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Lamrani FZ, Amri F, Koulali H, Mqaddem OE, Zazour A, Bennani A, Ismaili Z, Kharrasse G. Primary pancreatic lymphoma: Report of 4 cases with literature review. Radiol Case Rep 2024; 19:70-77. [PMID: 37920690 PMCID: PMC10618228 DOI: 10.1016/j.radcr.2023.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023] Open
Abstract
Pancreatic cancer (PC) is ranked as the 14th most common cancer and the 7th leading cause of cancer-related deaths. The most common histological type is adenocarcinoma, other type such as primary pancreatic lymphoma (PPL) still very rare. Due to the lack of specific clinical and imaging characteristics, the diagnostic of PPL remains challenging. We report 4 cases of PPL diagnosed and managed at our gastroenterology department between 2019 and 2023. Case 1: A 16-year-old male presented with abdominal pain, jaundice, and weight loss. Imaging revealed an 8 cm tumor in the pancreas, subsequent biopsies confirming Burkitt's lymphoma. Despite chemotherapy, the patient succumbed to the disease. Case 2: A 92-year-old female with no prior medical history presented with abdominal pain, jaundice, pruritus, and weight loss. Imaging revealed a large pancreatic mass, and biopsies identified large B-cell lymphoma. Unfortunately, the patient passed away before treatment initiation. Case 3: A 63-year-old male with a history of tobacco smoking presented with abdominal pain, weight loss, and anorexia. Imaging and biopsies confirmed diffuse large cell B-phenotype lymphoma. The patient achieved complete remission after rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP) therapy. Case 4: A 67-year-old man with jaundice, abdominal pain, and weight loss was diagnosed with diffuse large cell B lymphoma through imaging and fine needle aspiration (FNA). The patient responded well to R-CHOP therapy. In conclusion, PPL is an uncommon tumor, with no specific clinical or radiological characteristics. A thorough evaluation of clinical, radiological, biological and histological data is necessary to consider it as a differential diagnosis and ensure accurate and timely management.
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Affiliation(s)
- Fatima Zahra Lamrani
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Fakhrddine Amri
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Hajar Koulali
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Ouiam El Mqaddem
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Abdelkrim Zazour
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Amal Bennani
- Pathology Department, Mohammed VI University Hospital, Oujda, Morocco
| | - Zahi Ismaili
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Ghizlane Kharrasse
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
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2
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Madela F, Anderson F, Nhlonzi GB, Thomson SR. HIV associated malignancies presenting as acute pancreatitis: a case series. S AFR J SURG 2023; 61:234-236. [PMID: 38450696 DOI: 10.36303/sajs.3511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) may be the presenting symptom in a small percentage of patients harbouring pancreatic or extra pancreatic tumours. This case series aims to describe the pathological spectrum of tumours detected in two AP cohorts from a high HIV-endemic region. METHODS Prospectively collected databases of patients admitted with AP over two periods 2001 to 2010 and 2013 to 2015, were retrospectively evaluated to detect those with pancreatic and extra-pancreatic tumours. The diagnosis of AP was by standard criteria. HIV infection and CD4 counts were routinely tested for in the latter period and only tested on clinical grounds in the initial period. CT scan was performed when there was diagnostic doubt, predicted severe disease, and failure to improve clinically after one week. Demographic, clinical, investigative, and pathology details were collected and presented. RESULTS HIV-positive patients admitted with AP were 106 (17%) of 628 in the first period and 90 (38%) of 238 of the second period. No tumours were diagnosed in the HIV-negative patients. Seven of the HIV-positive patients had tumours diagnosed at endoscopy, CT scan, and endoscopic retrograde cholangiography. Of the seven HIV-positive patients with tumours, two patients had a CD4 count above 200. There were four patients with lymphoma involving the pancreatic head, three having associated cholestasis, and three patients with Kaposi's Sarcoma. One Kaposi's sarcoma patient died three months after presentation. One patient with lymphoma died on day 14 and another two months after initial presentation, and the remaining four patients were referred to oncology. CONCLUSION Despite their rarity (< 4%), when HIV-positive patients with low CD4 count and cholestasis present with AP,tumours should be suspected and evaluated by cross sectional imaging and endoscopic ultrasound.
