Abstract
IntroductionPrimary pancreatic lymphoma is a very rare but manageable malignant tumour which may be clinically confused as a pancreatic carcinoma. This case report demonstrates the value of surgical resection in the management of pancreatic lymphoma.Case presentationWe report a case of a 65-year-old man who was admitted with obstructive jaundice, vague upper abdominal pain and weight loss. Ultrasonography and computed tomography showed a mass at the head of the pancreas which was compressing the bile duct. The patient underwent pancreaticoduodenectomy. Histopathologic and immunohistochemical assessment of the pancreatic lesion established the diagnosis of a diffuse, extranodal, high-grade B-cell non-Hodgkin's lymphoma. Several doses of chemotherapy were administered postoperatively and at present the disease remains in remission.ConclusionThe favourable outcome for this patient and a thorough review of the literature underline the important role that operative resection may have in the management of at least the early stage of primary pancreatic lymphoma.
Highlights
Primary pancreatic lymphoma is a very rare but manageable malignant tumour which may be clinically confused as a pancreatic carcinoma
To distinguish primary pancreatic lymphoma (PPL) from secondary involvement of the pancreas by Non-Hodgkin's lymphoma (NHL), Behrns' diagnostic criteria include: a predominant pancreatic mass with gross involvement of only the peripancreatic lymph nodes; no hepatic or splenic involvement; no palpable superficial lymphadenopathy; no enlargement of the mediastinal lymph nodes on chest radiograph; and a normal leukocyte count [3]
To the potential role of surgery in the treatment of pancreatic NHL should be added its well-established place in the management of lymphoma involving other GI organ systems, such as gastric and small bowel lymphomas [7]
Summary
Non-Hodgkin's lymphoma (NHL) most frequently arises from the lymphatic system, with the gastrointestinal (GI) tract representing the most commonly involved extranodal site, accounting for half of such cases. Histologic evaluation of the surgical specimen revealed extensive involvement of the pancreas by a diffuse, extranodal, high grade, large cell, NHL (centroblastic lymphoma). In cases where a patient presents with abdominal pain and a palpable mass without jaundice is the clinical suspicion of pancreatic lymphoma, over adenocarcinoma, enhanced. DLBCL, diffuse large B-cell lymphoma; FLCL, follicular large cell lymphoma; CHOP, cyclophosphamide, doxorubicin, vincristine, prednisolone; PACEBO, prednisolone, hydroxydaunorubicine, cyclophosphamide, etoposide, bleomycin, vincristine; CAMEL, cyclophosphamide, adriamycin, vincristine, prednisone; CVP, cyclophosphamide, vincristine, prednisone; SCT, stem cell transplantation; NED, no evidence of disease; NR, not reported; CR, complete response; PR, partial response http://www.jmedicalcasereports.com/content/2/1/167 atic adenocarcinoma, in which almost 80% of cases have a high CA19-9 level [11]. To the potential role of surgery in the treatment of pancreatic NHL should be added its well-established place in the management of lymphoma involving other GI organ systems, such as gastric and small bowel lymphomas [7]
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