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Follicular lymphoma of the pancreas: a case report and proposed new
strategies for diagnosis and surgery of benign or low-grade malignant
lesions of the head of the pancreas.:
JOP. 2007 Jan
9;8(1):44-9.
CONTEXT: Primary
pancreatic lymphoma is a rare form of extranodal lymphoma originating
in the pancreas. The present report describes a case of follicular
lymphoma of the pancreas with unique CT and MRI findings. CASE REPORT:
A 58-year-old male complained of sudden abdominal pain, and routine
ultrasonography detected an 8 cm hypoechoic tumor in the head of the
pancreas. The 3D image generated using multi-cholangiography and
virtual duodenography provided the information necessary for a
laparotomy. The tumor was enucleated for diagnosis. Follicular
lymphoma is quite rare in the pancreas and gastrointestinal tract. A
considerable number of pancreatic lymphoma subtypes have been
reported. The expression "pancreatic lymphoma" has been used to
describe both primary lymphoid neoplasms originating in the pancreatic
parenchyma and tumors invading from a peri-pancreatic lymphadenopathy.
The present case belongs to the latter, which might explain the unique
imaging findings and histological type. These subtypes display
different imaging findings and different clinical characteristics. In
the future, primary pancreatic lymphoma should be discussed separately
depending on the subtype. CONCLUSION: We propose a new subtype of
primary pancreatic lymphoma. Multi-cholangiography and virtual
duodenography provided the information necessary for a laparotomy in
the present case. Enucleation is indicated for benign and low-grade
malignant tumors of the pancreas, even if the tumor is located in the
head of the pancreas.
Problems in
diagnosing lymphoma of the pancreas with computed tomography. A case
report.
J Gastrointestin Liver Dis. 2007
Mar;16(1):101-3.
Primary
lymphoma of the pancreas is a rare form of extranodal lymphoma
accounting for less than 0.5% of pancreatic tumors. Percutaneous
fine-needle aspiration of the pancreas with histopathological
examination and immunohistochemical assay confirm the diagnosis. A 73
year old male presented with recurrent pancreatic type abdominal pain
with significant weight loss over 1 year. He was pale with ill defined
epigastric mass. Contrast enhanced CT showed an ill defined poorly
marginated non enhancing hypodense mass lesion involving the body of
the pancreas. CA 19-9 was normal. CT guided aspiration cytology was
suggestive of hemolymphoid malignancy. Immunohistochemistry was
positive for Leukocyte Common Antigen and CD 34. It was negative for
CD3 and CD 20 indicating an undifferentiated lymphoma. Patient
received two sessions of chemotherapy and was followed-up.
Primary
pancreatic lymphoma: diagnostic and therapeutic dilemma.
Pancreas.
2006 Aug;33(2):192-4.
OBJECTIVES:
Non-Hodgkin lymphoma predominantly involving the pancreas is a rare
tumor and accounts for less than 0.7% of all pancreatic malignancies
and 1% of extranodal lymphomas. Diagnosis of primary pancreatic
lymphoma can be difficult because it may mimic carcinoma. The
principal aims of this review were to highlight the difficulties
encountered in making a diagnosis and to identify the role of surgery.
METHODS: A PubMed search was conducted using the following terms:
primary pancreatic lymphoma and non-Hodgkin lymphoma of the pancreas.
Additional references were sourced from key articles. RESULTS: A total
of 89 reported cases of pancreatic lymphoma between 1951 and 2005 were
reviewed. An accurate preoperative diagnosis of primary pancreatic
lymphoma is not always possible. A complete response rate of 100% and
a long-term survival rate of 94% have been reported with surgery and
adjuvant chemotherapy when compared with a 5-year survival rate of
less than 50% and an overall 3-year disease-free survival rate of 44%
with current chemotherapy, radiotherapy, or combined methods.
CONCLUSION: Pancreaticoduodenectomy may have a therapeutic role in
association with chemotherapy.
Primary
pancreatic lymphoma: report of six cases.World
J Gastroenterol. 2006 Aug
21;12(31):5064-7.
AIM: To
heighten recognition of primary pancreatic lymphoma (PPL) in clinical
practice. METHODS: A retrospective review of the clinical
presentation, imaging characteristics and pathological features of PPL
patients were presented, as well as their diagnosis and treatment, in
combination with literature review. RESULTS: Histological diagnosis
was made in four patients by surgery and in two patients by EUS-FNA.
