A 63‐year‐old white woman presented with a 3‐week history of painless jaundice, pruritus, and weight loss. She was a former smoker with a family history of colon cancer. The exam was unremarkable, except for generalized jaundice. Laboratory tests: AST 147, ALT 275, alkaline phosphatase 555, total bilirubin 16.6, albumin 3.5, LDH 299, lipase 564, CA 19‐9 287; CBC and basic metabolic panel were normal. Abdominal CT scan showed prominent biliary and pancreatic duct dilatation with a 4 × 4.5 cm hypodense mass, consistent with neoplasm, in the head of the pancreas. Also present was a 1.9‐cm retroperitoneal adenopathy. Chest CT revealed numerous lung nodules. CT‐guided fine‐needle biopsy of the lung nodule revealed large B‐cell lymphoma. Biopsy of the pancreatic mass confirmed non‐Hodgkin lymphoma (NHL) of the diffuse large B‐cell type. The patient underwent successful ERCP with biliary stents, and chemotherapy was started. After completing 6 cycles of R‐CHOP, she is currently in remission 8 months after diagnosis.
Primary pancreatic lymphoma is an infrequent entity, accounting for <1% of extranodal NHL and <0.5% of pancreatic tumors. Clinical and imaging presentation can mimic that of pancreatic carcinoma, although lymphomas tend to be larger in size and have homogenous enhancement with IV contrast on CT imaging, which can help to distinguish them from pancreatic cancer. Lymphomas have a better prognosis, and therapy is certainly different from that of carcinoma, so that establishing the correct histological diagnosis is of utmost importance. Fine‐needle aspiration is a useful tool in the diagnosis of a variety of pathological disorders at different anatomical sites, obviating the need for surgery in selected patients, such as the patient described here. Most patients with primary pancreatic lymphoma are treated with chemotherapy or a combination of chemo‐ and radiation therapy, with good clinical response. As illustrated by the current case, a pancreatic mass represents a diagnostic and therapeutic challenge that requires prompt intervention from a combination of medical and surgical consultants under the guidance of the hospitalist physician in order to expedite the diagnostic workup and start appropriate treatment.
Pancreatic lymphoma, although a rare entity, should be considered in the differential diagnosis of a pancreatic mass. It is important to establish the pathological diagnosis, as its treatment and outcome are distinctly different from those of pancreatic carcinoma.
J. Gallegos‐Orozco, none; T. Henges, none; M. Zarca, none; J. Charles, none.