1
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Yu R. Plea to radiologists: Please consider Mahvash disease when encountering an enlarged pancreas. World J Radiol 2024; 16:371-374. [DOI: 10.4329/wjr.v16.i8.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024] Open
Abstract
Radiologists play a key role in establishing an early and accurate diagnosis, especially for rare diseases. Mahvash disease (OMIM 619290) is an autosomal recessive hereditary disease caused by inactivating mutations of the glucagon receptor and its main clinical consequences are pancreatic neuroendocrine tumors and in some cases, porto-sinusoidal vascular disease and portal hypertension. Untreated Mahvash disease can be lethal. The diagnosis of Mahvash disease has almost always been delayed in the past due to radiologists’ unawareness of or unfamiliarity with the unique imaging features of Mahvash disease which are moderately to enormously enlarge pancreas with preserved pancreas contour and parenchyma without vascular involvement or lymphadenopathy. These features help differentiate Mahvash disease from other etiologies of diffusely enlarged pancreas such as diffuse pancreatic ductal carcinoma, diffuse pancreatic lymphoma, and autoimmune pancreatitis. Invoking Mahvash disease in the differential diagnosis of an enlarged pancreas has recently been shown to facilitate early diagnosis. To prevent missing the diagnosis of this significant disease, I sincerely ask radiologists to consider Mahvash disease in their differential diagnoses of diffusely enlarged pancreas.
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Affiliation(s)
- Run Yu
- Division of Endocrinology, Diabetes, and Metabolism, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA 90095, United States
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2
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Wang J, Zhou Y, Liu H, Zhou J, Li X. 18F-FDG PET/CT assists the diagnosis of primary pancreatic lymphoma: Two case reports and literature review. Front Med (Lausanne) 2024; 11:1370762. [PMID: 38463493 PMCID: PMC10924306 DOI: 10.3389/fmed.2024.1370762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
Primary pancreatic lymphoma (PPL) is a rare malignancy, which is defined as a mass centered in pancreas with involvement of contiguous lymph nodes and distant spread may exist. Accurate diagnosis of PPL prior to pathological confirmation remains challenging, underscoring the critical significance of preoperative imaging assessments. This case report collected two instances of PPL that underwent initial evaluation via 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) between August 2021 and July 2022. Correspondingly, pertinent literature encompassing 18F-FDG PET/CT data related to PPL was meticulously reviewed. Including our aforementioned pair of cases, a cumulative total of 25 instances of PPL were assembled. The distinctive profile of 18F-FDG PET/CT images of PPL predominantly manifests as hypermetabolic lesions with diminished density. Primarily characterized by singular lesions and comparatively substantial volumetric dimensions, a total of eleven cases revealed contiguous lymph node engagement, with five instances displaying distant dissemination encompassing lymph nodes in multiple locations. Amongst these, ten patients underwent sequential 18F-FDG PET/CT follow-up post-intervention. In comparison to pancreatic carcinoma, PPL lesions exhibited heightened hypermetabolism, augmented volumetric proportions, and distinct patterns of distant metastasis. This study indicates that the pivotal role of 18F-FDG PET/CT in the diagnosis and assessment of therapeutic efficacy in PPL is unequivocal. Combined with the clinical attributes of patients, the integration of 18F-FDG PET/CT augments the differential diagnostic capacity differentiating PPL from pancreatic carcinoma.
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Affiliation(s)
- Jian Wang
- Department of Nuclear Medicine, Qilu Hospital of Shandong University, Jinan, China
- Department of Nuclear Medicine, Dezhou People's Hospital, Dezhou, China
| | - Yujing Zhou
- Department of Nuclear Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Hongwei Liu
- Department of Nuclear Medicine, Dezhou People's Hospital, Dezhou, China
| | - Jianli Zhou
- Department of Nuclear Medicine, Dezhou People's Hospital, Dezhou, China
| | - Xin Li
- Department of Nuclear Medicine, Qilu Hospital of Shandong University, Jinan, China
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3
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Veron Sanchez A, Santamaria Guinea N, Cayon Somacarrera S, Bennouna I, Pezzullo M, Bali MA. Rare Solid Pancreatic Lesions on Cross-Sectional Imaging. Diagnostics (Basel) 2023; 13:2719. [PMID: 37627978 PMCID: PMC10453474 DOI: 10.3390/diagnostics13162719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.