The six PPL patients (5 males and 1 female; age range, 16-65 years;
mean age, 46 years) had the duration of symptoms for two weeks to
three months. The primary presenting symptoms, though not
characteristic, were abdominal pain, abdominal masses, weight loss,
jaundice, nausea and vomiting. One of the patients developed acute
pancreatitis. In one patient, the level of serum CA19-9 was 76.3
microg/L. Abdominal CT scan showed that three of the six tumors were
located in the head of pancreas, two in the body and tail, and one
throughout the pancreas. Diameter of the tumors in the pancreas in
four cases was more than 6 cm, with homogeneous density and unclear
borders. Enhanced CT scan showed that only the tumor edges were
slightly enhanced. The pancreatic duct was irregularly narrowed in two
cases whose tumors were located in the pancreatic head and body, in
which endoscopic retrograde cholangiopancreatography (ERCP) showed
that the proximal segment was slightly dilated. Two patients underwent
Whipple operation, one patient underwent pancreatectomy, and another
patient underwent operative biliary decompression. PPL was in stage I
E in 2 patients and in stage II E in 4 patients according to the Ann
Arbor classification system. The diagnosis of B-cell non-Hodgkin's
lymphoma was made in all patients histopathologically. All six
patients underwent systemic chemotherapy, one of whom was also treated
with gamma radiometry. One patient died two weeks after diagnosis, two
patients lost follow-up, two patients who received chemotherapy
survived 49 and 37 mo, and the remaining patient is still alive 21 mo,
after diagnosis and treatment. CONCLUSION: PPL is a rare form of
extranodal lymphoma originating from the pancreatic parenchyma.
Clinical and imaging findings are otherwise not specific in the
differentiation of pancreatic lymphoma and pancreatic cancer, which
deserves attention. EUS-guided fine-needle aspiration (EUS-FNA) of the
pancreas requires experienced cytopathologists as well as advanced
immunohistochemical assays to obtain a final diagnosis on a small
amount of tissue. Surgery and adjuvant chemotherapy or radiotherapy
can produce fairly good outcomes.
A case of
primary pancreatic non-Hodgkin's lymphoma.
Korean J Intern Med. 2006
Jun;21(2):123-6.
Primary
pancreatic lymphoma is rare, comprising 0.2-4.9% of all pancreatic
malignancies and less than 1% of cases of non-Hodgkin's lymphoma. Many
patients are diagnosed with lymphoma after radical resection. We
report a rare presentation of diffuse large B cell lymphoma, appearing
as a primary tumor of the pancreas. A 61-year old female was admitted
to the hospital with the complaint of right upper abdominal pain.
Computed tomography of the abdomen showed a well defined mass located
at the head of the pancreas. A frozen section of pancreas, during
laparotomy, revealed lymphoma. The patient received 6 cycles of
chemotherapy and is currently in complete remission. This case
underscores the importance of differentiating primary lymphoma from
the more common adenocarcinoma of the pancreas as treatment and
prognosis differ significantly. Primary pancreatic lymphoma should be
considered in the differential diagnosis of pancreatic tumors and an
attempt to obtain a tissue diagnosis is always necessary before
proceeding to radical surgery, especially on young patients.
Pancreatic
primary lymphoma: a case report and review of the literature.
Hepatobiliary Pancreat Dis Int.
2005 Nov;4(4):622-6.
BACKGROUND:
Primary pancreatic lymphoma is a rare but treatable malignancy (less
than 1% of pancreatic tumors) that may be clinically confused with
pancreatic adenocarcinoma. METHODS: In a patient with upper abdominal
pain, ultrasonography and CT detected a mass in pancreatic head, which
compressed the common bile duct. The patient received a Whipple's
operation and intraoperative frozen sections of the mass showed an
anaplastic carcinoma. Immunohistochemical staining was used to
indicate the origin and prognosis of tumor. RESULTS: Grossly the tumor
involved the pancreatic head, soft in consistence and invaded part of
the gastric wall. Histologically, the tumor was composed mainly of
large and moderate neoplastic cells, which were diffusely positive for
CD20 and Bcl-6 antigens, indicating the features of diffusely large B
cell lymphoma. CONCLUSIONS: The proper diagnosis of the tumor should
be made with CD20 and Bcl-6 immunohistochemical study. Radical surgery
is indicated for resectable carcinoma but not for a chemosensitive
lymphoma.
Anaplastic
large cell lymphoma of the pancreas: a pediatric case and literature
review.J
Pediatr Hematol Oncol. 2004
Dec;26(12):840-2.
A 13-year-old
boy presented with acute abdominal pain and later became jaundiced.
Medical imaging subsequently demonstrated a 7 x 8 cm pancreatic mass.
Examination of a biopsy specimen obtained by open laparotomy revealed
malignant lymphoma. Histology, immunohistochemistry, and cytogenetics
confirmed the diagnosis of ALK1-positive anaplastic large cell
lymphoma. He was treated with multiagent chemotherapy and remains in
complete remission 12 months off treatment. This is the first case of
primary pancreatic ALK1-positive anaplastic large cell lymphoma
described in a child and shows that aggressive surgical resection of
pancreatic tumors is not always necessary to achieve a cure.
