Large pancreatic mass with chylous ascites

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.

Chylous Ascites, Unusual Association with Ductal Pancreatic Adenocarcinoma with Plasmacytoid Morphology: A Case Report and Literature Review

“…1,2 The main mechanisms of acquired chylous ascites are the following ones: traumatic disruption of thoracic duct, obstruction of lymphatic flow, caused by infectious agents or tumor cells, fibrosis of the lymph vessels wall, in patients with autoimmune diseases or after radiotherapy, or increased lymph fluid production, such in cirrhosis or cardiovascular diseases. 3,6,[8][9][10] Although rare, malignancies such as lymphomas (30% of all reported cases), Kaposi sarcoma, leukemias, neuroendocrine tumors or adenocarcinomas of the gastrointestinal tract, and carcinomas of lung and endometrium were described to be the possible causes of chylous ascites. 1 As regarding the pancreas, chylous ascites was reported as a rare complication of iatrogenic lesions of the lymphatic channels during cephalic duodenopancreatectomy with extensive lymphadenectomy.…”

“…The main mechanisms of acquired chylous ascites are the following ones: traumatic disruption of thoracic duct, obstruction of lymphatic flow, caused by infectious agents or tumor cells, fibrosis of the lymph vessels wall, in patients with autoimmune diseases or after radiotherapy, or increased lymph fluid production, such in cirrhosis or cardiovascular diseases. 3 6 8 9 10 …”

“…

Chylous ascites, also known as chyloperitoneum or lymphorrhagia, is a rare lesion of adults, with a reported incidence of 1:20,500, which is defined by the presence of a milky and lipid-rich fluid in the peritoneal cavity. [1][2][3][4][5][6] Lymphatic fluid is characterized by thick consistency, cell count >500/mL, with lymphocytic predominance, total protein level between 2.5 and 7.0 g/dL, with serum to ascites albumin gradient (SAAG) less than 1.1 g/dL, lactate dehydrogenase (LDH) between 110 and 200 IU/L, glucose level >100 mg/dL, and triglyceride level in ascetic fluid >110 mg/dL. 1,2

…”

“…Chylous ascites, also known as chyloperitoneum or lymphorrhagia, is a rare lesion of adults, with a reported incidence of 1:20,500, which is defined by the presence of a milky and lipid-rich fluid in the peritoneal cavity. 1 2 3 4 5 6 …”

Primary hepatopancreatobiliary lymphoma: Pathogenesis, diagnosis, and management

“…The most commonly used regimen is CHOP or R-CHOP ( 176 ). The majority of patients with PPL receiving only chemotherapy can achieve long-term disease remission ( 12 , 148 , 149 , 163 , 202 ). Vijungco et al.…”