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Affiliation(s)
- F Madela
- Department of Surgery, Surgical Gastroenterology, University of KwaZulu-Natal, South Africa
| | - F Anderson
- Department of Surgery, Surgical Gastroenterology, University of KwaZulu-Natal, South Africa
| | - G B Nhlonzi
- Department of Anatomical pathology, University of KwaZulu-Natal, South Africa
| | - S R Thomson
- Division of Gastroenterology, Department of Medicine, University of Cape Town, South Africa
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3
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Garza-Morales R, Ganguly A, Hernandez D, Cantazaro B. Primary Pancreatic Mature T-Cell Lymphoma as a Cause of Obstructive Jaundice: A Case Report and Review of the Literature. Cureus 2023; 15:e40272. [PMID: 37448428 PMCID: PMC10336269 DOI: 10.7759/cureus.40272] [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] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Primary pancreatic lymphoma (PPL) is an extremely rare type of non-Hodgkin's lymphoma (NHL). It accounts for 0.1% of all lymphomas and less than 1% of pancreatic tumors. Within this subtype, T-cell lymphomas only account for up to 6.7% of pancreatic lymphomas. In this study, we present the case of a 78-year-old Hispanic man who presented with obstructive jaundice associated with a mass within the head of the pancreas; pathologic analysis of the tumor revealed a mature T-cell lymphoma, not otherwise specified (NOS).
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Affiliation(s)
- Rodolfo Garza-Morales
- Internal Medicine, The University of Texas Rio Grande Valley - Doctors Hospital at Renaissance, Edinburg, USA
| | - Arup Ganguly
- Internal Medicine, The University of Texas Rio Grande Valley - Doctors Hospital at Renaissance, Edinburg, USA
| | - Daniela Hernandez
- Internal Medicine, The University of Texas Rio Grande Valley - Doctors Hospital at Renaissance, Edinburg, USA
| | - Brandon Cantazaro
- Internal Medicine, The University of Texas Rio Grande Valley - Doctors Hospital at Renaissance, Edinburg, USA
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4
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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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5
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Bran Alvarado PJ, García Villarreal F, Jáquez-Quintana JO, González González JA, Maldonado Garza HJ. Primary pancreatic lymphoma: thinking beyond pancreatic adenocarcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:52-53. [PMID: 35748465 DOI: 10.17235/reed.2022.9012/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Primary pancreatic lymphoma is one of the rare primary pancreatic tumors with a low incidence compared to adenocarcinoma, which is the most frequent. Currently there are diagnostic tools such as percutaneous biopsy and endoscopic ultrasound to reach its diagnosis. Primary lymphoma of the pancreas has defined therapeutic targets as well as a better prognosis compared to other tumors.
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6
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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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7
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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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8
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Bakshi N, Dhawan S, Bhalla S, Verma R. Primary non hodgkin lymphoma and Ewing's sarcoma/PNET: Two rare pancreatic round cell tumors with diverse clinical outlook. INDIAN J PATHOL MICR 2021; 64:S184-S187. [PMID: 34135168 DOI: 10.4103/ijpm.ijpm_730_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Neha Bakshi
- Department of Nuclear Medicine and Bone Densitometry, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India
| | - Shashi Dhawan
- Department of Nuclear Medicine and Bone Densitometry, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India
| | - Sunita Bhalla
- Department of Nuclear Medicine and Bone Densitometry, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India
| | - Ritu Verma
- Department of Histopathology, Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India
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9
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Xie J, Rinker E, Zaarour M. A Rare, Yet Treatable Pancreatic Tumor: Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921269. [PMID: 32176677 PMCID: PMC7101472 DOI: 10.12659/ajcr.921269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a rare subtype of B-cell neoplasm that can have diverse presentations. When it involves the pancreas (i.e., pancreatic lymphoma), it can mimic metastatic pancreatic adenocarcinoma. Pancreatic lymphoma and adenocarcinoma often have similar clinical, laboratory, and radiographic features making the distinction challenging without pathological tissue examination. The differentiation of these 2 entities is important as the prognosis of pancreatic lymphoma is certainly more favorable with a chance of cure with chemoimmunotherapy. CASE REPORT We present an unusual case of EBV-positive DLBCL involving the pancreas that was initially believed to be metastatic pancreatic adenocarcinoma. The patient was treated with chemoimmunotherapy and had a remarkable response. This is the first known case of EBV-positive DLBCL involving the pancreas that was successfully treated with chemoimmunotherapy. CONCLUSIONS EBV-positive DLBCL can have diverse presentations, including a pancreatic mass with multi-organ involvement, which mimics metastatic pancreatic adenocarcinoma. The prognosis of EBV-positive DLBCL is thought to be worse than that of EBV-negative tumors. However, it remains certainly superior to that of its adenocarcinoma counterpart with conventional chemoimmunotherapy.