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Affiliation(s)
- Ana Veron Sanchez
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | | | | | - Ilias Bennouna
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
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4
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Chen Y, Zheng S, Wu Z, Lin Y, Miao W. Primary Pancreatic Lymphoma Masquerading as Carcinoma on 18F-FDG PET/CT. Clin Nucl Med 2023:00003072-990000000-00644. [PMID: 37486720 DOI: 10.1097/rlu.0000000000004778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
ABSTRACT A 76-year-old man with yellowish discoloration of sclera and skin for 2 months was referred to 18F-FDG PET/CT for metabolic characterization of the mass in the pancreas. The images showed intense FDG uptake in the head of the pancreas, as well as a lymph nodal mass in the hepatic hilar region, which was consistent with pancreatic malignancy. Histopathologic findings showed characteristic findings of diffuse large B-cell lymphoma with no evidence of adenocarcinoma.
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5
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Orsini-Arman AC, Surjan RCT, Venco FE, Ardengh JC. Primary Pancreatic Lymphoma: Endosonography-Guided Tissue Acquisition Diagnosis. Cureus 2023; 15:e34936. [PMID: 36938243 PMCID: PMC10017057 DOI: 10.7759/cureus.34936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Primary pancreatic lymphoma is a rare type of cancer, that accounts for 0.1-0.5% of lymphomas and about 0.2% of all primary pancreatic tumors. Diffuse Large B-cell Lymphoma is the most common subtype. The diagnosis is possible if the lymphoma is located in the pancreas, but the differential diagnosis with pancreatic ductal adenocarcinoma is difficult. The diagnostic accuracy of endosonography-guided fine needle aspiration is inadequate, and thus it is common to diagnose these masses only after surgical resection. The endosonography-guided tissue acquisition allows greater accuracy in the pancreatic masses, as it determines optimal access to histological analysis using tissue in paraffin blocks for complementary immunohistochemical, and molecular tests. Thus, this elaborate diagnostic environment allows the adoption of appropriate treatment strategies for patients with this condition. The authors describe four cases of primary pancreatic lymphoma indicated for surgical resection due to suspected pancreatic cancer, with the diagnosis of Diffuse Large B-cell Lymphoma obtained by endosonography-guided tissue acquisition, changing the therapeutic strategy through the adoption of adequate chemotherapy treatment with good progress.
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Affiliation(s)
| | - Rodrigo Cañada T Surjan
- Surgery Department, University of São Paulo, São Paulo, BRA
- Surgery Department, Dasa/Hospital Nove de Julho, São Paulo, BRA
| | | | - José C Ardengh
- Gastrointestinal Endoscopy Department, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, BRA
- Imaging Diagnostic Department, Universidade Federal de Sao Paulo, São Paulo, BRA
- Digestive Endoscopy Department, Hospital Moriah, São Paulo, BRA
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6
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Pancreatic Diffuse Large B-Cell Lymphoma. J Gastrointest Surg 2023; 27:201-202. [PMID: 36168077 DOI: 10.1007/s11605-022-05474-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 02/01/2023]
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7
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Harada Y, Sogame Y, Nakao R, Ogata T, Yasuda H, Sakagami J, Itoh Y, Tanaka H. Autopsy of a Patient with Primary Pancreatic Lymphoma with Findings Resembling Severe Acute Pancreatitis. Intern Med 2022; 62:1507-1512. [PMID: 36198606 DOI: 10.2169/internalmedicine.0757-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Primary pancreatic lymphoma is a rare pancreatic malignancy, reportedly accounting for only 0.2-0.7% of all primary pancreatic tumors. Primary pancreatic lymphoma is often difficult to distinguish from other diseases, such as acute pancreatitis. We herein report the autopsy of a patient with primary pancreatic lymphoma with imaging findings resembling those of severe acute pancreatitis, with a focus on the gross and histological features.