Pitfalls in
diagnosis of non-Hodgkin-lymphoma of the pancreas.Ultraschall
Med. 2002 Dec;23(6):407-10.
A 74
year-old woman was admitted because of upper abdominal pain radiating
to the back. The patient was in good health prior to onset of
symptoms. Both ultrasound and endoscopic ultrasound revealed a lesion
of low echogenicity in the pancreatic head without indication of
hepatic lesions, enlarged lymph nodes or vascular infiltration. An
computed tomography (CT) did not show the lesion in the pancreas.
Explorative laparotomy was performed. The biopsy specimen revealed a
diffuse large cell Non-Hodgkin-Lymphoma. This case report illustrates,
how simple ultrasound studies can detect lesions not seen in more
expensive, complex, and time consuming imaging techniques like CT. The
patient underwent a postoperative chemotherapy and is currently well.
Primary
pancreatic lymphoma.
Surg Endosc. 2002 Jul;16(7):1107-8.
Primary
pancreatic lymphoma (PPL) is a rare form of extranodal lymphoma (less
than 0.5% of pancreatic tumors) originating from the pancreatic
parenchyma. Histopathological examination is usually mandatory to
obtain a definitive diagnosis since symptoms and radiological features
are quite similar to those of other pancreatic masses. Percutaneous
fine-needle aspiration (FNA) of the pancreas requires experienced
cytopathologists as well as advanced immunohistochemical assays to
obtain a final diagnosis on a small amount of tissue. A 46-year-old
man complaining of watery diarrhea and severe weight loss (more than
20 kg) for more than 1 year was admitted to our hospital due to severe
diabetic crisis. Enlarged lymph nodes (2.5 x 1 cm) were found at the
right axillary stations. Abdominal ultrasound revealed the presence of
a large hyperechogenic mass, mainly located at the pancreatic head.
Abdominal computed tomography scan confirmed a diffuse enlargement of
the head and body of the pancreas associated with lymphadenopathy
along the lesser gastric curvature. Percutaneous ultrasound-guided FNA
of the pancreas as well as gross biopsy of the axillary lymph nodes
were unable to identify the nature of the mass. Diagnostic laparoscopy
was performed: several enlarged lymph nodes along the lesser gastric
curvature were revealed. Multiple biopsies of the pancreatic head were
taken and lymphadenectomy along the lesser curvature and the hepatic
hilus was also performed. The definitive histopathological examination
of the pancreatic specimen revealed a primary low-grade non-Hodgkin B
cell pancreatic lymphoma. The postoperative course was unremarkable;
the patient underwent systemic chemotherapy regime for low-grade B
cell Hodgkin lymphoma and he was symptom free at 9-month follow-up.
Pancreatic
involvement by non-Hodgkin's lymphoma.J
Hepatobiliary Pancreat Surg.
2000;7(6):610-3.
A case of
pancreatic involvement by non-Hodgkin's lymphoma is presented. The
patient, a 63-year-old man had a large tumor in the head of the
pancreas, without obstructive jaundice. Invasion of the tumor into the
duodenum and transverse colon induced progressive anemia and ileus.
Therefore, pancreatoduodenectomy and right hemicolectomy were
performed, although a definitive preoperative diagnosis was not
obtained. This tumor was identified, by histopathology and
immunohistochemistry, as diffuse mixed type lymphoma with a B-cell
phenotype. Postoperatively, the patient had severe congestive heart
failure, and he died without receiving chemotherapy. It is important
to establish a definitive diagnosis for this disease, to remove the
tumor, and to treat the patient with appropriate chemotherapy.
Primary
pancreatic lymphoma: a case report, literature review, and proposal
for nomenclature.
Med Oncol. 2000 Aug;17(3):237-47.
Primary
neoplasms of the pancreas are most often adenocarcinoma. Non-Hodgkin's
lymphoma (NHL) involving the pancreas is less common but well
documented; the pancreas as the primary site of NHL is rare. The
majority of patients with pancreatic cancer, whether it is
adenocarcinoma or lymphoma, present with a mass in the head of the
gland. Pancreatic lymphoma is often described as a large homogeneous
mass with extra-pancreatic extension, with or without associated
lymphadenopathy. Less common presentations are masses in the body or
tail, or more rarely diffuse involvement of the pancreas. We present a
case of diffuse pancreatic lymphoma with extra-pancreatic
dissemination to the spleen and lymph nodes, and review the literature
on pancreatic lymphoma. Because the definition of pancreatic lymphoma
and primary pancreatic lymphoma varies, we also propose a nomenclature
system to make future studies of pancreatic lymphoma more comparable.
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