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Stojanovic MM, Brzacki V, Marjanovic G, Nestorovic M, Zivadinovic J, Krstic M, Gmijovic M, Golubovic I, Jovanovic S, Stojanovic MP, Terzic K. Primary pancreatic lymphoma: A case report and review of literature. World J Clin Oncol 2024; 15:1444-1453. [PMID: 39582610 PMCID: PMC11514422 DOI: 10.5306/wjco.v15.i11.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/21/2024] [Accepted: 09/23/2024] [Indexed: 10/14/2024] Open
Abstract
BACKGROUND Primary pancreatic lymphoma (PPL) is a rare tumor that mimics pancreatic adenocarcinoma, leading to diagnostic and therapeutic challenges. PPL accounts for 0.2% of all pancreatic tumors and is typically treated with chemotherapy. However, the long-term survival rates for PPL with chemotherapy and radiotherapy alone are unsatisfactory. Due to the improvements in pancreatic surgery, there is a need to reevaluate the treatment strategies for PPL. CASE SUMMARY A 62-year-old male presented to our clinic. A biopsy was unsuccessful, and the imaging was suggestive of pancreatic adenocarcinoma. Therefore, subtotal splenopancreatectomy was performed and histopathology was performed. He was then diagnosed with primary pancreatic diffuse large B-cell lymphoma. He received adjuvant chemotherapy and radiotherapy. Currently, the patient is alive with no evidence of disease 36 months after surgery. CONCLUSION The potential role of surgery in the treatment of PPL should be emphasized and added in the management protocol of early stage lymphoma.
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Affiliation(s)
- Marko M Stojanovic
- Department of Gastroenterology and Hepatology Clinic, University Clinical Center Nis, Medical Faculty University of Nis, Nis 18000, Serbia
| | - Vesna Brzacki
- Department of Gastroenterology and Hepatology Clinic, University Clinical Center Nis, Medical Faculty University of Nis, Nis 18000, Serbia
| | - Goran Marjanovic
- Immunology, Medical Faculty University of Nis, Nis 18000, Serbia
| | - Milica Nestorovic
- Clinic for Digestive Surgery, University Clinical Center, Medical Faculty University of Nis, Nis 18000, Serbia
| | - Jelena Zivadinovic
- Clinic of Aneasthesiology and Intensive Therapy, University Clinical Center Nis, University of Nis, Nis 18000, Serbia
| | - Miljan Krstic
- Department of Pathology, Medical Faculty University of Nis, Nis 18000, Serbia
| | - Marko Gmijovic
- Clinic for Digestive Surgery, University Clinical Center, Medical Faculty University of Nis, Nis 18000, Serbia
| | - Ilija Golubovic
- Clinic for Digestive Surgery, University Clinical Center, Medical Faculty University of Nis, Nis 18000, Serbia
| | - Svetlana Jovanovic
- Clinic for Digestive Surgery, University Clinical Center, Medical Faculty University of Nis, Nis 18000, Serbia
| | - Miroslav P Stojanovic
- Clinic for Digestive Surgery, University Clinical Center, Medical Faculty University of Nis, Nis 18000, Serbia
| | - Katarina Terzic
- Clinic for Digestive Surgery, University Clinical Center, Medical Faculty University of Nis, Nis 18000, Serbia
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Hong JH, Kim JW, Yoon EJ, Song SG, Kim HC, Hur YH, Kim HJ. Pictorial Review of Rare Pancreatic Tumors and Tumor-like Lesions: Radiologic-Pathologic Correlation. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1766. [PMID: 39596951 PMCID: PMC11596154 DOI: 10.3390/medicina60111766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/17/2024] [Accepted: 10/24/2024] [Indexed: 11/29/2024]
Abstract
Rare pancreatic tumors and non-neoplastic tumor-like lesions present a diagnostic challenge due to their uncommon occurrence and overlapping imaging characteristics with more prevalent pancreatic neoplasms. Advances in imaging technologies and diagnostic criteria have contributed to increased detection of these rare entities in clinical practice. This pictorial review focuses on the radiologic-pathologic correlation of rare pancreatic tumors, including colloid carcinoma, acinar cell carcinoma, pancreatoblastoma, primary pancreatic lymphoma, and non-neoplastic tumor-like lesions such as hamartomas and inflammatory pseudotumors. Detailed imaging features, such as signal intensities on MRI and enhancement patterns on CT, are correlated with pathological findings to assist in the differential diagnosis. Familiarity with these characteristics is crucial for radiologists to ensure accurate diagnosis and guide appropriate treatment strategies, as management and prognosis significantly differ from common pancreatic neoplasms.
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Affiliation(s)
- Jun Hyung Hong
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju 61453, Republic of Korea; (J.H.H.); (J.W.K.)
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju 61453, Republic of Korea; (J.H.H.); (J.W.K.)
| | - Eun Ju Yoon
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju 61453, Republic of Korea; (J.H.H.); (J.W.K.)
| | - Sang Gook Song
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju 61453, Republic of Korea; (J.H.H.); (J.W.K.)
| | - Hyun Chul Kim
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju 61453, Republic of Korea; (J.H.H.); (J.W.K.)
| | - Young Hoe Hur
- Department of Hepato-Biliary-Pancreas Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Hyung Joong Kim
- Medical Science Research Institute, Kyung Hee University Hospital, Seoul 02447, Republic of Korea
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Nasr D, Joyce J, Kumar V, Khan HM, John S, Chaudhry S. A Rare Case of Primary B-Cell Lymphoma of the Pancreas. J Investig Med High Impact Case Rep 2024; 12:23247096241263536. [PMID: 39044565 PMCID: PMC11268002 DOI: 10.1177/23247096241263536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 07/25/2024] Open
Abstract
Primary pancreatic lymphomas (PPLs) are a subgroup of gastrointestinal (GI) lymphomas. They are an exceedingly rare entity, both in terms of pancreatic malignancies and also extranodal lymphomas. Epidemiological investigations have been challenging to do because of their rarity. This has resulted in a lack of clarity on the clinicopathological characteristics, differential diagnosis, best course of treatment, and prognosis of PPL. Because the clinical signs are frequently non-specific, it can lead to a diagnostic hazard for the unwary physician. Preoperatively, it is imperative to distinguish between adenocarcinoma and PPL, as they present similarly, but have vastly different treatment modalities and prognosis. We herein present a case of an elderly man who presented with obstructive jaundice and was found to have PPL.
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Affiliation(s)
- Dayana Nasr
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - John Joyce
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Vishnu Kumar
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Savio John
- SUNY Upstate Medical University, Syracuse, NY, USA
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4
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Lamrani FZ, Amri F, Koulali H, Mqaddem OE, Zazour A, Bennani A, Ismaili Z, Kharrasse G. Primary pancreatic lymphoma: Report of 4 cases with literature review. Radiol Case Rep 2024; 19:70-77. [PMID: 37920690 PMCID: PMC10618228 DOI: 10.1016/j.radcr.2023.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023] Open
Abstract
Pancreatic cancer (PC) is ranked as the 14th most common cancer and the 7th leading cause of cancer-related deaths. The most common histological type is adenocarcinoma, other type such as primary pancreatic lymphoma (PPL) still very rare. Due to the lack of specific clinical and imaging characteristics, the diagnostic of PPL remains challenging. We report 4 cases of PPL diagnosed and managed at our gastroenterology department between 2019 and 2023. Case 1: A 16-year-old male presented with abdominal pain, jaundice, and weight loss. Imaging revealed an 8 cm tumor in the pancreas, subsequent biopsies confirming Burkitt's lymphoma. Despite chemotherapy, the patient succumbed to the disease. Case 2: A 92-year-old female with no prior medical history presented with abdominal pain, jaundice, pruritus, and weight loss. Imaging revealed a large pancreatic mass, and biopsies identified large B-cell lymphoma. Unfortunately, the patient passed away before treatment initiation. Case 3: A 63-year-old male with a history of tobacco smoking presented with abdominal pain, weight loss, and anorexia. Imaging and biopsies confirmed diffuse large cell B-phenotype lymphoma. The patient achieved complete remission after rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP) therapy. Case 4: A 67-year-old man with jaundice, abdominal pain, and weight loss was diagnosed with diffuse large cell B lymphoma through imaging and fine needle aspiration (FNA). The patient responded well to R-CHOP therapy. In conclusion, PPL is an uncommon tumor, with no specific clinical or radiological characteristics. A thorough evaluation of clinical, radiological, biological and histological data is necessary to consider it as a differential diagnosis and ensure accurate and timely management.
