la parte anterior de la cabeza del pncreas y tambin encontramos metstasis en el hgado y ganglios regionales.
El anlisis histopatolgico demostr reas de adipocitos necrticos reemplazando el panculo adiposo. En el
tumor pancretico primario y en las metstasis observamos estructuras tubulares tapizadas con clulas epiteliales
neoplsicas. La etiologa de la necrosis del tejido adiposo fue posiblemente la liberacin a escala sistmica de
enzimas pancreticas lipolticas.
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Zusammenfassung Der Zusammenhang von Strungen des Pankreas mit einer Fettnekrose ist bei Haustieren
selten. Dieser Bericht beschreibt einen Fall von kutaner/ subkutaner nekrotisierender Pannikulitis und Steatitis
im Zusammenhang mit einem Adenokarzinom des Pankreas bei einer 11 Jahre alten mnnlichen Siamkatze. Bei
der klinischen Untersuchung wurden Knoten verschiedener Gre am Rumpf, an den Extremitten und am
Bauch gefunden. Einige davon waren ulzeriert, andere hatten einen glnzend gelben nekrotischen Hintergrund
mit unregelmigen Fistelffnungen. Die Katze wurde auf Wunsch des Besitzers euthanasiert bevor eine
Diagnose gestellt werden konnte. Bei der Post-mortem-Untersuchung wurde reichlich liges Material gefunden,
welches Senf-hnlich war und das subkutane Gewebe ersetzte. Kleine gelbe Knoten waren am Netz, am Gekrse
und an der Serosa des Abdomens verstreut. Eine multi-lobulre Masse, die vom vorderen Pankreasschenkel
abstammte, wurde zusammen mit Metastasen der Leber und der Lymphknoten gefunden. Die Histopathologie
zeigte breite Fistelkanle, die nekrotisches Fett von der Subkutis zur Oberflche abfhrten sowie multifokale
Areale aus nekrotischen Adipozyten, welche den Panniculus ersetzten. Kanal-hnliche Strukturen und Tubuli,
die mit neoplastischen Epithelzellen ausgekleidet waren, wurden im Primrtumor des Pankreas sowie in den
Metastasen gefunden. Mglicherweise war die Ursache fr die Fettnekrose eine systemische Ausscheidung von
lipolytischen Pankreasenzymen.

2005 European Society of Veterinary Dermatology, Veterinary Dermatology, 16, 413419