Abstract
Primary pancreatic lymphomas are extremely rare, when present mimics symptoms of adenocarcinoma of the pancreatic head. They account for less than 1% of pancreatic neoplasms [2]. The most common histological subtype is diffuse large B cell lymphoma (DLBCL) [3]. Herein, we present a case of a 47 year old female who presented with symptoms of pain abdomen and weight loss. CT (Computerized Tomography) was suggestive of a lesion in the pancreatic head which on histopathology was diagnosed as a primary non-Hodgkin’s lymphoma confirmed by immunohistochemistry.
Highlights
The gastrointestinal region is the commonest site of extra nodal non-Hodgkin lymphoma (NHL) followed by skin
Diagnostic criteria for Primary Pancreatic Lymphomas (PPLs), as described by Dawson et al Behrns include (a) mass predominantly located in the pancreas with lymph nodes confined to the peri pancreatic region. (b) neither superficial lymphadenopathy nor enlargement of mediastinal lymph nodes on chest radiography (c) a normal leukocyte count in peripheral blood, and (d) no liver or splenic involvement [4]. These days Computerised Tomography (CT) chest abdomen and/or PET-CT are standard baseline imaging tests, with higher sensitivity to pick up occult or small volume disease in the mediastinum and other sites, as illustrated in our case too.CA 19-9, Lactate dehydrogenase (LDH) and beta-2-microglobulin are essential serum markers for the diagnosis and differential diagnosis of PPL and for differentiating from pancreatic adenocarcinoma [4]
Earlier Studies have shown some evidence that an initial surgical resection, when coupled with chemotherapy and radiotherapy, was associated with increased long-term survival of PPL [7], but R-CHOP remains standard for extranodal lymphomas
Summary
The gastrointestinal region is the commonest site of extra nodal NHL followed by skin. Gastrointestinal non-Hodgkin lymphoma commonly involves the stomach and the small bowel. It rarely presents as a pancreatic mass accounting for less than 1% [1, 2]. Initial imaging done elsewhere with Computerised Tomography (CT) of abdomen was suggestive of a 34 x 57 x 66 mm pancreatic head lesion, with loss of fat planes with stomach. PET CT was suggestive of a metabolically active locally advanced primary pancreatic head lesion infiltrating the pyloric antrum with adjacent peripancreatic nodes. After three cycles,an interim PET-CT done suggested a complete metabolic response. She received a total of six cycles and continues to be in remission
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