Primary Pancreatic Lymphoma: Recommendations for Diagnosis and Management

Primary hepatopancreatobiliary lymphoma: Pathogenesis, diagnosis, and management

“…found that PPLs have the following common CT features: a large and hypo-attenuation mass with mild enhancement ( Figures 6A–C ), peri-pancreatic fat stranding, vessel encasement without infiltration, rare pancreatic duct dilatation, and absence of necrosis ( 158 , 159 ). These findings are in agreement with some studies reported by other teams ( 12 , 160 , 161 ). The “sandwich sign”, in which a mesenteric mass surrounds the mesenteric vessels, without vascular infiltration, is frequently observed in patients with PPL ( 161 , 162 ).…”

“…PPL is a rare disease and accounts for approximately 1% of extranodal lymphoma and 0.5% of pancreatic cancers ( 9 ). PPL commonly affects middle-age individuals with a median age of 53 years old and has a male predilection (male:female ratio of 1.5:1) ( 12 ).…”

“…The most common US finding is a bulky homogeneous hypoechoic mass confined to the pancreas, with or without dilatation of bile ducts. Peripancreatic vessels are encompassed by mass, but are always not infiltrated, which can be distinguished from pancreatic adenocarcinoma ( 12 , 156 ). The appearances of EUS are consistent with those of typical US; however, it has a higher sensitivity ( 157 ).…”

“…The MRI characteristics of PPL appear as a bulk lesion with mild enhancement, without significant pancreatic duct dilatation, which has a lower signal intensity on T1WI and a higher signal on T2WI ( Figures 5A, B ) ( 12 , 163 , 164 ). Unlike CT, MRI shows a slightly heterogeneous character of the lesion, especially on T2WI ( 165 ).…”

“…Primary hepatic lymphoma (PHL), primary biliary lymphoma (PBL), and primary pancreatic lymphoma (PPL) are rare and account for 0.4%, 0.4%, and 1% of extranodal non-Hodgkin’s lymphomas, respectively ( 7 – 9 ). PHL and PPL both affect middle-aged people, with a marked male preponderance, whereas PBL often affect elderly individuals, with a sight female preponderance ( 10 – 12 ). Due to their non-specific clinical manifestations and radiological features, PHPBL is always confused with other diseases of the hepatobiliary system and pancreas.…”