Primary Pancreatic Large B-Cell Lymphoma Presenting as Acute Pancreatitis

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). Clinical and imaging features of PPL may often overlap with pancreatic adenocarcinoma. Therefore, it is very important to obtain a preoperative cytohistology diagnosis of pancreatic tumors to avoid unnecessary surgeries in cases with a diagnosis of PPL. Herein, we report a 71-year-old male who was admitted to our hospital with a diagnosis of acute pancreatitis after he presented with complaints of nausea, vomiting, and epigastric abdominal pain. MRI of the abdomen revealed a pancreatic head mass, and histopathology and immunohistochemical assessment of the pancreatic lesion established the diagnosis of DLBCL. The patient achieved remission after six cycles of rituximab-cyclophosphamide, doxorubicin (hydroxydaunomycin), vincristine (oncovin), prednisolone (R-CHOP) chemotherapy.

Keywords: acute pancreatitis; diffuse large b cell lymphoma; non-hodgkin lymphoma; primary pancreatic lymphoma.

Figure 1. Contrast enhanced axial image through the abdomen shows homogenous confluent mass at the pancreatic head (green arrows), with the duodenum (red arrow), and the surrounding lymphadenopathy (cyan arrows).

Figure 2. Low power magnification of CD20 antibody staining shows a diffuse B-cell population, an abnormal finding.

Figure 3. White arrow points to mitotic figure and immediately at 10:00 adjacent can be seen a neoplastic B-cell.