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Affiliation(s)
- Fatima Zahra Lamrani
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Fakhrddine Amri
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Hajar Koulali
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Ouiam El Mqaddem
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Abdelkrim Zazour
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Amal Bennani
- Pathology Department, Mohammed VI University Hospital, Oujda, Morocco
| | - Zahi Ismaili
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
| | - Ghizlane Kharrasse
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morrocco
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Muacevic A, Adler JR, Bhardwaj MP, Patel VV, Ho S. Primary Pancreatic Lymphoma in the Tail: A Rare Anatomic Presentation. Cureus 2022; 14:e31709. [PMID: 36569730 PMCID: PMC9767814 DOI: 10.7759/cureus.31709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Non-Hodgkin's lymphoma is a common type of cancer, whose most common site of extranodal involvement is the gastrointestinal tract. However, primary presentation in the pancreas remains uncommon. Among cases with pancreatic involvement, the disease is often found in the head and rarely in the tail. Here, we present a case of a 56-year-old male patient with acute epigastric pain, early satiety, and abdominal distention. CT imaging showed a mass of the pancreatic tail with surrounding lymphadenopathy, concerning lymphoma. Endoscopic ultrasound-guided fine needle aspiration (EUS-guided FNA) diagnosed mature B-cell lymphoma, meeting novel diagnostic criteria for the rare diagnosis of primary pancreatic lymphoma (PPL).
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Harada Y, Sogame Y, Nakao R, Ogata T, Yasuda H, Sakagami J, Itoh Y, Tanaka H. Autopsy of a Patient with Primary Pancreatic Lymphoma with Findings Resembling Severe Acute Pancreatitis. Intern Med 2022; 62:1507-1512. [PMID: 36198606 DOI: 10.2169/internalmedicine.0757-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Primary pancreatic lymphoma is a rare pancreatic malignancy, reportedly accounting for only 0.2-0.7% of all primary pancreatic tumors. Primary pancreatic lymphoma is often difficult to distinguish from other diseases, such as acute pancreatitis. We herein report the autopsy of a patient with primary pancreatic lymphoma with imaging findings resembling those of severe acute pancreatitis, with a focus on the gross and histological features.
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Affiliation(s)
- Yoshinori Harada
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yoshio Sogame
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Ryuta Nakao
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Takehiro Ogata
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Hiroaki Yasuda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Junichi Sakagami
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Hideo Tanaka
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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Wang Q, Wu K, Zhang X, Liu Y, Sun Z, Wei S, Zhang B. Primary hepatopancreatobiliary lymphoma: Pathogenesis, diagnosis, and management. Front Oncol 2022; 12:951062. [PMID: 36110965 PMCID: PMC9469986 DOI: 10.3389/fonc.2022.951062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Primary hepatopancreatobiliary lymphoma (PHPBL) is extremely rare, which is defined as a lympho-proliferative disease confined to the hepatobiliary system and pancreas without any involvement of lymph nodes, bone marrow, or other organs. The clinical and imaging manifestations of PHPBL are variable and non-special, which are akin to those of tumors of the hepatobiliary and pancreatic systems. The overall prognosis and management of PHPBL differ from those of other tumors in the hepatobiliary system and pancreas. Proper diagnosis and prompt treatment are essential for improving clinical outcomes. Due to its rarity, the optimal treatment has not been issued. However, combination chemotherapy is considered as a standard treatment for them. This review provides an overview of the pathogenesis, diagnosis, pathology, and management of PHPBL and offers clinicians the diagnosis and management schedule for PHPBL.
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Affiliation(s)
- Qianwen Wang
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Kangze Wu
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuzhao Zhang
- Department of Hematology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Liu
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Zhouyi Sun
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Shumei Wei
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Bo Zhang, ; Shumei Wei,
| | - Bo Zhang
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Bo Zhang, ; Shumei Wei,
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8
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Zhu NX, Wang XY, Tong T, Xu JH, Yang YY, Tian L. Primary pancreatic lymphoma diagnosed by endoscopic ultrasound-guided fine needle biopsy. Hepatobiliary Pancreat Dis Int 2022; 21:99-102. [PMID: 34108082 DOI: 10.1016/j.hbpd.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Ning-Xin Zhu
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xiao-Yan Wang
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Ting Tong
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Jia-Hao Xu
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Yuan-Yuan Yang
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Li Tian
- Gastroenterology Department of the Third Xiangya Hospital, Central South University, Changsha 410013, China.
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9
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Facchinelli D, Boninsegna E, Visco C, Tecchio C. Primary Pancreatic Lymphoma: Recommendations for Diagnosis and Management. J Blood Med 2021; 12:257-267. [PMID: 33981170 PMCID: PMC8107008 DOI: 10.2147/jbm.s273095] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Primary pancreatic lymphoma (PPL) is a rare disease representing 0.1% of all malignant lymphomas, which lacks well-defined diagnostic and therapeutic protocols. We conducted a systematic review to analyze demographic, diagnostic and therapeutic features of PPL. METHODS This review identified small series and single case reports. Sources were MEDLINE, PubMed, and the Cochrane library from January 2001 to December 2020. Data were screened, extracted and the risk of bias analyzed by three independent reviewers. RESULTS A total of 107 eligible papers (17 small series, 90 single case reports) describing 266 patients were identified. Patients had a median age of 53.1 (range 3-86) years and were males in 64.6% of cases. Abdominal pain and jaundice were the most common presenting symptoms, affecting 75.3% and 41.8% of patients, respectively. PPL had a median size of 60.6 mm (range 16-200) and it was localized in the pancreatic head in 63.7% of cases. At diagnosis most patients underwent ultrasonography followed by computed tomography. PPL typically showed low echogenicity, and lower contrast enhancement than solid tumors. Histopathological specimens were obtained by percutaneous or endoscopic biopsies in 47.7% of patients; abdominal surgery was performed in 33.5% of cases. Overall, diffuse large B-cell lymphoma was the most frequent histological diagnosis (53.6%). However, patients aged <18 years were affected by Burkitt lymphoma in 52.4% of cases. Most patients (53.6%) received immunochemotherapy (IC) or IC plus radiotherapy (14%). Demolitive surgery appeared to be associated with impaired survival. Central nervous system (CNS) relapse or progression was observed in 20% of patients. CONCLUSION PPL is a rare entity, with some peculiar features at modern imaging. For diagnostic purposes percutaneous or endoscopic biopsies might be preferable, as opposed to surgery. No definite data is available about the optimal treatment, which should be tailored on the histological type and associated with CNS prophylaxis.
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Affiliation(s)
| | - Enrico Boninsegna
- Department of Radiology, Azienda Socio Sanitaria Territoriale, Mantova, Italy
| | - Carlo Visco
- Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Cristina Tecchio
- Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona, Verona, Italy
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10
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Jones H, Qiao J, Padilla O, Orazi A. Primary pancreatic diffuse large B-cell lymphoma, activated B-cell subtype, diagnosed by endoscopic ultrasound-guided fine needle aspiration-A case report and review of the literature. Clin Case Rep 2021; 9:669-672. [PMID: 33598222 PMCID: PMC7869370 DOI: 10.1002/ccr3.3605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022] Open
Abstract
Although primary pancreatic lymphoma is a rare cause of pancreatic mass, this diagnosis should be considered during work-up. Furthermore, when adequate diagnostic material is available from biopsy, complete workup of the lymphoma, including not only type but also subtype when applicable, should be performed.
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Affiliation(s)
- Heather Jones
- Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTXUSA
| | - Jesse Qiao
- Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTXUSA
- Department of PathologyPaul L. Foster School of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTXUSA
- The Hospitals of Providence, Transmountain CampusEl PasoTXUSA
| | - Osvaldo Padilla
- Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTXUSA
- Department of PathologyPaul L. Foster School of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTXUSA
- The Hospitals of Providence, Transmountain CampusEl PasoTXUSA
| | - Attilio Orazi
- Paul L. Foster School of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTXUSA
- Department of PathologyPaul L. Foster School of MedicineTexas Tech University Health Sciences Center El PasoEl PasoTXUSA
- The Hospitals of Providence, Transmountain CampusEl PasoTXUSA
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B P, K I, A A J, S G. Pancreatic Non-Hodgkin Lymphoma, a rare cause for obstructive jaundice. A Case reports. Int J Surg Case Rep 2020; 78:369-371. [PMID: 33401192 PMCID: PMC7787919 DOI: 10.1016/j.ijscr.2020.12.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Primary pancreatic lymphoma (PPL) is an uncommon condition. Clinical features of PPL are nonspecific & likely to be misrecognized as pancreatic malignancy. CASE PRESENTATION 71 years old male patient presented with upper abdominal pain with obstructive jaundice. CLINICAL FINDINGS AND INVESTIGATIONS Examination reveals RHC tenderness and deep icteric. CT shows a large pancreatic head and uncinate process mass. Final diagnosis made with USS guided core biopsy which confirmed B cell, Non-Hodgkin Lymphoma (NHL). INTERVENTION AND OUTCOME Complete remission of PPL occurred following six cycles of chemotherapy with R-CHOP regimen. RELEVANCE AND IMPACT PPL is rare condition, accounts 1% of extra nodal lymphomas and 0.5% of malignant pancreatic neoplasm. Ultrasonography, Endoscopic ultrasonography, CT and MRI are the imaging modalities use to diagnose the pancreatic neoplasm. Biopsy of all pancreatic lesion is crucial which can diagnose curable condition such as PPL. Combined therapy with chemotherapy and radiotherapy without surgery is advisable for PPL.
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Affiliation(s)
- Pragalathan B
- Professorial Surgical Unit, University of Jaffna, Sri Lanka.
| | | | - Jenil A A
- Base Hospital Point Pedro, Sri Lanka.
| | - Gobishangar S
- Professorial Surgical Unit, University of Jaffna, Sri Lanka.
