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Bai YL, Wang LJ, Luo H, Cui YB, Xu JH, Nan HJ, Yang PY, Niu JW, Shi MY. Primary pancreatic peripheral T-cell lymphoma: A case report. World J Gastrointest Oncol 2024; 16:1668-1675. [PMID: 38660638 PMCID: PMC11037062 DOI: 10.4251/wjgo.v16.i4.1668] [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: 12/30/2023] [Revised: 01/25/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Primary pancreatic lymphoma (PPL) is an exceedingly rare tumor with limited mention in scientific literature. The clinical manifestations of PPL are often nonspecific, making it challenging to distinguish this disease from other pancreatic-related diseases. Chemotherapy remains the primary treatment for these individuals.
CASE SUMMARY In this case study, we present the clinical details of a 62-year-old woman who initially presented with vomiting, abdominal pain, and dorsal pain. On further evaluation through positron emission tomography-computed tomography, the patient was considered to have a pancreatic head mass. However, subsequent endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) revealed that the patient had pancreatic peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). There was a substantial decrease in the size of the pancreatic mass after the patient underwent a cycle of chemotherapy comprised of brentuximab vedotin, gemcitabine, and oxaliplatin (brentuximab vedotin and Gemox). The patient had significant improvement in radiological findings at the end of the first cycle.
CONCLUSION Primary pancreatic PTCL-NOS is a malignant and heterogeneous lymphoma, in which the clinical manifestations are often nonspecific. It is difficult to diagnose, and the prognosis is poor. Imaging can only be used for auxiliary diagnosis of other diseases. With the help of immunostaining, EUS-FNA could be used to aid in the diagnosis of PPL. After a clear diagnosis, chemotherapy is still the first-line treatment for such patients, and surgical resection is not recommended. A large number of recent studies have shown that the CD30 antibody drug has potential as a therapy for several types of lymphoma. However, identifying new CD30-targeted therapies for different types of lymphoma is urgently needed. In the future, further research on antitumor therapy should be carried out to improve the survival prognosis of such patients.
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Affiliation(s)
- Yan-Liang Bai
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou 450003, Henan Province, China
| | - Li-Jie Wang
- Department of Hematology, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou 450003, Henan Province, China
| | - Hui Luo
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, Henan Province, China
| | - Ya-Bin Cui
- Department of Hematology, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou 450003, Henan Province, China
| | - Jin-Hui Xu
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou 450003, Henan Province, China
| | - Hui-Jie Nan
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou 450003, Henan Province, China
| | - Pei-Yao Yang
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou 450003, Henan Province, China
| | - Jun-Wei Niu
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou 450003, Henan Province, China
| | - Ming-Yue Shi
- Department of Hematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou 450003, Henan Province, China
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2
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Herman T, Wilson N, Abdallah M, Bilal M, Nemat H. Acute Pancreatitis Revealing a Diagnosis of Diffuse Large B-Cell Lymphoma. ACG Case Rep J 2024; 11:e01320. [PMID: 38560015 PMCID: PMC10977588 DOI: 10.14309/crj.0000000000001320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Acute pancreatitis is a common gastroenterological condition that can occur due to several causes. While not required for diagnosis, imaging is often performed and may reveal unexpected findings such as pancreatic masses. Malignancies such as lymphoma are uncommon causes of acute pancreatitis, especially as the initial presentation of malignancy. We present a case of a young patient with acute pancreatitis caused by diffuse large B-cell lymphoma with extranodal disease secondarily involving the pancreas. Our case highlights the importance of keeping a broad differential for acute pancreatitis and considering rare etiologies such as pancreatic lymphoma in patients without another obvious culprit.
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Affiliation(s)
- Tessa Herman
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN
| | - Natalie Wilson
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN
| | - Mohamed Abdallah
- Advanced Endoscopy, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Mohammad Bilal
- Advanced Endoscopy, Division of Gastroenterology, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN
| | - Hashim Nemat
- Advanced Endoscopy, Division of Gastroenterology & Hepatology, Regions Hospital, St. Paul, MN
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3
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Hiraga E, Yamai T, Ikezawa K, Kawamoto Y, Hirao T, Higashi S, Urabe M, Kai Y, Takada R, Nakabori T, Uehara H, Ryu A, Yuda S, Honma K, Ohkawa K. A case of multiple myeloma with pancreatic involvement diagnosed via endoscopic ultrasound-guided fine needle aspiration. Clin Case Rep 2023; 11:e7190. [PMID: 37077720 PMCID: PMC10106934 DOI: 10.1002/ccr3.7190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/21/2023] Open
Abstract
This report highlights the importance of considering multiple myeloma in the differential diagnosis of a pancreatic tumor with bone lesions. sampling not only from the pancreatic lesion but also from bone lesions may reach an accurate diagnosis.