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Affiliation(s)
- John Xie
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Elizabeth Rinker
- Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Mazen Zaarour
- Department of Medicine, Division of Hematology and Oncology, Tulane University School of Medicine, New Orleans, LA, USA
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10
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Primary Pancreatic Lymphoma Masquerading as Carcinoma. Case Rep Oncol Med 2020; 2020:5160545. [PMID: 32158572 PMCID: PMC7061115 DOI: 10.1155/2020/5160545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
Adenocarcinoma is the most common primary pancreatic neoplasm type, followed by secondary pancreatic lymphoma and primary pancreatic lymphoma (PPL). PPL is associated with peripancreatic lymphadenopathy and usually presents as a homogenous mass with extrapancreatic invasion into surrounding structures. However, localized involvement of the distal pancreas is uncommon, and diffuse involvement of the pancreas is even rarer. Herein, we present the case of a 53-year-old woman with PPL of the uncinate process with biliary obstruction mimicking pancreatic adenocarcinoma, successfully diagnosed nonoperatively. Abdominal computed tomography showed an ill-defined uncinate process mass, hypodense with mild enhancement (3.9 × 3.4 × 3.5 cm), infiltrating the second and third parts of the duodenum. Biopsy revealed NHL with no evidence of adenocarcinoma. PPL was diagnosed. She received chemotherapy with a CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) protocol with rituximab, which she tolerated with no clinical or radiological evidence of recurrence at 1-year follow-up.
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11
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McCullagh D. PRIMARY PANCREATIC LYMPHOMA. THE ULSTER MEDICAL JOURNAL 2020; 89:41-42. [PMID: 32218630 PMCID: PMC7027174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Savari O, Al-Duwal Z, Wang Z, Ganesan S, Danan-Rayes R, Ayub S. Pancreatic lymphoma: A cytologic diagnosis challenge. Diagn Cytopathol 2019; 48:350-355. [PMID: 31774250 DOI: 10.1002/dc.24349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/26/2019] [Accepted: 11/14/2019] [Indexed: 11/07/2022]
Abstract
Very rarely lymphoma primarily or secondarily involves the pancreas. Involvement of the pancreatic parenchyma with lymphoma clinically may mimic pancreatic ductal adenocarcinoma (PDA) and other mass-forming pancreatic lesions. Endoscopic ultrasound fine needle aspiration (EUS-FNA) is the first step in the diagnostic pathway of managing these patients by providing a cytology specimen. Cytologically, lymphoma of pancreas can be misdiagnosed for a wide variety of pancreatic neoplastic and non-neoplastic lesions. Cytological differential diagnosis includes well-differentiated adenocarcinoma, acinar cell carcinoma, well differentiated neuroendocrine tumor, and autoimmune pancreatitis. Gastroenterologist's skills in providing adequate sample for preparing smears, cell blocks and/or performing flow cytometry, and also cytopathologist's skills in detecting atypical lymphocytic population are crucial factors. Although cytology examination has limitations to subclassify lymphoma, it plays a key role to redirect clinicians into the right patient-care pathway. In this article, we present two cases of pancreatic lymphoma with emphasis on the discriminating cytomorphological features, and we also review literatures with reports of primary pancreatic lymphoma (PPL) to better understand the characteristics of this rare lesion.
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Affiliation(s)
- Omid Savari
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Zaynab Al-Duwal
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Zijian Wang
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Santhi Ganesan
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Rania Danan-Rayes
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Salman Ayub
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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13
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Badrinath M, Tambe A, Mandru R, Saleem S, Heisig D. Large pancreatic mass with chylous ascites. Proc (Bayl Univ Med Cent) 2019; 33:53-54. [PMID: 32063769 DOI: 10.1080/08998280.2019.1668661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 12/28/2022] Open
Abstract
Primary pancreatic lymphoma (PPL) is a rare entity, most likely to be clinically misdiagnosed as pancreatic adenocarcinoma. The cure rate of PPL is higher than that of adenocarcinoma. We present a case of PPL that presented as a pancreatic mass with chylous ascites and describe the incidence, clinical features, diagnostic approach, and most commonly used treatment regimens for PPL.
