A Rare Case of B-Cell Lymphoma Presenting as a Large Solid Pancreatic Mass: A Case Report

Abstract

The differential diagnosis of a pancreatic mass is categorized into cystic and solid lesions. Cystic pancreatic lesions include non-neoplastic cysts and pancreatic cystic neoplasms. Possible differential diagnoses for a solid pancreatic mass include primary exocrine pancreatic cancer, pancreatic neuroendocrine tumors, metastatic cancer, focal chronic pancreatitis, and autoimmune pancreatitis. We are presenting a rare case of B cell lymphoma presenting as a large solid pancreatic mass. A 62-year-old female with past medical history of type II diabetes and hypertension presented to University Medical Center (UMC) hospital in Las Vegas emergency room with four days of epigastric abdominal pain associated with jaundice. She reported unintentional weight loss, but no fever or night sweats. She had no history of pancreatic disease or malignancies. She denied smoking or alcohol use. Physical exam was significant for scleral icterus and a palpable epigastric mass. Initial liver function panel showed AST 189, ALT 213, ALP 140, total bilirubin 7.4 with direct bilirubin 6.2, Albumin 2.9 g/dl, Lipase 63, Lactate dehydrogenase 1,008 and CEA 12.6. Autoimmune panel was sent including antinuclear antibodies, antimitochondrial antibodies, anti-LKM antibodies, IgA, IgG and IgM levels. All were found to be unremarkable. CT of the abdomen and pelvis with IV contrast showed a 5.5 x 3.7 x 3.0 cm mass in the pancreatic tail encasing the splenic vein with splenic vein thrombosis in addition to enlarged retroperitoneal lymph nodes (figure 1). Gastroenterology was consulted and an endoscopic ultrasound with fine needle aspiration was subsequently performed. Tissue pathology revealed aggressive B cell lymphoma. A consult was made with oncology for further management. Hematologic malignancies can often manifest in extranodal locations. We present a rare case of aggressive B cell lymphoma presenting as a large pancreatic mass. Rare cases of hematologic malignancies presenting as pancreatic masses have been reported in the past. Early diagnosis is of primary importance so as to avoid unnecessary surgical resection. Clues suggesting the possibility of a primary hematologic malignancy include constitutional symptoms (weight loss, fever, and night sweats), an elevated serum lactate dehydrogenase (LDH) or beta-2 microglobulin level and a normal serum carbohydrate antigen 19-9 (CA 19-9).1429.tif Figure 1: 5.5 x 3.7 x 3.0 cm mass in the pancreatic tail encasing the splenic vein with splenic vein thrombosis in addition to enlarged retroperitoneal lymph nodes