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Affiliation(s)
- Erika Hiraga
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Takuo Yamai
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yasuharu Kawamoto
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Takeru Hirao
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Sena Higashi
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Makiko Urabe
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Yugo Kai
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Ryoji Takada
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Tasuku Nakabori
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Hiroyuki Uehara
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Ayumi Ryu
- Department of Clinical LaboratoryOsaka International Cancer InstituteOsakaJapan
| | - Sayako Yuda
- Department of HematologyOsaka International Cancer InstituteOsakaJapan
| | - Keichiro Honma
- Department of Diagnostic Pathology and CytologyOsaka International Cancer InstituteOsakaJapan
| | - Kazuyoshi Ohkawa
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
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4
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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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5
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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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6
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The Utility of Endoscopic-Ultrasonography-Guided Tissue Acquisition for Solid Pancreatic Lesions. Diagnostics (Basel) 2022; 12:diagnostics12030753. [PMID: 35328306 PMCID: PMC8947755 DOI: 10.3390/diagnostics12030753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 02/07/2023] Open
Abstract
Endoscopic-ultrasonography-guided tissue acquisition (EUS-TA) has been widely performed for the definitive diagnosis of solid pancreatic lesions (SPLs). As the puncture needles, puncture techniques, and sample processing methods have improved, EUS-TA has shown higher diagnostic yields and safety. Recently, several therapeutic target genomic biomarkers have been clarified in pancreatic ductal carcinoma (PDAC). Although only a small proportion of patients with PDAC can benefit from precision medicine based on gene mutations at present, precision medicine will also be further developed for SPLs as more therapeutic target genomic biomarkers are identified. Advances in next-generation sequencing (NGS) techniques enable the examination of multiple genetic mutations in limited tissue samples. EUS-TA is also useful for NGS and will play a more important role in determining treatment strategies. In this review, we describe the utility of EUS-TA for SPLs.
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7
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Diffuse Large B Cell Lymphoma with Cutaneous and Gastrointestinal Involvement. Case Rep Gastrointest Med 2022; 2022:2687291. [PMID: 35265383 PMCID: PMC8898773 DOI: 10.1155/2022/2687291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Diffuse large B cell lymphoma (DLBCL) is the histological subtype of non-Hodgkin's lymphoma, representing approximately 30%. The most common primary extranodal sites of DLBCL are the gastrointestinal (GI) tract, the head and neck, and the skin/soft tissue. We report a case of DLBCL with cutaneous involvement presenting with skin nodules and GI manifestations such as obstructive jaundice and upper GI bleeding. Malignant cystic pancreatic tumor occupying the head and body with invasion to lower end of common bile duct and periampullary region causing biliary obstruction and mesenteric lymphadenopathy were found in abdominal computed tomography and endoscopic ultrasonography. There was also a large gastric ulcer (Forrest IIa) at the greater curvature of body of the stomach. Histopathological results of the skin and stomach were consistent with diffuse large B cell lymphoma; gastric biopsy being negative for leucocyte common antigen. The patient was considered to have disseminated DLBCL. The aim of the present case report was to present the clinical, radiological, and histological characteristics of the patient, which may aid physicians in diagnosing involvement of multiple extranodal sites in DLBCL.
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Yamai T, Ikezawa K, Daiku K, Maeda S, Abe Y, Kai Y, Takada R, Nakabori T, Fukutake N, Uehara H, Masaie H, Ishida K, Kubo C, Ohkawa K. Primary Pancreatic Mantle Cell Lymphoma Diagnosed via Endoscopic Ultrasound-Guided Fine-Needle Aspiration. Case Rep Gastroenterol 2021; 15:482-487. [PMID: 34616244 PMCID: PMC8454237 DOI: 10.1159/000515570] [Citation(s) in RCA: 1] [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] [Received: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Primary pancreatic lymphomas (PPLs) are rare, and the histological classification of these tumors is difficult. To accurately diagnose and determine the appropriate treatment for PPLs, sufficient sample amounts are necessary. Here, we report a 73-year-old man with a primary pancreatic mantle cell lymphoma. Histological samples were obtained via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The tumor cells predominantly composed of atypical small to medium round cells, with diffuse immunoreactivity of CD20 and cyclin D1. In addition, immunoglobulin gene H chain rearrangement was detected. The patient underwent chemotherapy, resulting in complete remission. Eight years after the initiation of chemotherapy, the patient was still alive. EUS-FNA could be a useful and safe diagnostic modality for PPLs by providing enough samples for testing.