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Affiliation(s)
- Madhuri Badrinath
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Ajay Tambe
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Rachana Mandru
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Sheikh Saleem
- Department of Gastroenterology, State University of New York Upstate Medical UniversitySyracuseNew York
| | - David Heisig
- Department of Gastroenterology, State University of New York Upstate Medical UniversitySyracuseNew York
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14
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Ravi S, Stephen SN, Gochhait D, Potakkat B, Niranjani R, Siddaraju N. Primary pancreatic diffuse large B‐cell lymphoma diagnosed by endoscopic ultrasound guided FNAC: A rare entity. Diagn Cytopathol 2019; 48:57-60. [DOI: 10.1002/dc.24307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Soundarya Ravi
- Department of PathologyJawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Dhanvantari Nagar Puducherry India
| | - S. Norton Stephen
- Department of PathologyJawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Dhanvantari Nagar Puducherry India
| | - Debasis Gochhait
- Department of PathologyJawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Dhanvantari Nagar Puducherry India
| | - Biju Potakkat
- Department of Surgical GastroenterologyJawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Dhanvantari Nagar Puducherry India
| | - R. Niranjani
- Department of PathologyJawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Dhanvantari Nagar Puducherry India
| | - Neelaiah Siddaraju
- Department of PathologyJawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Dhanvantari Nagar Puducherry India
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15
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Mimery A, De Clercq S. Primary pancreatic lymphoma presenting as recurrent idiopathic pancreatitis: a diagnostic dilemma. ANZ J Surg 2019; 90:E81-E82. [PMID: 31218769 DOI: 10.1111/ans.15309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Alexander Mimery
- Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia
| | - Stefaan De Clercq
- Department of Surgery, Gladstone Hospital, Gladstone, Queensland, Australia
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Primary extranodal lymphoma of the glands. Literature review and options for best practice in 2019. Crit Rev Oncol Hematol 2019; 135:8-19. [PMID: 30819450 DOI: 10.1016/j.critrevonc.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 12/04/2018] [Accepted: 01/15/2019] [Indexed: 01/01/2023] Open
Abstract
Primary extranodal non-Hodgkin's lymphomas (EN-NHL) are a heterogeneous group of malignancies that involve numerous entities with significant difference in terms of tumor site locations, prognostic factors, biology expression, and therapeutic options. In the literature, many EN-NHL types were reported from limited series which only allowed narrow views for elucidating prognostic factors and defining the role of loco-regional therapies in the era of new systemic and biologically targeted therapies. The Rare Cancer Network (RCN), an international multidisciplinary consortium, has published a number of reports on several EN-NHL sites which included many gland locations. In this review, we will focus on the recent literature for a selected number of EN-NHL types in both exocrine and endocrine gland locations. We aim to provide renewed and clear messages for the best practice in 2019 for diagnosis, histopathology, treatments, and also their prognostic implications. We believe that better understanding of molecular and genetic characteristics of these particular diseases is crucial for an appropriate management in the era of personalized treatment developments.
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Manning MA, Paal EE, Srivastava A, Mortele KJ. Nonepithelial Neoplasms of the Pancreas, Part 2: Malignant Tumors and Tumors of Uncertain Malignant Potential From the Radiologic Pathology Archives. Radiographics 2018; 38:1047-1072. [PMID: 29787363 DOI: 10.1148/rg.2018170201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Almost all neoplasms of the pancreas are derived from pancreatic epithelial components, including the most common pancreatic mass, primary pancreatic ductal adenocarcinoma (PDAC). Nonepithelial neoplasms comprise only 1%-2% of all pancreatic neoplasms. Although some may arise directly from intrapancreatic elements, many originate from mesenchymal, hematopoietic, or neural elements in the retroperitoneal peripancreatic space and grow into the pancreas. Once these tumors reach a certain size, it can be challenging to identify their origin. Because these manifest at imaging as intrapancreatic masses, awareness of the existence and characteristic features of these nonepithelial neoplasms is crucial for the practicing radiologist in differentiating these tumors from primary epithelial pancreatic tumors, an important distinction given the vastly different management and prognosis. In part 1 of this article, the authors reviewed benign nonepithelial neoplasms of the pancreas. This article focuses on malignant nonepithelial neoplasms and those of uncertain malignant potential that can be seen in the pancreas. The most common malignant or potentially malignant nonepithelial pancreatic tumors are of mesenchymal origin and include soft-tissue sarcomas, solitary fibrous tumor, and inflammatory myofibroblastic tumor. These tumors commonly manifest as large heterogeneous masses, often containing areas of necrosis and hemorrhage. The clinical features associated with these tumors and the imaging characteristics including enhancement patterns and the presence of fat or calcification help distinguish these tumors from PDAC. Hematopoietic tumors, including lymphoma and extramedullary plasmacytoma, can manifest as isolated pancreatic involvement or secondarily involve the pancreas as widespread disease. Hyperenhancing paragangliomas or hypervascular metastatic disease can mimic primary pancreatic neuroendocrine tumors or vascular anomalies.
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Affiliation(s)
- Maria A Manning
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
| | - Edina E Paal
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
| | - Amogh Srivastava
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
| | - Koenraad J Mortele
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1010, Silver Spring, MD 20910 (M.A.M.); Department of Radiology, MedStar Georgetown University Hospital, Washington, DC (M.A.M.); Pathology and Laboratory Medicine Service, VA Medical Center, Washington, DC (E.E.P.); Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC (E.E.P.); Department of Radiology, MetroWest Medical Center, Framingham, Mass (A.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.M.)
