A Case of Primary Pancreatic Non-Hodgkin's Lymphoma

Abstract

Primary pancreatic lymphoma is rare, comprising 0.2~4.9% of all pancreatic malignancies and less than 1% of cases of non-Hodgkin's lymphoma. Many patients are diagnosed with lymphoma after radical resection. We report a rare presentation of diffuse large B cell lymphoma, appearing as a primary tumor of the pancreas. A 61-year old female was admitted to the hospital with the complaint of right upper abdominal pain. Computed tomography of the abdomen showed a well defined mass located at the head of the pancreas. A frozen section of pancreas, during laparotomy, revealed lymphoma. The patient received 6 cycles of chemotherapy and is currently in complete remission. This case underscores the importance of differentiating primary lymphoma from the more common adenocarcinoma of the pancreas as treatment and prognosis differ significantly. Primary pancreatic lymphoma should be considered in the differential diagnosis of pancreatic tumors and an attempt to obtain a tissue diagnosis is always necessary before proceeding to radical surgery, especially on young patients.

Extranodal Non-Hodgkin Lymphoma: A Rare Presentation Involving the Pancreas

“…10,11 Another key differentiating factor is the location of the lesion as primary pancreatic malignancies typically arise from the pancreatic head. 10 The diagnosis of pancreatic lymphoma may be difficult because the symptoms and initial imaging can closely mimic those of other pancreatic tumors, such as adenocarcinoma or a functioning/non-functioning neuroendocrine tumor.…”

“…Additionally, the presence of peripancreatic lymphadenopathy and splenomegaly, seen with extranodal lymphoma, are less associated with adenocarcinoma. 10…”

A Rare, Yet Treatable Pancreatic Tumor: Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma

“…In addition, the size of the mass itself can be an important clue in some cases. It is estimated that 60% of pancreatic lymphomas are greater than 6 cm, while adenocarcinomas are unlikely to be larger than 10 cm [25]. Lastly, peritoneal involvement suggests an underlying adenocarcinoma (peritoneal carcinomatosis), as the peritoneal folds consist of fatty tissue without lymphoid tissue.…”

Primary Pancreatic Diffuse Large B-Cell Lymphoma Involving the Stomach

“…The results of immunohistochemical staining were as follows: as noted in the diagnostic criteria [7]. Two patients with PPL involving other organs have been described in South Korea [9,10]. One patient had PPL with kidney involvement and the other had PPL that externally compressed the common bile duct.…”