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12
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KANTARCIOĞLU COŞKUN S, ÖZTÜRK NAZLIOĞLU H, BÜYÜKUYSAL MÇ. Clinicopathological Features of Extranodal Lymphomas. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.789919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Xie J, Rinker E, Zaarour M. A Rare, Yet Treatable Pancreatic Tumor: Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921269. [PMID: 32176677 PMCID: PMC7101472 DOI: 10.12659/ajcr.921269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a rare subtype of B-cell neoplasm that can have diverse presentations. When it involves the pancreas (i.e., pancreatic lymphoma), it can mimic metastatic pancreatic adenocarcinoma. Pancreatic lymphoma and adenocarcinoma often have similar clinical, laboratory, and radiographic features making the distinction challenging without pathological tissue examination. The differentiation of these 2 entities is important as the prognosis of pancreatic lymphoma is certainly more favorable with a chance of cure with chemoimmunotherapy. CASE REPORT We present an unusual case of EBV-positive DLBCL involving the pancreas that was initially believed to be metastatic pancreatic adenocarcinoma. The patient was treated with chemoimmunotherapy and had a remarkable response. This is the first known case of EBV-positive DLBCL involving the pancreas that was successfully treated with chemoimmunotherapy. CONCLUSIONS EBV-positive DLBCL can have diverse presentations, including a pancreatic mass with multi-organ involvement, which mimics metastatic pancreatic adenocarcinoma. The prognosis of EBV-positive DLBCL is thought to be worse than that of EBV-negative tumors. However, it remains certainly superior to that of its adenocarcinoma counterpart with conventional chemoimmunotherapy.
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Affiliation(s)
- John Xie
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Elizabeth Rinker
- Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Mazen Zaarour
- Department of Medicine, Division of Hematology and Oncology, Tulane University School of Medicine, New Orleans, LA, USA
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14
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Epidemiology, Tumor Characteristics, and Survival in Patients With Primary Pancreatic Lymphoma: A Large Population-based Study Using the SEER Database. Am J Clin Oncol 2020; 42:454-458. [PMID: 30950860 DOI: 10.1097/coc.0000000000000544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Primary pancreatic lymphoma (PPL) is an extranodal manifestation of non-Hodgkin lymphoma originating in the pancreas, which constitutes <1% of all pancreatic neoplasms. Because of the rarity of the disease, most data on PPL are derived from case reports and small case series. To provide better insight into the epidemiology, treatment, and outcomes of these patients, we conducted an analysis of patients with PPL from the Surveillance, Epidemiology and End Results (SEER) database, which is presented in this study. METHODS Patients with PPL were identified using the International Classification of Disease for Oncology, third edition histology codes for lymphoma (9590/3-9734/3), with pancreas (C25.0-C25.9) listed as the primary disease site. We collected data on patient demographics, year of diagnosis, primary tumor site, histology, first line of treatment received, and survival until death or last follow-up for the period 1973-2014. RESULTS Overall, 835 patients were included. The median (range) age of the study population was 67 (2 to 98) years. The median (95% confidence interval) overall survival for the cohort was 53 (37 to 73) months. On univariable analyses, age, stage, and use of chemotherapy were statistically associated with improved overall survival. Besides these factors, white race was associated with improved cause-specific survival on multivariable analysis. CONCLUSIONS This large population-based series describes PPL in detail. Younger age, white race, early stage, and initial treatment with chemotherapy are associated with improved survival in patients with PPL.
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Dunphy L, Abbas SH, Al Shoek I, Al-Salti W. Primary Pancreatic lymphoma: a rare clinical entity. BMJ Case Rep 2020; 13:13/1/e231292. [PMID: 31907215 DOI: 10.1136/bcr-2019-231292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Primary pancreatic lymphoma is a rare clinical entity representing <0.5% of pancreatic cancers and 1% of extranodal lymphomas. Due to the paucity of cases described in the literature, its clinicopathological features, differential diagnosis, optimal therapy and outcomes are not well defined. As the clinical manifestations are often non-specific, it can create a diagnostic pitfall for the unwary physician. Preoperative distinction of adenocarcinoma and primary pancreatic lymphoma is critical since the management and prognosis of these malignancies are mutually exclusive. Due to its rarity, epidemiological studies have been difficult to conduct. Chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin and vincristine) has proven to be effective. The authors present the case of a 52-year-old man with epigastric pain and obstructive jaundice. Further investigation with a CT of the abdomen and pelvis showed a low attenuation mass in the head of the pancreas measuring 35×25 mm, suspicious for malignancy. The mass involved the common bile duct distally causing moderate retrograde intrahepatic and extrahepatic biliary tree dilation of 14 mm. He underwent endoscopic retrograde cholangiopancreatography, sphincterotomy and insertion of a stent. Core biopsies confirmed the diagnosis of a high-grade B cell pancreas lymphoma. He started treatment with R-CHOP and prednisolone. Due to disease progression, he started treatment with DA-EPOCH-R (etoposide phosphate, prednisone, vincristine sulfate, cyclophosphamide, doxorubicin hydrochloride and rituximab). There was no clinical response, and treatment with RICE (rituximab, ifosfamide, carboplatin and etoposide) was initiated. He showed partial response and was under consideration for chimeric antigen receptor T cell therapy. He deteriorated clinically and succumbed to his disease 5 months following his initial presentation. This paper will provide an overview of the spectrum of haematological malignancies and describe useful features in distinguishing primary lymphoma of the pancreas from an adenocarcinoma, hence avoiding its surgical resection.
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Affiliation(s)
- Louise Dunphy
- Department of Surgery, Wexham Park Hospital, Slough, UK
| | | | | | - Wassim Al-Salti
- Department of Histopathology, Wexham Park Hospital, Slough, UK
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16
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Savari O, Al-Duwal Z, Wang Z, Ganesan S, Danan-Rayes R, Ayub S. Pancreatic lymphoma: A cytologic diagnosis challenge. Diagn Cytopathol 2019; 48:350-355. [PMID: 31774250 DOI: 10.1002/dc.24349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/26/2019] [Accepted: 11/14/2019] [Indexed: 11/07/2022]
Abstract
Very rarely lymphoma primarily or secondarily involves the pancreas. Involvement of the pancreatic parenchyma with lymphoma clinically may mimic pancreatic ductal adenocarcinoma (PDA) and other mass-forming pancreatic lesions. Endoscopic ultrasound fine needle aspiration (EUS-FNA) is the first step in the diagnostic pathway of managing these patients by providing a cytology specimen. Cytologically, lymphoma of pancreas can be misdiagnosed for a wide variety of pancreatic neoplastic and non-neoplastic lesions. Cytological differential diagnosis includes well-differentiated adenocarcinoma, acinar cell carcinoma, well differentiated neuroendocrine tumor, and autoimmune pancreatitis. Gastroenterologist's skills in providing adequate sample for preparing smears, cell blocks and/or performing flow cytometry, and also cytopathologist's skills in detecting atypical lymphocytic population are crucial factors. Although cytology examination has limitations to subclassify lymphoma, it plays a key role to redirect clinicians into the right patient-care pathway. In this article, we present two cases of pancreatic lymphoma with emphasis on the discriminating cytomorphological features, and we also review literatures with reports of primary pancreatic lymphoma (PPL) to better understand the characteristics of this rare lesion.
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Affiliation(s)
- Omid Savari
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Zaynab Al-Duwal
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Zijian Wang
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Santhi Ganesan
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Rania Danan-Rayes
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Salman Ayub
- Department of Pathology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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17
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Karaosmanoglu AD, Uysal A, Onur MR, Hahn PF, Ayhan AS, Ozmen MN, Akata D, Karcaaltincaba M. Primary lymphomas of the intraabdominal solid organs and the gastrointestinal tract: spectrum of imaging findings with histopathological confirmation. Abdom Radiol (NY) 2019; 44:2988-3005. [PMID: 31209544 DOI: 10.1007/s00261-019-02100-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Unlike nodal lymphoma, primary lymphomas of the intraabdominal organs are uncommon neoplasms whose diagnosis may be challenging in certain clinical circumstances. Despite this difficulty for imaging diagnosis, there are several imaging features on ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography that may suggest the correct diagnosis. The scope of this review is to describe and illustrate the imaging features of primary lymphoma of intraabdominal organs providing clues to the diagnosis, together with their pathological correlations.
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18
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Zafar Y, Kaur A, Banno F, Anuj S. Primary Pancreatic Lymphoma: An Uncommon Presentation in the Pancreatic Tail. Cureus 2019; 11:e5479. [PMID: 31667029 PMCID: PMC6816535 DOI: 10.7759/cureus.5479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/25/2019] [Indexed: 12/29/2022] Open
Abstract
Primary pancreatic lymphoma is a rare form of pancreatic cancer that represents a diagnostic and therapeutic challenge due to its rarity and presentation mimicking pancreatic adenocarcinoma. Herein, we report a case of a 57-year-old Caucasian male who presented with left-sided chest pain, epigastric pain, and melena. Abdominal imaging was remarkable for a large, necrotic mass near the tail of the pancreas extending into the splenic hilum and left kidney. Biopsy of the mass confirmed lymphoma of B-cell origin. The patient was diagnosed with Stage IV disease and started on chemotherapy. This case combines an uncommon presentation of lymphoma with a rarely documented primary site in the tail of the pancreas.