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Blouhos K, Boulas KA, Paraskeva A, Kariotis I, Barettas N, Hatzigeorgiadis A. Obstructive jaundice as primary presentation of a stage IIE Non-Hodgkin lymphoma: A decision making process between advanced lymphoma and locally advanced/metastatic pancreatic adenocarcinoma. Int J Surg Case Rep 2018; 44:226-229. [PMID: 29547849 PMCID: PMC5857486 DOI: 10.1016/j.ijscr.2018.02.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Secondary pancreatic tumors are uncommon and account for 2-5% of pancreatic cancer. Tumors characterized most commonly with pancreatic involvement are lymphoma, renal cell and lung carcinomas. PRESENTATION OF CASE A 76-year-old female patient with obstructive jaundice as the primary symptom and inguinal lymphadenopathy is presented. Imaging revealed a bulky solitary solid pancreatic head mass along with paraaortic and mesenteric lymphadenopathy. The absence of a previous history of malignancy and the presence of a dominant pancreatic mass along with distal lymphadenopathy confined differential diagnosis to advanced secondary pancreatic lymphoma, which is the most common secondary pancreatic tumor, and locally advanced/metastatic pancreatic adenocarcinoma. Pathologic confirmation with excisional biopsy of an enlarged inguinal lymph node and EUS-FNB of the pancreatic head mass confirmed the diagnosis of secondary Non-Hodgkin pancreatic lymphoma allowing initiation of induction chemotherapy. DISCUSSION Secondary pancreatic lymphoma can be seen up to 30% of patients with advanced lymphoma; although the head of the pancreas is the most common location, obstructive jaundice is not the predominant symptom as obstruction of the common bile duct is usually absent. In the setting of a solitary nodular type pancreatic mass, key imaging findings highly suggestive of secondary pancreatic lymphoma and not of adenocarcinoma are the absence of vascular invasion, bile and pancreatic duct obstruction, and the presence of lymphadenopathy below the level of the left renal vein. CONCLUSION When a secondary pancreatic tumor is highly suspected pathologic confirmation is always needed before initiation of induction or palliative chemotherapy.
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Affiliation(s)
- K Blouhos
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - K A Boulas
- Department of General Surgery, General Hospital of Drama, Drama, Greece.
| | - A Paraskeva
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - I Kariotis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - N Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece
| | - A Hatzigeorgiadis
- Department of General Surgery, General Hospital of Drama, Drama, Greece
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Qiu T, Li W, Geng H, Shi S. Clinicopathological characteristics of primary pancreatic lymphoma: report of two cases. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:10941-10946. [PMID: 31966438 PMCID: PMC6965887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/03/2016] [Indexed: 06/10/2023]
Abstract
Primary pancreatic lymphoma (PPL), originating from the pancreatic parenchyma, is a rare type of lymphoma. The symptoms and radiographic findings of PPL are quite similar to pancreatic adenocarcinoma (PAC), and thus it is often misdiagnosed. In this study, we described the clinical features, radiographic findings, histological and immunohistochemical analysis, molecular detection and clinical treatment of two cases of PPL, aiming to distinguish PPL from PAC. The two cases were both low-grade PPL. One was follicular lymphoma and the other was small lymphocytic lymphoma. Imaging examination of the two cases both showed solid mass, thus highly suspecting of PAC. However, after surgery, PPL was diagnosed by the pathologists through histopathological observation, immunohistochemistry (IHC) assay and clonality analysis. Therefore, accurately diagnosing and classifying of PPL is essential for patient management, since PPL is a treatable malignant tumor.
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Rad N, Heidarnezhad A, Soheili S, Mohammad-Alizadeh AH, Nikmanesh A. A Man with Pancreatic Head Mass Lesion on Endoscopic Ultrasound and Granuloma on Cytopathology. Case Rep Gastroenterol 2016; 10:760-768. [PMID: 28100998 PMCID: PMC5216211 DOI: 10.1159/000448875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/29/2016] [Indexed: 01/15/2023] Open
Abstract
Primary pancreatic lymphoma is an unlikely malignancy accounting for less than 0.5% of pancreatic tumors. Clinical presentation is often nonspecific and may be clinically misdiagnosed as pancreatic adenocarcinoma. Here we present an Iranian case of primary pancreatic lymphoma in a 47-year-old male suffering from jaundice and 20% weight loss. Endoscopic ultrasound revealed a mixed echoic mass lesion at the head of pancreas. The patient underwent endoscopic ultrasound-guided fine needle aspiration of solid pancreatic mass and histopathologic diagnosis revealed granuloma. Computed tomography-guided core needle biopsy was performed and eventually histological examination showed granuloma that was coherent with the diagnosis of primary pancreatic lymphoma. Primary pancreatic lymphoma is a rare entity presenting with nonspecific symptoms, laboratory and radiological findings. Computed tomography results in combination with clinical and radiological studies generally provide guidance for appropriate investigation.
