S3468 Atypical Presentation of Newly Diagnosed Diffuse Large B Cell Lymphoma

Abstract

Introduction: Acute pancreatitis is caused by inflammation of the pancreas due to the obstruction of pancreatic secretory transport ducts and sequential activation of inflammatory pancreatic enzymes. Both alcohol use and gallstones remain among the leading risks. Pancreatic involvement is frequently report but diffuse large B cell lymphoma presenting as pancreatitis is rare. Case Description/Methods: A 69 y/o male with no PMH presented to the Emergency room complaining of a 3-week history of worsening sharp epigastric pain associated with dysphagia and odynophagia to solid foods. He denied fever, weight loss, night sweats, nausea, vomiting, diarrhea, melena, smoking, alcohol use, recent steroid use, surgery, trauma or autoimmune disease. Physical exam was notable for tenderness in the epigastric region, lower abdomen and hypoactive bowel sounds. Laboratory analysis is appreciated in figure A. Lipid panel was unremarkable and Covid was negative. CT abdomen/pelvis showed peripancreatic inflammatory changes with trace fluid along both anterior parietal fasciae. A 21 x 14 mm right sided distal esophageal mass, and an ill-defined 40 x 26 mm bilobed necrotic mass at the inferior margin of gastric pylorus. Also multiple ill-defined enlarged periportal and retroperitoneal lymph nodes, appreciated mainly in periportal and infrarenal retrocaval lymph nodes. Esophagogastroduodenoscopy was performed with findings of large fungating ulcerating mass that was oozing blood in the cardia, which can be appreciated in figure B. Biopsy revealed diffuse proliferation of lymphoid cells strongly positive for CD 45, CD20, CD79a, BCL 6 which suggested diffuse large B cell lymphoma. CEA, CA 19-9 were within normal limits. Patient was treated with Lactate Ringer's solution on day 1 with resolution of pancreatitis within 1 week. He was discharged and lost to follow up for management of DLBCL. Discussion: Although he had no signs of pancreatic metastasis, he presented with features that fulfill diagnostic criteria for pancreatitis. This case report provided key information into the various possibilities that could initially present with abdominal pain, and why it is essential to keep various diagnoses in mind, even when there is one already established.Due to the proximity and small space of the abdominal compartment, many of these can present with overlapping symptoms. A key takeaway from this review is to follow up with each symptom individually and explore all needed diagnosis tests, in order to rule in or out other possible causes..