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Case Reports
. 2007 Sep 28;13(36):4909-11.
doi: 10.3748/wjg.v13.i36.4909.

Secondary pancreatic involvement by a diffuse large B-cell lymphoma presenting as acute pancreatitis

M-Wasif Saif  1 , Sapna Khubchandani, Marek Walczak
Affiliations
Case Reports

Secondary pancreatic involvement by a diffuse large B-cell lymphoma presenting as acute pancreatitis

M-Wasif Saif et al. World J Gastroenterol. .

Abstract

Diffuse large B-cell lymphoma is the most common type of non-Hodgkin's lymphoma. More than 50% of patients have some site of extra-nodal involvement at diagnosis, including the gastrointestinal tract and bone marrow. However, a diffuse large B-cell lymphoma presenting as acute pancreatitis is rare. A 57-year-old female presented with abdominal pain and matted lymph nodes in her axilla. She was admitted with a diagnosis of acute pancreatitis. Abdominal computed tomography (CT) scan showed diffusely enlarged pancreas due to infiltrative neoplasm and peripancreatic lymphadenopathy. Biopsy of the axillary mass revealed a large B-cell lymphoma. The patient was classified as stage IV, based on the Ann Arbor Classification, and as having a high-risk lymphoma, based on the International Prognostic Index. She was started on chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone). Within a week after chemotherapy, the patient's abdominal pain resolved. Follow-up CT scan of the abdomen revealed a marked decrease in the size of the pancreas and peripancreatic lymphadenopathy. A literature search revealed only seven cases of primary involvement of the pancreas in B-cell lymphoma presenting as acute pancreatitis. However, only one case of secondary pancreatic involvement by B-cell lymphoma presenting as acute pancreatitis has been published. Our case appears to be the second report of such a manifestation. Both cases responded well to chemotherapy.

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Figures

Figure 1
Figure 1
A: Baseline CT scan (pre-therapy). Abdominal CT scan shows diffusely enlarged pancreas due to infiltrative neoplasm, along with bulky retroperitoneal lymphadenopathy, bulky peripancreatic, mesenteric adenopathy, ascites and peritoneal carcinomatosis; B: Post-therapy CT Scan ( non-enhanced). A follow-up CT scan of the abdomen reveals a marked decrease in size of the pancreas and retroperitoneal lymph nodes.
Figure 2
Figure 2
Biopsy of the axillary mass reveals a diffuse large B-cell lymphoma.
See this image and copyright information in PMC

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