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Affiliation(s)
- Yousaf Zafar
- Internal Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, USA
| | - Anahat Kaur
- Internal Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, USA
| | - Fady Banno
- Internal Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, USA
| | - Shrestha Anuj
- Hematology / Oncology, University of Missouri - Kansas City School of Medicine, Kansas City, USA
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19
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Huang Z, Li M, He D, Wei Y, Yu H, Wang Y, Yuan F, Song B. Two-dimensional Texture Analysis Based on CT Images to Differentiate Pancreatic Lymphoma and Pancreatic Adenocarcinoma: A Preliminary Study. Acad Radiol 2019; 26:e189-e195. [PMID: 30193819 DOI: 10.1016/j.acra.2018.07.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/25/2018] [Accepted: 07/25/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To retrospectively assess the diagnostic performance of texture analysis and characteristics of CT images for the discrimination of pancreatic lymphoma (PL) from pancreatic adenocarcinoma (PA). METHODS Fifteen patients with pathologically proved PL were compared with 30 age-matched controls with PA in a 1:2 ratio. Patients underwent a CT scan with three phases including the precontrast phase, the arterial phase, and the portal vein phase. The regions of interest of PA and PL were drawn and analyzed to derive texture parameters with MaZda software. Texture features and CT characteristics were selected for the discrimination of PA and PL by the least absolute shrinkage and selection operator and logistic regression analysis. Receiver operating characteristic analysis was performed to assess the diagnostic performance of texture analysis and characteristics of CT images. RESULTS Sixty texture features were obtained by MaZda. Of these, four texture features were selected by least absolute shrinkage and selection operator. Following this, three texture features and nine CT characteristics were excluded by logistic regression analysis. Finally, "S(5, -5)SumAverg" (texture feature) and "Size" (CT characteristic) were selected for the receiver operating characteristic analysis. The AUC of "S(5, -5)SumAverg" and "Size" were to be 0.704 and 0.821, respectively, with no significance between them (p = 0.3064). CONCLUSION Two-dimensional texture analysis is a quantitative method for differential diagnosis of PL from PA. The diagnostic performance of both texture analysis and CT characteristics was similar.
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Affiliation(s)
- Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China
| | - Mou Li
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China
| | - Du He
- Department of Pathology West China Hospital, Sichuan University, Chengdu, PR China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China
| | - Haopeng Yu
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China
| | - Yi Wang
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China
| | - Fang Yuan
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu 610041, PR China.
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20
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Al-Majed HT, El-Basmi AA, Al-Mohannadi SH, Govindan R, Rajakumari GB. Pancreatic cancer: Incidence, clinical profile, and frequency of associated factors in Kuwait. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2012.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Hana T. Al-Majed
- Department of Applied Medical Sciences, College of Health Sciences, Public Authority of Applied Education and Training (PAAET) , Kuwait
| | - Amani A. El-Basmi
- Kuwait Cancer Control Center (KCCC), Kuwait Kuwait Cancer Control Center (KCCC), Kuwait
| | | | - Rogini Govindan
- Kuwait Cancer Control Center (KCCC), Kuwait Kuwait Cancer Control Center (KCCC), Kuwait
| | - Glory B. Rajakumari
- Kuwait Cancer Control Center (KCCC), Kuwait Kuwait Cancer Control Center (KCCC), Kuwait
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21
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Amine B, Najat L, Ilias T. [Epigastralgia revealing primary pancreatic large B-cell lymphoma in a young patient: about a case]. Pan Afr Med J 2018; 31:161. [PMID: 31065319 PMCID: PMC6488249 DOI: 10.11604/pamj.2018.31.161.16850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/09/2018] [Indexed: 11/30/2022] Open
Abstract
Le lymphome malin non hodgkinien (LMNH) primitif du pancréas est une localisation extrêmement rare des LMNH extraganglionnaires représentant moins de 0,7% de tous les LMNH et moins de 0,5% des tumeurs malignes pancréatiques, touchant essentiellement le sujet âgé et très rarement le sujet jeune (l'intérêt de notre cas). Son diagnostic est difficile simulant cliniquement l'adénocarcinome de pancréas et les pancréatites chroniques. Nous rapportons le cas d'un patient de 25ans, suivi pour lymphome non hodgkinien (LNH) diffus à grandes cellules B de localisation pancréatique primitive révélé par des épigastralgies avec ictère foudroyant d'installation brutale dans un contexte d'altération de l'état général et diagnostiqué sur une biopsie de la loge duodéno-pancréatique. Le diagnostic et la prise en charge précoce de ces tumeurs agressives permettent d'améliorer significativement leur pronostic.
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Affiliation(s)
- Benmoussa Amine
- Service d'Hématologie CHU Mohammed VI Marrakech, Faculté de Médecine et de Pharmacie Cadi Ayyad, Maroc
| | - Lasri Najat
- Service d'Hématologie CHU Mohammed VI Marrakech, Faculté de Médecine et de Pharmacie Cadi Ayyad, Maroc
| | - Tazi Ilias
- Service d'Hématologie CHU Mohammed VI Marrakech, Faculté de Médecine et de Pharmacie Cadi Ayyad, Maroc
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22
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Zhou J, Wu H, Lin J, Wang X, Zhang S, Cramer H, Chen S. Fine needle aspiration evaluation of pancreatic lymphoma: A retrospective study of 25 cases in a single institution. Diagn Cytopathol 2017; 46:131-138. [DOI: 10.1002/dc.23862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/02/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Jiehao Zhou
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Howard Wu
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Jingmei Lin
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Xiaoyan Wang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Shanxiang Zhang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Harvey Cramer
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Shaoxiong Chen
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
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23
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Qiu T, Li W, Geng H, Shi S. Clinicopathological characteristics of primary pancreatic lymphoma: report of two cases. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:10941-10946. [PMID: 31966438 PMCID: PMC6965887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/03/2016] [Indexed: 06/10/2023]
Abstract
Primary pancreatic lymphoma (PPL), originating from the pancreatic parenchyma, is a rare type of lymphoma. The symptoms and radiographic findings of PPL are quite similar to pancreatic adenocarcinoma (PAC), and thus it is often misdiagnosed. In this study, we described the clinical features, radiographic findings, histological and immunohistochemical analysis, molecular detection and clinical treatment of two cases of PPL, aiming to distinguish PPL from PAC. The two cases were both low-grade PPL. One was follicular lymphoma and the other was small lymphocytic lymphoma. Imaging examination of the two cases both showed solid mass, thus highly suspecting of PAC. However, after surgery, PPL was diagnosed by the pathologists through histopathological observation, immunohistochemistry (IHC) assay and clonality analysis. Therefore, accurately diagnosing and classifying of PPL is essential for patient management, since PPL is a treatable malignant tumor.
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24
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Abstract
Hodgkin's lymphoma is a group of malignant lymphoid which involve various organs including gastrointestinal tract. Stomach and small intestine are commonly involved more; however, pancreas can be primarily involved as well. The secondary involvement of pancreas caused by Hodgkin's lymphoma is more prevalent than the primarily involvement (1 .25-2.2% vs. <1%). Primary pancreatic lymphomas (PPLs) consist of 1-2% of all lymphoma outside nods. The symptoms and findings of PPL imaging can be akin to that of pancreas adenocarcinoma and differentiating them is difficult without examining the tissue sample. The prognosis and treatment of PPL are different from those of adenocarcinoma and due to the superior prognosis of PPL compared to pancreas adenocarcinoma, the proper diagnosis of the disease is important.