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Affiliation(s)
- Yoshinori Harada
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yoshio Sogame
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Ryuta Nakao
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Takehiro Ogata
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Hiroaki Yasuda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Junichi Sakagami
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Hideo Tanaka
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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8
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Wang Q, Wu K, Zhang X, Liu Y, Sun Z, Wei S, Zhang B. Primary hepatopancreatobiliary lymphoma: Pathogenesis, diagnosis, and management. Front Oncol 2022; 12:951062. [PMID: 36110965 PMCID: PMC9469986 DOI: 10.3389/fonc.2022.951062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Primary hepatopancreatobiliary lymphoma (PHPBL) is extremely rare, which is defined as a lympho-proliferative disease confined to the hepatobiliary system and pancreas without any involvement of lymph nodes, bone marrow, or other organs. The clinical and imaging manifestations of PHPBL are variable and non-special, which are akin to those of tumors of the hepatobiliary and pancreatic systems. The overall prognosis and management of PHPBL differ from those of other tumors in the hepatobiliary system and pancreas. Proper diagnosis and prompt treatment are essential for improving clinical outcomes. Due to its rarity, the optimal treatment has not been issued. However, combination chemotherapy is considered as a standard treatment for them. This review provides an overview of the pathogenesis, diagnosis, pathology, and management of PHPBL and offers clinicians the diagnosis and management schedule for PHPBL.
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Affiliation(s)
- Qianwen Wang
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Kangze Wu
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuzhao Zhang
- Department of Hematology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Liu
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Zhouyi Sun
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Shumei Wei
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Bo Zhang, ; Shumei Wei,
| | - Bo Zhang
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Bo Zhang, ; Shumei Wei,
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9
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Gan Q, Caraway NP, Ding C, Stewart JM. Primary Pancreatic Lymphoma Evaluated by Fine-Needle Aspiration. Am J Clin Pathol 2022; 158:242-248. [PMID: 35311939 DOI: 10.1093/ajcp/aqac030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/08/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Primary pancreatic lymphoma (PPL) is rare, mimicking pancreatic ductal adenocarcinoma (PDAC) clinically and radiologically. The aim of this study is to evaluate the clinical, radiologic, and pathological characteristics of PPL diagnosed by fine-needle aspiration (FNA) in our institution. METHODS Patient clinical, radiologic, and pathological information was collected from the electronic health record system. RESULTS In total, 11 of 4,353 pancreatic FNAs met the criteria. The most common clinical symptom was jaundice, followed by abdominal pain, weight loss, and diarrhea. Abnormal laboratory findings included elevated alkaline phosphatase, total bilirubin, lactate dehydrogenase, and cancer antigen 19-9. Abnormal radiologic findings included pancreatic mass, biliary dilatation, vessel encasement, and common bile duct encasement and thickening. Five patients underwent more than 1 tissue sampling procedure before the final diagnosis of lymphoma. Final pathologic diagnosis included 7 large B-cell lymphomas and 4 follicular lymphomas. Flow cytometric analysis was performed on 9 specimens, and all demonstrated an aberrant monoclonal B-cell population. CONCLUSIONS PPL mimics PDAC clinically and radiologically and could be a challenge for pathologic diagnosis if lymphoma is not included in the differential diagnosis during immediate evaluation. If lymphoma is suspected during immediate evaluation, PPL could be reliably diagnosed by FNA with the aid of ancillary studies.
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Affiliation(s)
- Qiong Gan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nancy P Caraway
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cady Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John M Stewart
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Khdhir M, El Annan T, El Amine MA, Shareef M. Complications of lymphoma in the abdomen and pelvis: clinical and imaging review. Abdom Radiol (NY) 2022; 47:2937-2955. [PMID: 35690955 PMCID: PMC10509750 DOI: 10.1007/s00261-022-03567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/18/2023]
Abstract
Involvement of the abdomen and pelvis is common in lymphoma. Nodal and extranodal abdominal and pelvic lymphoma may present with various complications. Complications are most common in high-grade lymphomas, especially diffuse large B-cell lymphoma. Complications may occur as the initial manifestation of lymphoma, during treatment course, or late following complete disease remission. Most complications are associated with worse prognosis and increased mortality. Imaging is essential in evaluation of disease extent and diagnosis of complications. Therefore, radiologists should be familiar with the clinical context and imaging features of abdominal and pelvic lymphoma complications. We provide a comprehensive, organ system-based approach, and clinical and imaging review of complications of abdominal and pelvic lymphoma along with radiologic images of illustrated cases of the most commonly encountered complications.