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Affiliation(s)
- Neda Rad
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
| | - Arash Heidarnezhad
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
| | - Setareh Soheili
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
| | - Amir Houshang Mohammad-Alizadeh
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
| | - Arash Nikmanesh
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
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Abstract
OBJECTIVE This article reviews the computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) CT findings of primary and secondary pancreatic lymphomas and discusses the role of endoscopic ultrasound-guided fine needle aspiration in diagnosis and management. CONCLUSION Pancreatic lymphoma has certain characteristic imaging features which may help distinguish it from the more common pancreatic adenocarcinoma. It is critical to make an accurate diagnosis, as the management of these two conditions is vastly different.
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23
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Wallace D, Dang N, Dhawan M, Kulkarni A. Diagnosis of a patient with primary pancreatic lymphoma. Gastroenterol Hepatol (N Y) 2012; 8:850-852. [PMID: 24693276 PMCID: PMC3971900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Dustin Wallace
- West Penn Allegheny Health System ana Drexel University College of Medicine, Pittsburgh, Pennsylvania
| | - Navneet Dang
- West Penn Allegheny Health System ana Drexel University College of Medicine, Pittsburgh, Pennsylvania
| | - Manish Dhawan
- West Penn Allegheny Health System ana Drexel University College of Medicine, Pittsburgh, Pennsylvania
| | - Abhijit Kulkarni
- West Penn Allegheny Health System ana Drexel University College of Medicine, Pittsburgh, Pennsylvania
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Pancreatic imaging mimics: part 1, imaging mimics of pancreatic adenocarcinoma. AJR Am J Roentgenol 2012; 199:301-8. [PMID: 22826390 DOI: 10.2214/ajr.11.7907] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The purpose of this article is to describe the imaging features of diseases that may closely simulate pancreatic adenocarcinoma, either radiologically or pathologically. CONCLUSION Neoplastic and inflammatory diseases that can closely simulate pancreatic adenocarcinoma include neuroendocrine tumor, metastasis to the pancreas, lymphoma, groove pancreatitis, autoimmune pancreatitis, and focal chronic pancreatitis. Atypical imaging findings that should suggest diagnoses other than adenocarcinoma include the absence of significant duct dilatation, incidental detection, hypervascularity, large size (> 5 cm), IV tumor thrombus, and intralesional ducts or cysts.
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26
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Primary pancreatic lymphoma: will laparoscopy change the role of surgery in the treatment of this pathology? Pancreas 2012; 41:1132-4. [PMID: 22940828 DOI: 10.1097/mpa.0b013e31824b23eb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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27
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Holalkere NS, Soto J. Imaging of miscellaneous pancreatic pathology (trauma, transplant, infections, and deposition). Radiol Clin North Am 2012; 50:515-28. [PMID: 22560695 DOI: 10.1016/j.rcl.2012.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this article's coverage of miscellaneous pancreatic topics, a brief review of pancreatic trauma; pancreatic transplantation; rare infections, such as tuberculosis; deposition disorders, including fatty replacement and hemochromatosis; cystic fibrosis; and others are discussed with pertinent case examples.
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Affiliation(s)
- Nagaraj-Setty Holalkere
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA.
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28
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Ghobakhlou M, Alizadeh AHM, Naderi N, Haghighi S, Molaei M, Rafiezadeh M, Zali MR. A patient with chronic hepatitis C and a pancreatic mass in endoscopic ultrasound. Case Rep Gastroenterol 2012; 6:387-93. [PMID: 22855657 PMCID: PMC3398077 DOI: 10.1159/000339693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We report a rare case of pancreas tumor (lymphoma) in a patient with a history of chronic hepatitis C virus (HCV) infection without treatment, with a high viral load (20,199,805 IU/ml). He presented with abdominal pain, jaundice, weight loss and sweating. Computed tomography showed a hypodense mass located in the head of the pancreas, and immunohistochemistry of a specimen obtained by endoscopic ultrasound-guided fine needle aspiration revealed non-Hodgkin's lymphoma of the pancreas, B cell type. An association of HCV infection with pancreatic lymphoma has only been reported rarely in the literature and its clinical significance is uncertain.
