Primary pancreatic lymphoma: a rare tumour that mimics pancreatic carcinoma. Clinical case

Abstract

Primary pancreatic lymphomas are extremely rare. Clinically, primary pancreatic lymphomas usually present with symptoms of pancreatic carcinoma. A localized and well‑circumscribed tumour that replaces most of the pancreatic gland and compression of the blood vessels are radiological features of lymphoma, which are similar to pancreatic adenocarcinoma. Many patients are diagnosed with lymphoma after radical resection. It’s a challenging clinical task for physicians, radiologists, and pathologists.
 We report a case of primary pancreatic lymphoma that was confirmed by surgical resection. A 60‑year‑old woman came to the clinic with non‑specific upper abdominal pain that lasted 8 weeks. Computed tomography (CT) scan showed a mass in the body of the pancreas, involving the superior mesenteric artery and the celiac trunk, and regional lymphadenopathy. Endoscopic ultrasound‑guided fine needle aspiration of the pancreatic mass was performed. A morphological pattern indicated ductal carcinoma. The tumour board determined the treatment plan (chemotherapy) for the patient. The patient underwent 3 courses of GEMCAP chemotherapy in our hospital. A follow‑up radiological exam showed no improvement. The chemotherapy regimen was changed to FOLFIRINOX. The patient underwent 6 courses of the FOLFIRINOX regimen.
 A follow‑up magnetic resonance imaging of the pancreas showed tumour regression by more than 90 % in comparison with the previous study. The patient underwent distal pancreatosplenectomy with standard lymph node dissection. Postoperative period was uncomplicated. These pathological results confirm the diagnosis of diffuse B‑cell lymphoma.
 Conclusions. This case shows that lack of tissue can make histological examination of FNA specimens challenging and mistakes can happen due to rare occurrence of primary pancreatic lymphomas.