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Affiliation(s)
- Mihran Khdhir
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
| | - Tamara El Annan
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon
| | | | - Muhammed Shareef
- Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, CT, USA
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11
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Primary pancreatic lymphoma-diagnosed on computed tomography: A rare case report. Radiol Case Rep 2022; 17:1831-1835. [PMID: 35401908 PMCID: PMC8990050 DOI: 10.1016/j.radcr.2022.02.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 01/17/2023] Open
Abstract
Primary pancreatic lymphoma is a rare disease. It comprises less than 0.5 % of pancreatic neoplasm and 0.1% of malignant lymphoma. It should be differentiated from pancreatic adenocarcinoma because management differs. At computed tomography, 2 types of morphology of primary pancreatic lymphoma have been described- a localized well-circumscribed tumoral form and another diffuse enlargement infiltrating or replacing most of the pancreatic gland. Here, we are presenting computed tomography (CT) imaging features of a case of primary pancreatic lymphoma in a 27 year old female who presented with a complaint of abdominal pain radiating to the back for 3 months and yellowish discoloration of sclera and skin for the last 15 days. In contrast-enhanced computed tomography an exophytic homogenously hypoenhancing mass arising from head and neck region of pancreas was seen. Involvement of common bile duct (CBD) and duodenum was there. The main pancreatic duct was not dilated. Common hepatic artery was encased by mass without arterial luminal narrowing or distortion. Diagnosis of primary pancreatic lymphoma was suggested on basis of imaging findings and further confirmed with fine-needle aspiration cytology.
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12
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Mutluoglu M, Cruyt L, Gryspeerdt S. Imaging features of primary pancreatic lymphoma. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2022; 87:253-255. [PMID: 35623989 DOI: 10.1016/j.rgmxen.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Affiliation(s)
- M Mutluoglu
- Departamento de Radiología, AZ Delta campus Rumbeke, Roeselare, Belgium.
| | - L Cruyt
- Departamento de Radiología, AZ Delta campus Rumbeke, Roeselare, Belgium
| | - S Gryspeerdt
- Departamento de Radiología, AZ Delta campus Rumbeke, Roeselare, Belgium
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13
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Zhu NX, Wang XY, Tong T, Xu JH, Yang YY, Tian L. Primary pancreatic lymphoma diagnosed by endoscopic ultrasound-guided fine needle biopsy. Hepatobiliary Pancreat Dis Int 2022; 21:99-102. [PMID: 34108082 DOI: 10.1016/j.hbpd.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Ning-Xin Zhu
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xiao-Yan Wang
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Ting Tong
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Jia-Hao Xu
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Yuan-Yuan Yang
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Li Tian
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China.
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14
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Segaran N, Sandrasegaran K, Devine C, Wang MX, Shah C, Ganeshan D. Features of primary pancreatic lymphoma: A bi-institutional review with an emphasis on typical and atypical imaging features. World J Clin Oncol 2021; 12:823-832. [PMID: 34631445 PMCID: PMC8479350 DOI: 10.5306/wjco.v12.i9.823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/29/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary pancreatic lymphoma (PPL) is a rare neoplasm. Being able to distinguish it from other pancreatic malignancies such as pancreatic ductal adenocarcinoma (PDAC) is important for appropriate management. Unlike PDAC, PPL is highly sensitive to chemotherapy and usually does not require surgery. Therefore, being able to identify PPL preoperatively will not only direct physicians towards the correct avenue of treatment, it will also avoid unnecessary surgical intervention.
AIM To evaluate the typical and atypical multi-phasic computed tomography (CT) imaging features of PPL.
METHODS A retrospective review was conducted of the clinical, radiological, and pathological records of all subjects with pathologically proven PPL who presented to our institutions between January 2000 and December 2020. Institutional review board approval was obtained for this investigation. The collected data were analyzed for subject demographics, clinical presentation, laboratory values, CT imaging features, and the treatment received. Presence of all CT imaging findings including size, site, morphology and imaging characteristics of PPL such as the presence or absence of nodal, vascular and ductal involvement in these subjects were recorded. Only those subjects who had a pre-treatment multiphasic CT of the abdomen were included in the study.
