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Review
. 2006 May 4:6:117.
doi: 10.1186/1471-2407-6-117.

Primary pancreatic lymphoma--pancreatic tumours that are potentially curable without resection, a retrospective review of four cases

Peter S Grimison  1 , Melvin T Chin, Michelle L Harrison, David Goldstein
Affiliations
Review

Primary pancreatic lymphoma--pancreatic tumours that are potentially curable without resection, a retrospective review of four cases

Peter S Grimison et al. BMC Cancer. .

Abstract

Background: Primary pancreatic lymphomas (PPL) are rare tumours of the pancreas. Symptoms, imaging and tumour markers can mimic pancreatic adenocarcinoma, but they are much more amenable to treatment. Treatment for PPL remains controversial, particularly the role of surgical resection.

Methods: Four cases of primary pancreatic lymphoma were identified at Prince of Wales Hospital, Sydney, Australia. A literature review of cases of PPL reported between 1985 and 2005 was conducted, and outcomes were contrasted.

Results: All four patients presented with upper abdominal symptoms associated with weight loss. One case was diagnosed without surgery. No patients underwent pancreatectomy. All patients were treated with chemotherapy and radiotherapy, and two of four patients received rituximab. One patient died at 32 months. Three patients are disease free at 15, 25 and 64 months, one after successful retreatment. Literature review identified a further 103 patients in 11 case series. Outcomes in our series and other series of chemotherapy and radiotherapy compared favourably to surgical series.

Conclusion: Biopsy of all pancreatic masses is essential, to exclude potentially curable conditions such as PPL, and can be performed without laparotomy. Combined multimodality treatment, utilising chemotherapy and radiotherapy, without surgical resection is advocated but a cooperative prospective study would lead to further improvement in treatment outcomes.

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Figures

Figure 1
Figure 1
Case 1 CT Scan. CT scan of upper abdomen in arterial phase shows low density soft tissue in region of pancreatic head and posterior to body of pancreas, and biliary stent
Figure 2
Figure 2
Case 2 MRI. MRI (magnetic resonance imaging) shows mass arising from head of pancreas, as well as hepatic and renal cysts.
Figure 3
Figure 3
Case 2 Biopsy. Histological section shows large mononuclear cells, consistent with diffuse large B-cell lymphoma (H&E stain, ×200)
Figure 4
Figure 4
Case 2 Biopsy CD20 stain. CD20 positive staining of cells, consistent with B cell origin (×200)
See this image and copyright information in PMC

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