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Affiliation(s)
- Neda Rad
- Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khafaf
- Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Sadaf S, Loya A, Akhtar N, Yusuf MA. Role of endoscopic ultrasound-guided-fine needle aspiration biopsy in the diagnosis of lymphoma of the pancreas: A clinicopathological study of nine cases. Cytopathology 2017; 28:536-541. [DOI: 10.1111/cyt.12442] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 12/27/2022]
Affiliation(s)
- S. Sadaf
- Fellow Cytopathology; Department of Histopathology; Shaukat Khanum Memorial Cancer Hospital & Research Center Lahore; Lahore Pakistan
| | - A. Loya
- Consultant Pathologist; Department of Pathology; Shaukat Khanum Memorial Cancer Hospital & Research Centre Lahore; Lahore Pakistan
| | - N. Akhtar
- Consultant Pathologist; Department of Pathology; Shaukat Khanum Memorial Cancer Hospital & Research Centre Lahore; Lahore Pakistan
| | - M. A. Yusuf
- Consultant Gastroenterologist; Department of Internal Medicine; Shaukat Khanum Memorial Cancer Hospital & Research Centre Lahore; Lahore Pakistan
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26
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Zheng SM, Zhou DJ, Chen YH, Jiang R, Wang YX, Zhang Y, Xue HL, Wang HQ, Mou D, Zeng WZ. Pancreatic T/histiocyte-rich large B-cell lymphoma: A case report and review of literature. World J Gastroenterol 2017; 23:4467-4472. [PMID: 28706431 PMCID: PMC5487512 DOI: 10.3748/wjg.v23.i24.4467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/26/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
Primary pancreatic lymphoma (PPL) is an extremely rare form of extranodal malignant lymphoma. The most common histological subtype of PPL is diffuse large B cell lymphoma (DLBCL). In rare cases, PPL can also present as follicular lymphoma, small lymphocytic lymphoma, and T cell lymphoma either of non-Hodgkin’s lymphoma or of Hodgkin’s lymphoma. T-cell/histiocyte-rich large B-cell lymphoma (T/HRBCL) is an uncommon morphologic variant of DLBCL with aggressive clinical course, it is predominantly a nodal disease, but extranodal sites such as bone marrow, liver, and spleen can be involved. Pancreatic involvement of T/HRBCL was not presented before. Herein, we report a 48-year-old male who was hospitalized with complaints of jaundice, dark brown urine, pale stools, and nausea. The radiological evaluation revealed a pancreatic head mass and, following operative biopsy, the tumor was diagnosed as T/HRBCL. The patient achieved remission after six cycles of CHOP chemotherapy. Therefore, T/HRBCL can be treated similarly to the stage-matched DLBCL and both of them get equivalent outcomes after chemotherapy.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bile Ducts/diagnostic imaging
- Bile Ducts/surgery
- Biopsy
- Chemotherapy, Adjuvant/methods
- Cholangiopancreatography, Endoscopic Retrograde
- Choledochostomy
- Cyclophosphamide/therapeutic use
- Diagnosis, Differential
- Doxorubicin/therapeutic use
- Gastroenterostomy
- Histiocytes/pathology
- Hodgkin Disease/diagnosis
- Humans
- Jaundice/etiology
- Jaundice/surgery
- Jejunum/surgery
- Liver Function Tests
- Lymph Nodes/pathology
- Lymphatic Metastasis
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Mesentery/pathology
- Middle Aged
- Nausea/etiology
- Nausea/surgery
- Pancreas/diagnostic imaging
- Pancreas/pathology
- Pancreatic Neoplasms/complications
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Pancreatitis/diagnosis
- Prednisone/therapeutic use
- Stomach/surgery
- Tomography, X-Ray Computed
- Vincristine/therapeutic use
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27
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Yu L, Chen Y, Xing L. Primary pancreatic lymphoma: two case reports and a literature review. Onco Targets Ther 2017; 10:1687-1694. [PMID: 28356755 PMCID: PMC5367597 DOI: 10.2147/ott.s121521] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary pancreatic lymphoma (PPL) is an extremely rare disease, with only a few cases reported in the literature. Clinical manifestations of PPL are often nonspecific and may mimic other pancreatic diseases. Because of the limited experience of PPL, clinicopathological features, differential diagnosis, optimal therapy, and outcomes are not well defined. We described two cases diagnosed as PPL and confirmed by histological examination and immunohistochemical analysis. Case 1 was a young man with obstructive jaundice and upper abdominal malaise mimicking a pancreatic adenocarcinoma. A computed tomography (CT) scan revealed a diffuse heterogeneous mass in the head of the pancreas along with dilated bile ducts, no dilated pancreatic duct, no liver or splenic involvement, or evident retroperitoneal adenopathies. The patient underwent a pancreatico-duodenectomy, and the postoperative histopathology confirmed diffuse large B-cell non-Hodgkin lymphoma. Postoperatively, he received six courses of the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisolone). Case 2 was an older man with left flank pain. A CT confirmed a mass with irregular margins at the tail of the pancreas and the hilum of the spleen. The mass was heterogeneous, with no clear boundary between lesions, spleen, stomach, and pancreas, with nearby blood vessels wrapped around it, and multiple enlarged lymph nodes in the abdominal cavity. A CT-guided biopsy was performed. The immunohistological findings of the specimen revealed a diffuse large B-cell lymphoma. The size of the tumor was significantly reduced after four cycles of the CHOP chemotherapy regimen. These two cases were different in clinical manifestation, location, and treatment. We reviewed the literature and discussed the clinicopathological features, differential diagnosis, optimal therapy, and outcomes of this neoplasm.
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Affiliation(s)
- Lili Yu
- School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Yajun Chen
- School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, University of Jinan; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, People's Republic of China
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28
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Rad N, Heidarnezhad A, Soheili S, Mohammad-Alizadeh AH, Nikmanesh A. A Man with Pancreatic Head Mass Lesion on Endoscopic Ultrasound and Granuloma on Cytopathology. Case Rep Gastroenterol 2016; 10:760-768. [PMID: 28100998 PMCID: PMC5216211 DOI: 10.1159/000448875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/29/2016] [Indexed: 01/15/2023] Open
Abstract
Primary pancreatic lymphoma is an unlikely malignancy accounting for less than 0.5% of pancreatic tumors. Clinical presentation is often nonspecific and may be clinically misdiagnosed as pancreatic adenocarcinoma. Here we present an Iranian case of primary pancreatic lymphoma in a 47-year-old male suffering from jaundice and 20% weight loss. Endoscopic ultrasound revealed a mixed echoic mass lesion at the head of pancreas. The patient underwent endoscopic ultrasound-guided fine needle aspiration of solid pancreatic mass and histopathologic diagnosis revealed granuloma. Computed tomography-guided core needle biopsy was performed and eventually histological examination showed granuloma that was coherent with the diagnosis of primary pancreatic lymphoma. Primary pancreatic lymphoma is a rare entity presenting with nonspecific symptoms, laboratory and radiological findings. Computed tomography results in combination with clinical and radiological studies generally provide guidance for appropriate investigation.
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Affiliation(s)
- Neda Rad
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
| | - Arash Heidarnezhad
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
| | - Setareh Soheili
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
| | - Amir Houshang Mohammad-Alizadeh
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
| | - Arash Nikmanesh
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
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29
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Barral M, Faraoun S, Fishman E, Dohan A, Pozzessere C, Berthelin MA, Bazeries P, Barat M, Hoeffel C, Soyer P. Imaging features of rare pancreatic tumors. Diagn Interv Imaging 2016; 97:1259-1273. [DOI: 10.1016/j.diii.2016.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 02/07/2023]
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30
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Abstract
OBJECTIVE This article reviews the computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) CT findings of primary and secondary pancreatic lymphomas and discusses the role of endoscopic ultrasound-guided fine needle aspiration in diagnosis and management. CONCLUSION Pancreatic lymphoma has certain characteristic imaging features which may help distinguish it from the more common pancreatic adenocarcinoma. It is critical to make an accurate diagnosis, as the management of these two conditions is vastly different.
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Affiliation(s)
- Deepa Anand
- Abdominal Imaging, Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler Street, Unit 1473, Houston, TX, 77030-4009, USA.
| | - Chandana Lall
- Abdominal Imaging, Department of Radiology, University of California, Irvine, 101 The City Dr South Suite 0115, Orange, CA, 92868, USA
| | - Priya Bhosale
- Abdominal Imaging, Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler Street, Unit 1473, Houston, TX, 77030-4009, USA
| | - Dhakshinamoorthy Ganeshan
- Abdominal Imaging, Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler Street, Unit 1473, Houston, TX, 77030-4009, USA.
| | - Aliya Qayyum
- Abdominal Imaging, Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler Street, Unit 1473, Houston, TX, 77030-4009, USA
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31
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Eloubeidi MA, Decker GA, Chandrasekhara V, Chathadi KV, Early DS, Evans JA, Fanelli RD, Fisher DA, Foley K, Hwang JH, Jue TL, Lightdale JR, Pasha SF, Saltzman JR, Sharaf R, Shergill AK, Cash BD, DeWitt JM. The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia. Gastrointest Endosc 2016; 83:17-28. [PMID: 26706297 DOI: 10.1016/j.gie.2015.09.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023]
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32
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Fukuba N, Moriyama I, Ishihara S, Sonoyama H, Yamashita N, Tada Y, Oka A, Oshima N, Yuki T, Kawashima K, Kinoshita Y. Primary Pancreatic Malignant Lymphoma Diagnosed from Endoscopic Ultrasound-guided Fine-needle Aspiration Findings. Intern Med 2016; 55:31-35. [PMID: 26726082 DOI: 10.2169/internalmedicine.55.5749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 60-year-old woman was admitted to our hospital with upper abdominal pain and jaundice. Computed tomography showed a 9-cm mass that was penetrated by the common hepatic artery in the pancreatic head area. Endoscopic retrograde pancreatography revealed no stenosis or obstruction of the main pancreatic duct, and a cytologic examination of the patient's pancreatic juice was negative. Next, endoscopic ultrasound-guided fine needle aspiration was performed. The immunohistological findings of the specimen revealed a diffuse large B-cell lymphoma. The size of the tumor was significantly reduced after 8 cycles of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone).