RESULTS Twenty-nine cases of PPL were diagnosed between January 2000 and December 2020 (mean age 66 years; 13 males/16 females). All twenty-nine subjects were symptomatic but only 4 of the 29 subjects (14%) had B symptoms. Obstructive jaundice occurred in 24% of subjects. Elevated lactate dehydrogenase was seen in 81% of cases, whereas elevated cancer antigen 19-9 levels were present in only 10% of cases for which levels were recorded. The vast majority (90%) of tumors involved the pancreatic head and uncinate process. Mean tumor size was 7.8 cm (range, 4.0-13.8 cm). PPL presented homogenous hypoenhancement on CT in 72% of cases. Small volume peripancreatic lymphadenopathy was seen in 28% of subjects. Tumors demonstrated encasement of superior mesenteric vessels in 69% of cases but vascular stenosis or occlusion only manifested in 5 out of the twenty-nine individuals (17%). Mild pancreatic duct dilatation was also infrequent and seen in only 17% of cases, whereas common bile duct (CBD) dilation was seen in 41% of subjects. Necrosis occurred in 10% of cases. Size did not impact the prevalence of pancreatic and CBD dilation, necrosis, or mesenteric root infiltration (P = 0.525, P = 0.294, P = 0.543, and P = 0.097, respectively). Pancreatic atrophy was not present in any of the subjects.
CONCLUSION PPL is an uncommon diagnosis best made preoperatively to avoid unnecessary surgery and ensure adequate treatment. In addition to the typical CT findings of PPL, such as homogeneous hypoenhancement, absence of vascular stenosis and occlusion despite encasement, and peripancreatic lymphadenopathy, this study highlighted many less typical findings, including small volume necrosis and pancreatic and bile duct dilation.
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Affiliation(s)
- Nicole Segaran
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, United States
| | | | - Catherine Devine
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Mindy X Wang
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Chintan Shah
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Dhakshinamoorthy Ganeshan
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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15
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Okamoto T, Sasaki T, Nishimura N, Takamatsu M, Mori C, Mie T, Furukawa T, Yamada Y, Takeda T, Kasuga A, Matsuyama M, Ozaka M, Maruyama D, Sasahira N. Pancreatic follicular lymphoma: a report of two cases and literature review. Clin J Gastroenterol 2021; 14:1756-1765. [PMID: 34453279 PMCID: PMC8395385 DOI: 10.1007/s12328-021-01507-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
Primary pancreatic lymphomas are extremely rare, accounting for 0.1–0.5% of malignant lymphomas and about 0.2% of primary pancreatic tumors. They occur most commonly in the pancreatic head of elderly males, with diffuse large B-cell lymphoma being the most common subtype. Primary pancreatic follicular lymphoma is the most commonly reported primary pancreatic indolent lymphoma, accounting for 9–14% of primary pancreatic lymphomas. We report two cases of primary pancreatic follicular lymphoma treated with obinutuzumab, a second-generation humanized anti-CD20 monoclonal antibody, and bendamustine. One was diagnosed by endoscopic ultrasound-guided fine-needle aspiration, while the other required laparoscopic lymph node sampling to reach a diagnosis. Both achieved complete response with induction therapy and opted for maintenance therapy with obinutuzumab. We also conducted a literature review of primary pancreatic follicular lymphoma cases reported over the last 30 years.
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Affiliation(s)
- Takeshi Okamoto
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Noriko Nishimura
- Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Manabu Takamatsu
- Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Chinatsu Mori
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takafumi Mie
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takaaki Furukawa
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yuto Yamada
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Takeda
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akiyoshi Kasuga
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masato Matsuyama
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Dai Maruyama
- Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Naoki Sasahira
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Facchinelli D, Boninsegna E, Visco C, Tecchio C. Primary Pancreatic Lymphoma: Recommendations for Diagnosis and Management. J Blood Med 2021; 12:257-267. [PMID: 33981170 PMCID: PMC8107008 DOI: 10.2147/jbm.s273095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Primary pancreatic lymphoma (PPL) is a rare disease representing 0.1% of all malignant lymphomas, which lacks well-defined diagnostic and therapeutic protocols. We conducted a systematic review to analyze demographic, diagnostic and therapeutic features of PPL. METHODS This review identified small series and single case reports. Sources were MEDLINE, PubMed, and the Cochrane library from January 2001 to December 2020. Data were screened, extracted and the risk of bias analyzed by three independent reviewers. RESULTS A total of 107 eligible papers (17 small series, 90 single case reports) describing 266 patients were identified. Patients had a median age of 53.1 (range 3-86) years and were males in 64.6% of cases. Abdominal pain and jaundice were the most common presenting symptoms, affecting 75.3% and 41.8% of patients, respectively. PPL had a median size of 60.6 mm (range 16-200) and it was localized in the pancreatic head in 63.7% of cases. At diagnosis most patients underwent ultrasonography followed by computed tomography. PPL typically showed low echogenicity, and lower contrast enhancement than solid tumors. Histopathological specimens were obtained by percutaneous or endoscopic biopsies in 47.7% of patients; abdominal surgery was performed in 33.5% of cases. Overall, diffuse large B-cell lymphoma was the most frequent histological diagnosis (53.6%). However, patients aged <18 years were affected by Burkitt lymphoma in 52.4% of cases. Most patients (53.6%) received immunochemotherapy (IC) or IC plus radiotherapy (14%). Demolitive surgery appeared to be associated with impaired survival. Central nervous system (CNS) relapse or progression was observed in 20% of patients. CONCLUSION PPL is a rare entity, with some peculiar features at modern imaging. For diagnostic purposes percutaneous or endoscopic biopsies might be preferable, as opposed to surgery. No definite data is available about the optimal treatment, which should be tailored on the histological type and associated with CNS prophylaxis.