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Affiliation(s)
| | - Amir Houshang Mohammad Alizadeh
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
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29
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Rock J, Bloomston M, Lozanski G, Frankel WL. The spectrum of hematologic malignancies involving the pancreas: potential clinical mimics of pancreatic adenocarcinoma. Am J Clin Pathol 2012; 137:414-22. [PMID: 22338053 DOI: 10.1309/ajcpcxw7qug9efto] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Hematologic malignancies often involve the pancreas, causing potential diagnostic pitfalls and, rarely, potentially avoidable surgical resection. We review the spectrum of hematologic malignancies involving the pancreas and describe features useful in preoperative distinction from adenocarcinoma. Archived clinical, pathologic, and radiologic data (1965 to present) for hematologic malignancies involving the pancreas were reviewed and compared with the data for 157 surgically resected pancreatic adenocarcinomas. Of 42 cases, 27 (64%) were clinically "suspicious" for hematologic malignancies. Of the remaining 15 cases, 4 patients underwent resection for presumed pancreatic adenocarcinoma. Isolated pancreatic masses proved most difficult to identify clinically. Significant factors in distinguishing hematologic malignancies from adenocarcinoma included history of hematologic malignancy, young age, large tumor size, low CA19-9 level, B symptoms, and lack of jaundice or diabetes mellitus. Various hematologic malignancies involve the pancreas, most commonly diffuse large B-cell lymphoma. Pancreatic masses are usually correctly identified clinically. Preoperative and operative sampling is strongly recommended when hematologic malignancies cannot be excluded.
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30
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Rose JF, Jie T, Usera P, Ong ES. Pancreaticoduodenectomy for primary pancreatic lymphoma. GASTROINTESTINAL CANCER RESEARCH : GCR 2012; 5:32-34. [PMID: 22574235 PMCID: PMC3348715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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31
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Primary pancreatic lymphoma: a rare cause of massive upper gastrointestinal hemorrhage. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2011; 25:532-3. [PMID: 22059154 DOI: 10.1155/2011/605928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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32
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Zolotarevsky E, Kurtz RC. Pancreatic tumor: when is it not pancreatic adenocarcinoma? Gastroenterol Hepatol (N Y) 2011; 7:838-840. [PMID: 22347826 PMCID: PMC3280419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Eugene Zolotarevsky
- Gastroenterology and Nutrition Service Department of Medicine Memorial Sloan-Kettering Cancer Center New York, New York
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Serin KR, Güven K, Ozden I, Doğan O, Gök K, Demir C, Emre A. Curative Chemoradiotherapy of Primary Pancreatic Lymphoma with Vertebral Metastasis: Palliation of Persistent Biliary Stricture by Roux-en-Y Hepaticojejunostomy. Case Rep Gastroenterol 2011; 5:642-7. [PMID: 22171216 PMCID: PMC3237111 DOI: 10.1159/000334725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Primary pancreatic lymphoma (PPL) is a rare tumor that usually presents with the clinical picture of advanced adenocarcinoma but has a much better prognosis. A 38-year-old man was referred after percutaneous transhepatic external biliary drainage for obstructive jaundice. Abdominal magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography had revealed a 5-cm pancreatic head mass that caused biliary tract dilation. Computed tomography angiography showed that the mass encased the celiac trunk as well as the common hepatic and splenic arteries. MRI also revealed a metastatic lesion at the third lumbar vertebra. Serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels were within normal range. The initial diagnosis was inoperable pancreatic adenocarcinoma; however, Tru-Cut pancreatic biopsy showed a large B cell lymphoma. After 6 sessions of chemotherapy and 21 sessions of radiotherapy, both the pancreatic mass and the vertebral metastasis had disappeared. However, he had persistent distal common bile duct stricture that could not be negotiated by either the endoscopic or percutaneous route. A Roux-en-Y hepaticojejunostomy was performed. The patient stayed alive without recurrence for 52 months after the initial diagnosis and 45 months after completion of oncologic treatment. In conclusion, a large pancreatic mass with grossly involved peripancreatic lymph nodes, without ascites, liver or splenic metastasis, should alert the clinician to the possibility of PPL. Cure is possible by chemoradiotherapy even in the presence of vertebral metastasis. Persistent stricture in the distal common bile duct may require a biliodigestive anastomosis.