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MESH Headings
- Abdominal Pain/diagnostic imaging
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Endoscopic Ultrasound-Guided Fine Needle Aspiration
- Female
- Humans
- Jaundice/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Pancreatic Ducts/pathology
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/drug therapy
- Pancreatic Neoplasms/pathology
- Prednisone/administration & dosage
- Radiography, Abdominal
- Rituximab
- Tomography, X-Ray Computed
- Treatment Outcome
- Vincristine/administration & dosage
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Affiliation(s)
- Nobuhiko Fukuba
- Department of Internal Medicine II, Shimane University School of Medicine, Japan
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Sellam F, Harir N, Khaled MB, Mrabent NM, Salah R, Benchouk A, Diaf M. Delayed diagnosis of pancreatic cancer reported as more common in a population of North African young adults. J Gastrointest Oncol 2015; 6:505-10. [PMID: 26487944 DOI: 10.3978/j.issn.2078-6891.2015.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pancreatic cancer is one of the most challenging tumor entities worldwide, characterized as a highly aggressive disease with dismal overall prognosis and an incidence rate equaling mortality rate. OBJECTIVE In order to have an update about pancreatic cancer incidence and evolution in North Africa, we conducted an epidemiological analytical retrospective study at the level of three Algerian regions: Sidi-bel-Abbes, Oran and Tlemcen along the last eight years [2006-2013]. METHODS We performed a retrospective hospital-based study in which we analyzed the records of 160 pancreatic cancer patients registered, evaluated and treated in a Northern African region; at the level of hospital centers of the three western Algerian regions from 2006 to 2013. RESULTS Along the period of study, 160 patients were diagnosed with pancreatic cancer; with a mean age of 66.2 years, and a sex ratio of 1.65; other parameters such as a medical history smoking and alcoholism history, tumor site; histological type as well as the stage of diagnosis were also enrolled in the study. Our statistical analyses reported a very significant correlation between patients who belonged to the age group of 21-40 years and the advanced stage of diagnosis (basing on TNM classification) with P=0.02. CONCLUSIONS Pancreatic cancer is increasingly diagnosed in young adults at an advanced stage in North African regions.
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Affiliation(s)
- Feriel Sellam
- 1 Department of Biology, Djillali Liabes University, Sidi bel Abbes, Algeria ; 2 Military Hospital of Oran (HMRUO), Oran, Algeria
| | - Noria Harir
- 1 Department of Biology, Djillali Liabes University, Sidi bel Abbes, Algeria ; 2 Military Hospital of Oran (HMRUO), Oran, Algeria
| | - Méghit B Khaled
- 1 Department of Biology, Djillali Liabes University, Sidi bel Abbes, Algeria ; 2 Military Hospital of Oran (HMRUO), Oran, Algeria
| | - Nesrine M Mrabent
- 1 Department of Biology, Djillali Liabes University, Sidi bel Abbes, Algeria ; 2 Military Hospital of Oran (HMRUO), Oran, Algeria
| | - Rachida Salah
- 1 Department of Biology, Djillali Liabes University, Sidi bel Abbes, Algeria ; 2 Military Hospital of Oran (HMRUO), Oran, Algeria
| | - Arslane Benchouk
- 1 Department of Biology, Djillali Liabes University, Sidi bel Abbes, Algeria ; 2 Military Hospital of Oran (HMRUO), Oran, Algeria
| | - Mustapha Diaf
- 1 Department of Biology, Djillali Liabes University, Sidi bel Abbes, Algeria ; 2 Military Hospital of Oran (HMRUO), Oran, Algeria
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Sandrasegaran K, Tomasian A, Elsayes KM, Nageswaran H, Shaaban A, Shanbhogue A, Menias CO. Hematologic malignancies of the pancreas. ACTA ACUST UNITED AC 2015; 40:411-23. [PMID: 25120155 DOI: 10.1007/s00261-014-0217-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hematologic malignancies are relatively uncommon neoplasms of abdominal soft tissue. This article discusses the clinical and imaging features of pancreatic lymphoma, pancreatic extraosseous multiple myeloma, granulocytic sarcoma (chloroma), posttransplant lymphoproliferative disorder, and Castleman disease. The combination of imaging findings and the appropriate clinical presentation should allow the radiologist to raise a provisional diagnosis of hematologic malignancy.
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Affiliation(s)
- Kumar Sandrasegaran
- Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN, 46202, USA,
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Baysal B, Kayar Y, Ince AT, Arici S, Türkmen I, Şentürk H. Primary pancreatic lymphoma: A rare cause of pancreatic mass. Oncol Lett 2015; 10:1701-1703. [PMID: 26622735 DOI: 10.3892/ol.2015.3412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 06/05/2015] [Indexed: 11/06/2022] Open
Abstract
Primary pancreatic lymphoma (PPL) is a rare entity, most likely to be clinically misdiagnosed as pancreatic cancer. The cure rate of PPL is higher compared with that of pancreatic adenocarcinoma. This is the case report of a 57-year-old male patient who was hospitalized with complaints of abdominal pain, weight loss and jaundice. The radiological evaluation revealed a pancreatic head mass and, following endoscopic ultrasound-guided fine-needle aspiration biopsy, the tumor was diagnosed as diffuse large B-cell lymphoma. The final diagnosis was PPL, and the patient went into remission after receiving three cycles of treatment with rituximab, doxorubicin, cyclophosphamide, vincristine and prednisolone (R-CHOP regimen). Therefore, PPL should be considered in the differential diagnosis of pancreatic masses and its management differs from that of other types of pancreatic tumor.
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Affiliation(s)
- Birol Baysal
- Department of Gastroenterology, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - Yusuf Kayar
- Department of Gastroenterology, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - Ali Tüzün Ince
- Department of Gastroenterology, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - Sema Arici
- Department of Pathology, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - Ihsan Türkmen
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - Hakan Şentürk
- Department of Gastroenterology, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
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36
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Johnson EA, Benson ME, Guda N, Pfau PR, Frick TJ, Gopal DV. Differentiating primary pancreatic lymphoma from adenocarcinoma using endoscopic ultrasound characteristics and flow cytometry: A case-control study. Endosc Ultrasound 2014; 3:221-5. [PMID: 25485269 PMCID: PMC4247529 DOI: 10.4103/2303-9027.144530] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/12/2014] [Indexed: 12/14/2022] Open
Abstract
Background: Primary pancreatic lymphoma (PPL) is a rare pancreatic neoplasm that is difficult to diagnose. PPL has a vastly different prognosis and treatment regimen than other pancreatic tumors; therefore, accurate diagnosis is vital. In this article, we describe the characteristic presentation, endoscopic ultrasound (EUS) features, and the role of fine-needle aspiration (FNA) in the diagnosis of PPL compared with pancreatic adenocarcinoma. Materials and Methods: This was a retrospective case-control study of 11 patients diagnosed with PPL via EUS between 2002 and 2011. The clinical and EUS features of the cases were then compared with age-matched controls with adenocarcinoma in a 1:3 ratio. Results: There were 11 patients with PPL and 33 with adenocarcinoma. At last follow-up, 7 of 11 PPL patients were alive, and 3 of 33-adenocarcinoma patients were alive (P < 0.001). The most common presenting symptoms for PPL were pain 73%, weight loss 45%, and jaundice 18%, while patients with adenocarcinoma presented with pain 52% (P = 0.3), weight loss 30% (P = 0.47) and jaundice 76% (P = 0.001). The EUS appearance was similar in the two groups in that ultrasound imaging of the pancreas lesions tended to be hypoechoic and heterogenous, but the PPL group was more likely to have peripancreatic lymphadenopathy (LAD) (64% vs. 18%, P = 0.008) and were larger (4.8 cm × 5.3 cm vs. 3.2 cm × 3.1 cm, P < 0.001). The PPL group was less likely to have vascular invasion (18% vs. 55%, P = 0.045) and less likely to be found in the head of the pancreas (36% vs. 85%, P = 0.004). FNA and cytology (without flow cytometry [FC]) made the diagnosis in 28% of PPL patients compared with 91% of adenocarcinoma patients (P = 0.002). In the PPL group, 7 of 11 FNA samples were sent for FC. If FC was added, then the diagnosis of PPL was increased to 100%. Conclusions: Compared with adenocarcinoma, pancreatic lymphoma has a better prognosis, is less likely to present with jaundice and less likely to have vascular invasion. PPL is more likely to be located outside the head of the pancreas and to include peripancreatic LAD, and is less likely to be diagnosed with cytology. The diagnostic accuracy of FNA for PPL is improved greatly with the addition of FC.
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Affiliation(s)
- Eric A Johnson
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, USA
| | - Mark E Benson
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, USA
| | - Nalini Guda
- GI Associates - Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Patrick R Pfau
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, USA
| | - Terrence J Frick
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, USA
| | - Deepak V Gopal
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, USA
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Abstract
OBJECTIVES Contrast-enhanced ultrasound (CEUS) has been developed to better characterize the microvasculature of solid masses in several organs, including the pancreas. In this study, we assessed CEUS accuracy in differentiating exocrine from endocrine pancreatic tumors. METHODS A total of 127 patients with single, undetermined pancreatic masses were prospectively examined with transabdominal ultrasound and CEUS, before surgical resection or percutaneous biopsy. RESULTS Exocrine and endocrine pancreatic tumors showed different intralesional vascularization patterns: 98.9% (90/91) of exocrine tumors were hypoenhancing, whereas 95.8 % (23/24) of endocrine tumors had a hypervascular supply. A hypoenhancing pattern, indicative of ductal adenocarcinoma, had a significant (P < 0.001) diagnostic accuracy of 91.3% with a sensitivity of 96.8%, a specificity of 85.3%, a positive predictive value and a negative predictive value of 94.7% and 90.6%, respectively. The hyperenhancing pattern, indicative of endocrine tumors, had a significant (P = 0.031) diagnostic accuracy of 73.8% with a sensitivity of 83.3%, a specificity of 60.0%, a positive predictive value and negative predictive value of 83.3% and 60.0%, respectively. CONCLUSIONS Contrast-enhanced ultrasound has a valuable diagnostic accuracy in differentiating exocrine from endocrine pancreatic tumors, which is a fundamental step to address appropriate histological evaluation, therapeutic approach, and follow-up.