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Affiliation(s)
| | - Enrico Boninsegna
- Department of Radiology, Azienda Socio Sanitaria Territoriale, Mantova, Italy
| | - Carlo Visco
- Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Cristina Tecchio
- Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona, Verona, Italy
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17
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Facchinelli D, Sina S, Boninsegna E, Borin A, Tisi MC, Piazza F, Scapinello G, Maiolo E, Hohaus S, Zamò A, Merli M, Stefani PM, Mellone F, Basso M, Sartori R, Rusconi C, Parisi A, Manfrin E, Krampera M, Ruggeri M, Visco C, Tecchio C. Primary pancreatic lymphoma: Clinical presentation, diagnosis, treatment, and outcome. Eur J Haematol 2020; 105:468-475. [PMID: 32542880 DOI: 10.1111/ejh.13468] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022]
Abstract
Primary pancreatic lymphoma (PPL) is a rare disease representing 0.1% of malignant lymphomas, which lacks well-defined diagnostic and therapeutic protocols. OBJECTIVES To describe PPL clinical, diagnostic and histological characteristics, together with therapy and outcome, in a relatively large series of patients. METHODS The study includes 39 PPL patients, aged ≥15 years, observed from January 2005 to December 2018, in 8 Italian Institutions. RESULTS The main symptoms were abdominal pain (58%) and jaundice (47%). Lactate dehydrogenase serum levels were elevated in 43% of patients. Histological specimens were mostly obtained by percutaneous (41%) or endoscopic (36%) biopsy, with diffuse large B-cell lymphoma being the most frequent (69%) histological diagnosis. Chemotherapy was administered alone in 65% of patients, with radiotherapy in 17%, or after surgery in 9%. The 2-year overall survival (OS) was 62%, the 2-year progression-free survival (PFS) 44%. Debulking surgery (with or without chemotherapy) was associated with a significant worse OS. Three (9.4%) of 32 high-grade patients experienced a central nervous system (CNS) relapse. CONCLUSIONS PPL is rare, often high-grade, with symptoms and localization similar to other pancreatic malignancies. Biopsy should be the preferred diagnostic method. High-grade PPL should undergo CNS prophylaxis.