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Affiliation(s)
- Kürşat Rahmi Serin
- Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Hilal MA, Ghoul WE, Zeidan S, Scio A, Di Fabio F. Laparoscopic Multivisceral Resection for Infiltrating Primary Pancreatic Non-Hodgkin's Lymphoma Mimicking a Vast Cystic Neoplasm. Am Surg 2011. [DOI: 10.1177/000313481107700918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mohammed Abu Hilal
- Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit Southampton University Hospitals NHS Trust Southampton, United Kingdom
| | - Wessam El Ghoul
- Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit Southampton University Hospitals NHS Trust Southampton, United Kingdom
| | - Shadi Zeidan
- Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit Southampton University Hospitals NHS Trust Southampton, United Kingdom
| | - Antonio Scio
- Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit Southampton University Hospitals NHS Trust Southampton, United Kingdom
| | - Francesco Di Fabio
- Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit Southampton University Hospitals NHS Trust Southampton, United Kingdom
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35
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Akkinepally S, Poreddy V. Medical images. Pancreatic adenocarcinoma? Mayo Clin Proc 2010; 85:11. [PMID: 20042554 PMCID: PMC2800279 DOI: 10.4065/mcp.2009.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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36
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McCauley AM, Gottlieb KT. Primary pancreatic lymphoma coexisting with chronic lymphocytic leukemia: EUS findings. Gastrointest Endosc 2008; 68:188-9. [PMID: 18291383 DOI: 10.1016/j.gie.2007.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 11/14/2007] [Indexed: 12/10/2022]
Affiliation(s)
- Alice M McCauley
- Department of Internal Medicine, University of Washington, Spokane, USA
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37
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Liakakos T, Misiakos EP, Tsapralis D, Nikolaou I, Karatzas G, Macheras A. A role for surgery in primary pancreatic B-cell lymphoma: a case report. J Med Case Rep 2008; 2:167. [PMID: 18489739 PMCID: PMC2396657 DOI: 10.1186/1752-1947-2-167] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 05/19/2008] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Primary pancreatic lymphoma is a very rare but manageable malignant tumour which may be clinically confused as a pancreatic carcinoma. This case report demonstrates the value of surgical resection in the management of pancreatic lymphoma. CASE PRESENTATION We report a case of a 65-year-old man who was admitted with obstructive jaundice, vague upper abdominal pain and weight loss. Ultrasonography and computed tomography showed a mass at the head of the pancreas which was compressing the bile duct. The patient underwent pancreaticoduodenectomy. Histopathologic and immunohistochemical assessment of the pancreatic lesion established the diagnosis of a diffuse, extranodal, high-grade B-cell non-Hodgkin's lymphoma. Several doses of chemotherapy were administered postoperatively and at present the disease remains in remission. CONCLUSION The favourable outcome for this patient and a thorough review of the literature underline the important role that operative resection may have in the management of at least the early stage of primary pancreatic lymphoma.
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Affiliation(s)
- Theodore Liakakos
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1 Street, Chaidari, Athens, Greece.
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38
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Mortenson MM, Katz MHG, Tamm EP, Bhutani MS, Wang H, Evans DB, Fleming JB. Current diagnosis and management of unusual pancreatic tumors. Am J Surg 2008; 196:100-13. [PMID: 18466869 DOI: 10.1016/j.amjsurg.2008.02.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 02/11/2008] [Accepted: 02/11/2008] [Indexed: 12/24/2022]
Abstract
BACKGROUND The finding of a solid or cystic mass in the pancreas is becoming more common secondary to the increasing use of cross-sectional imaging and the improved sensitivity of such studies for the detection of pancreatic abnormalities. Because of the aggressive natural history of pancreatic cancer, this has caused concern that all pancreatic abnormalities may be cancer as well as confusion over proper diagnostic and treatment algorithms. This review provides an overview of the natural history, diagnostic considerations, and treatment recommendations for the less common tumors of the pancreas which can be misinterpreted as pancreatic cancer including: solid pseudopapillary tumors (SPT), acinar cell carcinoma (ACC), lymphoplasmacytic sclerosing pancreatitis (LPSP), primary pancreatic lymphoma (PPL), and metastatic renal cell carcinoma to the pancreas. DATA SOURCES A Medline search was conducted to identify studies investigating the clinicopathologic features, molecular genetics, pathogenesis, diagnosis, and treatment of SPT, ACC, LPSP, PPL, and pancreatic metastases. CONCLUSIONS It is often possible to obtain an accurate pretreatment diagnosis for these unusual pancreatic tumors and to successfully differentiate them from the more common pancreatic malignancies.
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Affiliation(s)
- Melinda M Mortenson
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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39
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Piesman M, Forcione DG. A case of pancreatic lymphoma. MEDGENMED : MEDSCAPE GENERAL MEDICINE 2007; 9:32. [PMID: 18092038 PMCID: PMC2100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
| | - David G. Forcione
- Gastroenterology Division, Massachusetts General Hospital; Instructor in Medicine, Harvard Medical School, Boston, Massachusetts Author's
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