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Fujinaga Y, Lall C, Patel A, Matsushita T, Sanyal R, Kadoya M. MR features of primary and secondary malignant lymphoma of the pancreas: a pictorial review. Insights Imaging 2013; 4:321-9. [PMID: 23512272 PMCID: PMC3675250 DOI: 10.1007/s13244-013-0242-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/14/2013] [Accepted: 02/22/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe the imaging findings of primary and secondary pancreatic malignant lymphoma on magnetic resonance imaging (MRI), to help differentiate lymphoma of the pancreas from primary adenocarcinoma and autoimmune pancreatitis among others, and to discuss a few atypical presentations of pancreatitis mimicking lymphoma. CONCLUSION Knowledge of these imaging manifestations of lymphoma may be helpful to arrive at an accurate diagnosis and avoid unnecessary morbidity and mortality from inadvertent surgery. MAIN MESSAGES • Pancreatic malignant lymphoma is shown as a nodular low-density area with mild enhancement on CT. • It sometimes shows variable manifestations mimicking other tumours and inflammatory conditions. • MRI provides useful information for differentiating malignant lymphoma from other mimickers.
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Affiliation(s)
- Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan,
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Ghobakhlou M, Alizadeh AHM, Naderi N, Haghighi S, Molaei M, Rafiezadeh M, Zali MR. A patient with chronic hepatitis C and a pancreatic mass in endoscopic ultrasound. Case Rep Gastroenterol 2012; 6:387-93. [PMID: 22855657 PMCID: PMC3398077 DOI: 10.1159/000339693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We report a rare case of pancreas tumor (lymphoma) in a patient with a history of chronic hepatitis C virus (HCV) infection without treatment, with a high viral load (20,199,805 IU/ml). He presented with abdominal pain, jaundice, weight loss and sweating. Computed tomography showed a hypodense mass located in the head of the pancreas, and immunohistochemistry of a specimen obtained by endoscopic ultrasound-guided fine needle aspiration revealed non-Hodgkin's lymphoma of the pancreas, B cell type. An association of HCV infection with pancreatic lymphoma has only been reported rarely in the literature and its clinical significance is uncertain.
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Affiliation(s)
| | - Amir Houshang Mohammad Alizadeh
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
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40
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Primary pancreatic lymphoma: a rare cause of massive upper gastrointestinal hemorrhage. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2011; 25:532-3. [PMID: 22059154 DOI: 10.1155/2011/605928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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41
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Serin KR, Güven K, Ozden I, Doğan O, Gök K, Demir C, Emre A. Curative Chemoradiotherapy of Primary Pancreatic Lymphoma with Vertebral Metastasis: Palliation of Persistent Biliary Stricture by Roux-en-Y Hepaticojejunostomy. Case Rep Gastroenterol 2011; 5:642-7. [PMID: 22171216 PMCID: PMC3237111 DOI: 10.1159/000334725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Primary pancreatic lymphoma (PPL) is a rare tumor that usually presents with the clinical picture of advanced adenocarcinoma but has a much better prognosis. A 38-year-old man was referred after percutaneous transhepatic external biliary drainage for obstructive jaundice. Abdominal magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography had revealed a 5-cm pancreatic head mass that caused biliary tract dilation. Computed tomography angiography showed that the mass encased the celiac trunk as well as the common hepatic and splenic arteries. MRI also revealed a metastatic lesion at the third lumbar vertebra. Serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels were within normal range. The initial diagnosis was inoperable pancreatic adenocarcinoma; however, Tru-Cut pancreatic biopsy showed a large B cell lymphoma. After 6 sessions of chemotherapy and 21 sessions of radiotherapy, both the pancreatic mass and the vertebral metastasis had disappeared. However, he had persistent distal common bile duct stricture that could not be negotiated by either the endoscopic or percutaneous route. A Roux-en-Y hepaticojejunostomy was performed. The patient stayed alive without recurrence for 52 months after the initial diagnosis and 45 months after completion of oncologic treatment. In conclusion, a large pancreatic mass with grossly involved peripancreatic lymph nodes, without ascites, liver or splenic metastasis, should alert the clinician to the possibility of PPL. Cure is possible by chemoradiotherapy even in the presence of vertebral metastasis. Persistent stricture in the distal common bile duct may require a biliodigestive anastomosis.
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Affiliation(s)
- Kürşat Rahmi Serin
- Department of General Surgery (Hepatopancreatobiliary Surgery Unit), Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Abstract
OBJECTIVE To investigate the clinical feature and treatment strategy of primary pancreatic lymphoma. METHODS Thirty-nine cases of primary pancreatic lymphoma reported in China were reviewed retrospectively with their clinical characters, treatment, and outcome, as well as a literature review of worldwide reports. RESULTS The major clinical presentations included discomfort or pain in the upper abdomen and jaundice without specificity. Only 2 cases were identified correctly by computed tomography, and 5 cases obtained a positive finding in a biopsy before operation. Thirty-two patients accepted operation; 13 pancreatoduodenectomy and 6 distal pancreatectomy were performed. Thirty-one patients accepted postoperative chemotherapy. Until now, 26 patients are still alive at a range of 3 to 72 months; 5 patients died at 5 to 24 months after operation. Literature review revealed 85 additional cases of pancreatic lymphoma in English reports. Their diagnosis and treatment methods varied. CONCLUSIONS Primary pancreatic lymphoma was misdiagnosed as pancreatic adenocarcinoma frequently. Fine needle aspiration biopsy is the most valuable method in preoperative diagnosis. The cyclophosphamide, doxorubicin, vincristine, and prednisone scheme was still the most commonly used regimen of chemotherapy. The value of surgery and radiotherapy remains controversial; an operation combining chemotherapy seems to be an appropriate method of treatment for a patient in whom malignancy cannot be ruled out.
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43
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Săftoiu A, Iordache SA, Gheonea DI, Popescu C, Maloş A, Gorunescu F, Ciurea T, Iordache A, Popescu GL, Manea CTL. Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos). Gastrointest Endosc 2010; 72:739-47. [PMID: 20674916 DOI: 10.1016/j.gie.2010.02.056] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 02/13/2010] [Indexed: 12/10/2022]
Abstract
BACKGROUND Contrast-enhanced power Doppler (CEPD) and real-time sonoelastography (RTSE) performed during EUS were previously described to be useful for the differential diagnosis between chronic pseudotumoral pancreatitis and pancreatic cancer. OBJECTIVE To prospectively assess the accuracy of the combination of CEPD and RTSE to differentiate pancreatic focal masses. DESIGN Cross-sectional feasibility study. SETTING A tertiary-care academic referral center. PATIENTS The study group included 54 patients with chronic pancreatitis (n = 21) and pancreatic adenocarcinoma (n = 33). INTERVENTIONS Both imaging methods (CEPD and RTSE) were performed sequentially during the same EUS examination. Power Doppler mode examination was performed after intravenous injection of a second-generation contrast agent (2.4 mL of SonoVue), and the data were digitally recorded, comprising both the early arterial phase and venous/late phase. Three 10-second sonoelastographic videos were also digitally recorded that included the focal mass and the surrounding pancreatic parenchyma. Postprocessing analyses based on specially designed software were used to analyze the CEPD and RTSE videos. A power Doppler vascularity index was used to characterize CEPD videos, the values being averaged during a 10-second video in the venous phase. Hue histogram analysis was used to characterize RTSE videos, with the mean hue histogram values being also averaged during a 10-second video. MAIN OUTCOME MEASUREMENTS To differentiate chronic pancreatitis and pancreatic cancer. RESULTS The sensitivity, specificity, and accuracy of combined information provided by CEPD and RTSE to differentiate hypovascular hard masses suggestive of pancreatic carcinoma were 75.8%, 95.2%, and 83.3%, respectively, with a positive predictive value and negative predictive value of 96.2% and 71.4%, respectively. LIMITATION A single-center, average size of study population. CONCLUSIONS A combination of CEPD and RTSE performed during EUS seems to be a promising method that allows characterization and differentiation of focal pancreatic masses.
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Affiliation(s)
- Adrian Săftoiu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.