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Affiliation(s)
- Davide Facchinelli
- Hematology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Sokol Sina
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Alex Borin
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy
| | - Maria C Tisi
- Hematology Unit, Ospedale San Bortolo, Vicenza, Italy
| | - Francesco Piazza
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Greta Scapinello
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Elena Maiolo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefan Hohaus
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Zamò
- Department of Oncology and Pathology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Michele Merli
- Division of Hematology, Ospedale di Circolo e Fondazione Macchi- ASST Sette Laghi, University of Insubria, Varese, Italy
| | | | - Federica Mellone
- Institute of Medical Statistics, University of Verona, Verona, Italy
| | - Marco Basso
- Hematology Unit, Ospedale di Castelfranco Veneto, Vicenza, Italy
| | - Roberto Sartori
- Hematology Unit, Ospedale di Castelfranco Veneto, Vicenza, Italy
| | - Chiara Rusconi
- Division of Hematology, ASST Niguarda Hospital, Milano, Italy
| | - Alice Parisi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Erminia Manfrin
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Mauro Krampera
- Hematology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Marco Ruggeri
- Hematology Unit, Ospedale San Bortolo, Vicenza, Italy
| | - Carlo Visco
- Hematology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Cristina Tecchio
- Hematology Unit, Department of Medicine, University of Verona, Verona, Italy
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18
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Factors associated with missed and misinterpreted cases of pancreatic ductal adenocarcinoma. Eur Radiol 2020; 31:2422-2432. [PMID: 32997176 DOI: 10.1007/s00330-020-07307-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/03/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To retrospectively examine US, CT, and MR imaging examinations of missed or misinterpreted pancreatic ductal adenocarcinoma (PDAC), and identify factors which may have confounded detection or interpretation. METHODS We reviewed 107 examinations in 66/257 patients (26%, mean age 73.7 years) diagnosed with PDAC in 2014 and 2015, with missed or misinterpreted imaging findings as determined by a prior study. For each patient, images and reports were independently reviewed by two radiologists, and in consensus, the following factors which may have confounded assessment were recorded: inherent tumor factors, concurrent pancreatic pathology, technical limitations, and cognitive biases. Secondary signs of PDAC associated with each examination were recorded and compared with the original report to determine which findings were missed. RESULTS There were 66/107 (62%) and 49/107 (46%) cases with missed and misinterpreted imaging findings, respectively. A significant number of missed tumors were < 2 cm (45/107, 42%), isoattenuating on CT (32/72, 44%) or non-contour deforming (44/107, 41%). Most (29/49, 59%) misinterpreted examinations were reported as uncomplicated pancreatitis. Almost all examinations (94/107, 88%) demonstrated secondary signs; pancreatic duct dilation was the most common (65/107, 61%) and vascular invasion was the most commonly missed 35/39 (90%). Of the CT and MRIs, 28 of 88 (32%) had suboptimal contrast dosing. Inattentional blindness was the most common cognitive bias, identified in 55/107 (51%) of the exams. CONCLUSION Recognizing pitfalls of PDAC detection and interpretation, including intrinsic tumor features, secondary signs, technical factors, and cognitive biases, can assist radiologists in making an early and accurate diagnosis. KEY POINTS • There were 66/107 (62%) and 49/107 (46%) cases with missed and misinterpreted imaging findings, respectively, with tumoral, technical, and cognitive factors leading to the misdiagnosis of pancreatic ductal adenocarcinoma. • The majority (29/49, 59%) of misinterpreted cases of pancreatic ductal adenocarcinoma were mistaken for pancreatitis, where an underlying mass or secondary signs were not appreciated due to inflammatory changes. • The most common missed secondary sign of pancreatic ductal adenocarcinoma was vascular encasement, missed in 35/39 (90%) of cases, indicating the importance of evaluating the peri-pancreatic vasculature.
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Karaosmanoglu AD, Uysal A, Onur MR, Hahn PF, Ayhan AS, Ozmen MN, Akata D, Karcaaltincaba M. Primary lymphomas of the intraabdominal solid organs and the gastrointestinal tract: spectrum of imaging findings with histopathological confirmation. Abdom Radiol (NY) 2019; 44:2988-3005. [PMID: 31209544 DOI: 10.1007/s00261-019-02100-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Unlike nodal lymphoma, primary lymphomas of the intraabdominal organs are uncommon neoplasms whose diagnosis may be challenging in certain clinical circumstances. Despite this difficulty for imaging diagnosis, there are several imaging features on ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography that may suggest the correct diagnosis. The scope of this review is to describe and illustrate the imaging features of primary lymphoma of intraabdominal organs providing clues to the diagnosis, together with their pathological correlations.
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Abstract
Hepatic abnormalities in patients with lymphoproliferative disorders are common and can occur from direct infiltration by abnormal cells, bile duct obstruction, paraneoplastic syndrome, hemophagocytic syndrome, drug-induced liver injury, opportunistic infections, and reactivation of viral hepatitis. Hepatic involvement by lymphoma is often in association with systemic disease and rarely seen as a primary hepatic lymphoma. Vanishing bile duct syndrome is a well-known complication of Hodgkin disease. Antiviral prophylaxis for hepatitis B virus (HBV) reactivation is recommended for all HBsAg+ patients undergoing chemotherapy and all resolved HBV patients undergoing rituximab therapy and stem cell transplantation.
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Affiliation(s)
- Chalermrat Bunchorntavakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Ratchathewi, Bangkok 10400, Thailand; Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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