Ultrasound-guided biopsy of the spleen was performed leading to the rare diagnosis of pancreas acinar cell carcinoma. 

Pancreas acinar cell carcinoma highlights:

• very rare <1%
• exocrine tumor
• larger size at diagnosis and often better prognosis than adenocarcinoma
• some have paraneoplastic syndrome with hypersecretion of lipase (as in this case), which can lead to fat necrosis of subcutaneous nodules and polyarthralgia

On physical exam, this patient did have subcutaneous nodules in the lower extremities which would be clinically consistent with fat necrosis related to hyperlipasemia.