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Case Reports
. 2016 Dec 13;10(3):760-768.
doi: 10.1159/000448875. eCollection 2016 Sep-Dec.

A Man with Pancreatic Head Mass Lesion on Endoscopic Ultrasound and Granuloma on Cytopathology

Neda Rad  1 , Arash Heidarnezhad  1 , Setareh Soheili  1 , Amir Houshang Mohammad-Alizadeh  1 , Arash Nikmanesh  1
Affiliations
Case Reports

A Man with Pancreatic Head Mass Lesion on Endoscopic Ultrasound and Granuloma on Cytopathology

Neda Rad et al. Case Rep Gastroenterol. .

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.

Keywords: Computed tomography-guided core needle biopsy; Endoscopic ultrasound; Endoscopic ultrasound-guided fine needle aspiration; Primary pancreatic lymphoma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
EUS-FNA from pancreatic head mass lesion by 22-gauge needle: dilated common bile duct (CBD).
Fig. 2
Fig. 2
EUS-FNA from pancreatic head mass lesion by 22-gauge needle.
Fig. 3
Fig. 3
a Histocytic aggregation consistent with granulomatous reaction (hematoxylin-eosin stain). b CD68-positive histocytes detected by immunohistochemistry method. Histopathological examination. c, d Low-grade B-cell lymphoma (hematoxylin-eosin stain; original magnification, ×200). e, f CD20-BCL2-CD10-CD43-CD3-positive atypical lymphocytic cells (immunohistochemistry; magnification, ×25).
Fig. 4
Fig. 4
CT-guided biopsy of pancreatic mass.
Fig. 5
Fig. 5
Cannulation was impossible, so needle knife fistulotomy was done.
Fig. 6
Fig. 6
Cannulation was performed through accessory path.
Fig. 7
Fig. 7
One biliary plastic stent (7 cm, 10 Fr) was inserted inside the common bile duct.
See this image and copyright information in PMC

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