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Ravi K, Sanchez W, Sweetser S. Primary pancreatic follicular lymphoma mimicking adenocarcinoma. Clin Gastroenterol Hepatol 2010; 8:e101-2. [PMID: 20580941 DOI: 10.1016/j.cgh.2010.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 04/28/2010] [Accepted: 05/08/2010] [Indexed: 02/07/2023]
Affiliation(s)
- Karthik Ravi
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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45
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Abe Y, Tamura K, Sakata I, Ishida J, Mukai M, Ohtaki M, Nakamura M, Machida K. Unique intense uptake demonstrated by (18)F-FDG positron emission tomography/computed tomography in primary pancreatic lymphoma: A case report. Oncol Lett 2010; 1:605-607. [PMID: 22966351 DOI: 10.3892/ol_00000107] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 04/21/2010] [Indexed: 11/06/2022] Open
Abstract
Patients with primary pancreatic lymphoma (PPL), which is rare, require a different therapeutic approach and have a better prognosis than those with pancreatic cancer. However, conventional imaging modalities alone are not able to differentiate between pancreatic cancer and other rare tumors such as PPL, although the accurate diagnosis of PPL is crucial. The development of new modalities such as F-18 2'-deoxy-2fluoro-D-glucose (FDG) positron emission tomography combined with computed tomography (PET/CT) contributes to the evaluation of lymphoma staging. However, few reports are currently available regarding PET/CT findings in PPL. In this study, a 56-year old man with PPL was examined using FDG PET/CT imaging, which showed the unique intense uptake of FDG in the pancreas with atypical findings of malignancy in the CT scan and magnetic resonance images.
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Affiliation(s)
- Yoshiyuki Abe
- Tokorozawa PET Diagnostic Imaging Clinic, Saitama 359-1124
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46
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Kopelman Y, Marmor S, Ashkenazi I, Fireman Z. Value of EUS-FNA cytological preparations compared with cell block sections in the diagnosis of pancreatic solid tumours. Cytopathology 2010; 22:174-8. [PMID: 20482717 DOI: 10.1111/j.1365-2303.2010.00766.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is performed in order to achieve a definite tissue diagnosis of pancreatic lesions. This in turn is a guide to the appropriate treatment for the patient. Tissue samples collected by the same needle for cytological preparations and cell block histological sections (often referred to as FNA-cytology and FNA-biopsy, respectively) are handled differently. The specific contribution of each of these tests was evaluated. METHODS One hundred and two consecutive patients underwent EUS-FNA while being investigated for pancreatic solid lesions. Diagnosis was made by cytology, cell block sections or both. The diagnosis was confirmed by clinical outcome. RESULTS Male/female ratio was 61/41. Mean age was 65±12 years (range, 22-94). Mean lesion size was 3.1±1.8 cm (range, 0.6-10 cm); 68% were >2 cm and 75% were located in the pancreatic head. The average number of needle passes was two (range, 1-4 passes). Final tissue diagnosis was malignant in 66 (65%) patients. Sensitivity, specificity and accuracy were 73%, 94% and 81%, respectively, for cytology alone, and 63%, 100% and 78%, for cell blocks alone. Eighty-two patients (80%) had cytology and cell blocks, which matched in 64 (78%) patients. EUS-FNA results that relied on both techniques had 84% sensitivity, 94% specificity and 88% accuracy. Cytology revealed 13 malignancies not diagnosed on cell blocks, while cell blocks revealed five malignancies not diagnosed by cytology. Malignant lesions were more common in men; they were larger in size and located in the pancreatic head. CONCLUSION EUS-FNA cytology was more sensitive than cell blocks but less specific for the diagnosis of solid pancreatic lesions. The two methods are complementary and implementing both improves the diagnostic value of EUS-FNA.
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Affiliation(s)
- Y Kopelman
- Department of Gastroenterology, Hillel-Yaffe Medical Centre, Hadera, Israel.
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47
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Yoon WJ, Yoon YB, Kim YJ, Ryu JK, Kim YT. Primary pancreatic lymphoma in Korea--a single center experience. J Korean Med Sci 2010; 25:536-40. [PMID: 20357994 PMCID: PMC2844603 DOI: 10.3346/jkms.2010.25.4.536] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 06/16/2009] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to report a single center experience of primary pancreatic lymphoma (PPL) in Korea. We analyzed the clinicopathological data from four PPL patients (three male, median age 36 yr) diagnosed from 1997 to 2007 at Seoul National University Hospital. The diagnoses were: diffuse large B cell lymphoma (n=2), Ki-1 (+) anaplastic large cell lymphoma (n=1), and Burkitt lymphoma (n=1). Presenting symptoms and signs were: abdominal pain (n=4), pancreatitis (n=2), weight loss (n=2) and abdominal mass (n=1). No patient underwent surgery. The Ann Arbor stages of the patients were: IEA (n=1), IIEA (n=1), and IVEB (n=2). Two patients underwent treatment. The stage IEA patient underwent chemotherapy and radiation therapy that resulted in a complete remission. The stage IVEB patient who underwent chemotherapy relapsed. This patient underwent subsequent peripheral blood stem cell transplantation and is alive at 30 months. Two patients (stages IVEB and IIEA) without treatment died at 0.8 and 7.0 months, respectively. For PPL patients, chemotherapy-based treatment, and addition of radiation therapy, if possible, may offer good prognosis.
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Affiliation(s)
- Won Jae Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Bum Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Youn Joo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Kon Ryu
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Tae Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Sugishita H, Watanabe Y, Yamamoto Y, Yoshida M, Sato K, Horiuchi A, Kawachi K. Primary Pancreatic Lymphoma: The Role of Surgical Treatment. Case Rep Gastroenterol 2010; 4:104-110. [PMID: 21103236 PMCID: PMC2988906 DOI: 10.1159/000283405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Primary pancreatic lymphoma (PPL) is a rare disease that is difficult to diagnose preoperatively. We describe the youngest case of PPL treated by surgical excision and chemotherapy. A 16-year-old male presented with abdominal pain and jaundice. Abdominal computed tomography showed a 3.0 × 4.5 cm homogeneously enhanced mass localized between the inferior vena cava and pancreatic head; the common pancreatic duct was dilated and the common bile duct was stenosed. Magnetic resonance imaging findings showed a 4.5 cm tumor localized between the inferior vena cava and pancreatic head with low signal intensity on T1W images and high intensity on T2W images, which enhanced inhomogeneously. Endoscopic retrograde cholangiopancreatography findings were compatible with smooth stenosis of the common bile duct. He was diagnosed as pancreatitis secondary to pancreatic tumor and pylorus-preserving pancreaticoduodenectomy was performed. Postoperative diagnosis was PPL and chemotherapy was performed. After 4 years of treatment he has no signs of recurrence.
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Affiliation(s)
- Hiroki Sugishita
- Department of Organ Regenerative Surgery, Ehime University School of Medicine, Toon, Japan
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Abstract
To determine the variety of chemotherapy drugs administrable for malignant pancreatic neoplasm as a result of typification with endoscopic ultrasonography-fine needle aspiration (EUS-FNA). A retrospective assessment, in one center, over a period of 1 year. Only malignant pancreatic neoplasm diagnosed by EUS-FNA was recorded. Benign (serous cystic neoplasm) and potentially malignant lesions (mucinous cystic neoplasm and intraductal papillary-mucinous neoplasm) were excluded. Medical data were recorded and Oncological Pharmacy records were studied. Ductal adenocarcinoma were detected in 17 patients (N = 17/22), 2 of them with adenocarcinoma in signet ring and 1 with mucinous adenocarcinoma. The primary therapies used were as follows: Whipple pancreaticoduodenectomy (3), biliary stent by endoscopic retrograde cholangiopancreatography (3), radiological transhepatic percutaneous stent (2), intestinal bypass (2), and a gastric stent (1). The adjuvant drugs used were gemcitabine (10), erlotinib (3), and cetuximab (1), and also radiotherapy was used (1). An unresectable squamous cell carcinoma (N = 1) of the tail was detected, and gemcitabine + vinorelbine + fluorouracil + cisplatin used. Nonfunctioning neuroendocrine tumors were seen in 3 (N = 3) cases and long-acting somatostatin analogues were used (1); the remaining 2 patients showed resectable tumors and were resected accordingly. A metastasis to the pancreatic head in a hepatocellular carcinoma was found in 1 patient (N = 1), allowing specific treatment with sorafenib. Histopathologic analysis with EUS-FNA implies a variety of different treatments. Optimal management was achieved as a result of improved diagnosis, with the advent of new molecular genetic diagnostic methods facilitating the design of specific new therapy and neoadjuvant targeting strategies.
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Vida Pérez L, González Galilea A, Fraga Rivas E. [Bleeding from gastric varices as the initial manifestation of primary pancreatic lymphoma]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 33:165-70. [PMID: 19923039 DOI: 10.1016/j.gastrohep.2009.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 09/28/2009] [Accepted: 10/02/2009] [Indexed: 12/16/2022]
Abstract
In patients with pancreatic cancer, the most frequent symptoms are abdominal pain, weight loss and jaundice. Upper gastrointestinal bleeding produced by gastric varices is a rare entity in these patients and requires the presence of splenic vein thrombosis (SVT) to be excluded. We describe the case of a young man who presented to the emergency department with hematemesis. Diagnostic tests revealed primary pancreatic lymphoma (PPL), which provoked splenic vein thrombosis, collateral circulation and the formation of isolated bleeding gastric varices. To date, we have found no reports in the literature of PPL with this form of presentation. Finally, we review the literature, with emphasis on the importance of excluding splenic vein thrombosis in patients with isolated gastric varices, and discuss certain features of the diagnosis and treatment of PPL.
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Affiliation(s)
- Luis Vida Pérez
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España.
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