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Affiliation(s)
- Takuo Yamai
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuma Daiku
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shingo Maeda
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yutaro Abe
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yugo Kai
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryoji Takada
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tasuku Nakabori
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Nobuyasu Fukutake
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyuki Uehara
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroaki Masaie
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Kaori Ishida
- Department of Clinical Laboratory, Osaka International Cancer Institute, Osaka, Japan
| | - Chiaki Kubo
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuyoshi Ohkawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
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9
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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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Ohtsubo K, Yamashita K, Yanagimura N, Suzuki C, Tanimoto A, Nishiyama A, Takeuchi S, Iwaki N, Kawano M, Izumozaki A, Inoue D, Gabata T, Ikeda H, Watanabe M, Yano S. Multiple Malignant Lymphomas of the Bile Duct Developing after Spontaneous Regression of an Autoimmune Pancreatitis-like Mass. Intern Med 2021; 60:409-415. [PMID: 32863365 PMCID: PMC7925286 DOI: 10.2169/internalmedicine.5429-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We herein report a 67-year-old woman with malignant lymphomas of the bile duct that developed after regression of a pancreatic head mass. Computed tomography suggested the mass was pancreatic head cancer. Endoscopic ultrasonography showed a low-echoic mass with hyperechoic strands resembling autoimmune pancreatitis. Her serum IgG4 concentration was elevated to 674 mg/dL. After the pancreatic head mass spontaneously diminished, three masses were detected in the common bile duct. A biopsy of the major papilla revealed high-grade B-cell lymphoma with MYC, BCL2 and/or BCL6 rearrangement. Systemic chemotherapy with rituximab plus etoposide, prednisolone, vincristine, cyclophosphamide and doxorubicin resulted in complete remission.
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Affiliation(s)
- Koushiro Ohtsubo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
| | - Kaname Yamashita
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
| | - Naohiro Yanagimura
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
| | - Chiaki Suzuki
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
| | - Azusa Tanimoto
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
| | - Akihiro Nishiyama
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
| | - Shinji Takeuchi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
| | - Noriko Iwaki
- Department of Hematology, Kanazawa University, Japan
| | | | | | - Dai Inoue
- Department of Radiology, Kanazawa University, Japan
| | | | - Hiroko Ikeda
- Division of Human Pathology, Kanazawa University, Japan
| | | | - Seiji Yano
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
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11
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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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12
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Heymann JJ, Siddiqui MT. Ancillary Techniques in Cytologic Specimens Obtained from Solid Lesions of the Pancreas: A Review. Acta Cytol 2019; 64:103-123. [PMID: 30970350 DOI: 10.1159/000497153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/22/2019] [Indexed: 12/21/2022]
Abstract
Advanced methods of molecular characterization have elucidated the genetic, epigenetic, and proteomic alterations associated with the broad spectrum of pancreatic disease, particularly neoplasia. Next-generation sequencing, in particular, has revealed the genomic diversity among pancreatic ductal adenocarcinoma, neuroendocrine and acinar tumors, solid pseudopapillary neoplasm, and other pancreatico-biliary neoplasms. Differentiating these entities from one another by morphologic analysis alone may be challenging, especially when examining the small quantities of diagnostic material inherent to cytologic specimens. In order to enhance the sensitivity and specificity of pancreatic cytomorphology, multiple diagnostic, prognostic, and predictive ancillary tests have been and continue to be developed. Although a great number of such tests have been developed for evaluation of specimens collected from cystic lesions and strictures, ancillary techniques also play a significant role in the evaluation of cytologic specimens obtained from solid lesions of the pancreas. Furthermore, while some tests have been developed to differentiate diagnostic entities from one another, others have been developed to simply identify dysplasia and malignancy. Ancillary studies are particularly important in the subset of cases for which cytomorphologic analysis provides a result that is equivocal or insufficient to guide clinical management. Selection of appropriate ancillary testing modalities requires familiarity with both their methodology and the molecular basis of the pancreatic diseases for which testing is being performed.
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Affiliation(s)
- Jonas J Heymann
- Division of Cytopathology, Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA,
| | - Momin T Siddiqui
- Division of Cytopathology, Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
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13
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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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14
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Hayat M, Syed TA, Disbrow M, Tran NTB, Asad ZUA, Tierney WM. Recurrent Pancreatitis Secondary to Diffuse Large B Cell Lymphoma. J Gastrointest Cancer 2018; 50:1009-1013. [PMID: 30393828 DOI: 10.1007/s12029-018-0175-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Maham Hayat
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L Young Boulevard, Oklahoma City, OK, 73117, USA.
| | - Taseen A Syed
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L Young Boulevard, Oklahoma City, OK, 73117, USA
| | - Molly Disbrow
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ngoc Thy Bao Tran
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zain Ul Abideen Asad
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - William M Tierney
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Rare pancreatic masses: a pictorial review of radiological concepts. Clin Imaging 2018; 50:314-323. [DOI: 10.1016/j.clinimag.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/08/2018] [Accepted: 05/01/2018] [Indexed: 02/07/2023]
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Zhou J, Wu H, Lin J, Wang X, Zhang S, Cramer H, Chen S. Fine needle aspiration evaluation of pancreatic lymphoma: A retrospective study of 25 cases in a single institution. Diagn Cytopathol 2017; 46:131-138. [DOI: 10.1002/dc.23862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/02/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Jiehao Zhou
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Howard Wu
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Jingmei Lin
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Xiaoyan Wang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Shanxiang Zhang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Harvey Cramer
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Shaoxiong Chen
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
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Sadaf S, Loya A, Akhtar N, Yusuf MA. Role of endoscopic ultrasound-guided-fine needle aspiration biopsy in the diagnosis of lymphoma of the pancreas: A clinicopathological study of nine cases. Cytopathology 2017; 28:536-541. [DOI: 10.1111/cyt.12442] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 12/27/2022]
Affiliation(s)
- S. Sadaf
- Fellow Cytopathology; Department of Histopathology; Shaukat Khanum Memorial Cancer Hospital & Research Center Lahore; Lahore Pakistan
| | - A. Loya
- Consultant Pathologist; Department of Pathology; Shaukat Khanum Memorial Cancer Hospital & Research Centre Lahore; Lahore Pakistan
| | - N. Akhtar
- Consultant Pathologist; Department of Pathology; Shaukat Khanum Memorial Cancer Hospital & Research Centre Lahore; Lahore Pakistan
| | - M. A. Yusuf
- Consultant Gastroenterologist; Department of Internal Medicine; Shaukat Khanum Memorial Cancer Hospital & Research Centre Lahore; Lahore Pakistan
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Kim JH, Paik WH, Joo M, Kim JG, Kim JW, Bae WK, Kim NH, Kim KA, Lee JS. Extramedullary plasmacytoma mimicking pancreatic cancer: A case report and literature review. Endosc Ultrasound 2017; 6:269-272. [PMID: 28663530 PMCID: PMC5579914 DOI: 10.4103/2303-9027.190923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pancreatic adenocarcinoma may account for more than 80% of all pancreatic neoplasms. Occasionally, other rare tumors such as lymphoma, metastatic tumor, and solid pseudopapillary neoplasm can be considered in the differential diagnosis. We report the case of an 82-year-old man with a pancreatic solid mass. This case suggests that endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) with biopsy, that is, EUS-FNA is recommended in the differential diagnosis of the pancreatic solid mass apart from pancreatic adenocarcinoma. In particular, the histologic core obtained by EUS-guided biopsy is helpful for the immunostaining of molecular markers to confirm the final diagnosis.
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Affiliation(s)
- Jae Hyung Kim
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Mee Joo
- Department of Pathology, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Jung Gon Kim
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Jong Wook Kim
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Won Ki Bae
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Nam-Hoon Kim
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Kyung-Ah Kim
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - June Sung Lee
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Goyang, South Korea
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Jin M, Wakely PE. Endoscopic/Endobronchial Ultrasound-Guided Fine Needle Aspiration and Ancillary Techniques, Particularly Flow Cytometry, in Diagnosing Deep-Seated Lymphomas. Acta Cytol 2016; 60:326-335. [PMID: 27414717 DOI: 10.1159/000447253] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/24/2016] [Indexed: 12/14/2022]
Abstract
Evaluation of deep-seated lymphomas by fine-needle aspiration (FNA) can be challenging due to their reduced accessibility. Controversy remains as to whether FNA and ancillary techniques can be used to diagnose deep-seated lymphomas reliably and sufficiently for clinical management. Most published studies are favorable that endobronchial ultrasound (EBUS)/endoscopic ultrasound (EUS)-FNA plays an important role in the diagnosis of deep-seated lymphomas. The addition of ancillary techniques, particularly flow cytometry, increases diagnostic yield. While subclassification is possible in a reasonable proportion of cases, the reported rates of successful subclassification are lower than those for lymphoma detection/diagnosis. The diagnostic limitation exists for Hodgkin's lymphoma, grading of follicular lymphoma, and some T-cell lymphomas. The role of FNA in deep-seated lymphomas is much better established for recurrent than primary disease. It remains unclear whether the use of large-sized-needle FNA or a combination of core needle biopsy and FNA improves subclassification. It is important for cytopathologists to have considerable understanding of the WHO lymphoma classification and develop a collaborative working relationship with hematopathologists and oncologists. As EUS/EBUS-FNA techniques advance and sophisticated molecular techniques such as next- generation sequencing become possible, the role of FNA in the diagnosis of deep-seated lymphomas will possibly increase.
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Affiliation(s)
- Ming Jin
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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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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