Synchronous pancreatic adenocarcinoma and duodenal mucosa‑associated lymphoid tissue lymphoma: A case report

Abstract

Rationale: Duodenal mucosa-associated lymphoid tissue (MALT) lymphoma is a rare condition. Simultaneous presence of pancreatic ductal adenocarcinoma along with duodenal MALT lymphoma has not been documented in the scientific literature. We report an exceptionally rare case of synchronous duodenal MALT lymphoma and pancreatic ductal adenocarcinoma.

Patient concerns: A 75-year-old man was referred to our hospital with dyspepsia and weight loss.

Diagnoses: Esophagogastroduodenoscopy was performed, revealing synchronous tumor comprising pancreatic ductal adenocarcinoma and MALT lymphoma of the duodenum.

Interventions: Given that the pancreatic carcinoma would be the primary determinant of prognosis, we prioritized treatment of the pancreatic carcinoma. Consequently, we performed a Whipple operation first. Post-operative pathologic examination revealed metastasis of pancreatic cancer to peri-pancreatic lymph nodes, whereas the MALT lymphoma was localized to the duodenum; therefore, only adjuvant chemotherapy for pancreatic cancer was performed.

Outcomes: To date, the patient has had no recurrence of either the pancreatic cancer or the MALT lymphoma.

Lessons: To the best of our knowledge, this is the first case to be reported. Awareness of this co-occurrence may help diagnosis and management of similar cases.

Figure 1.

An ill-defined low-density lesion (arrowheads), with a small cystic portion in the pancreatic head, is suggestive pancreatic cancer. This is accompanied by a double-duct sign dilatation of the main pancreatic duct (arrow) and the common bile duct (asterisk), as observed on axial (A) and coronal (B) CT images. CT = computed tomography.

Figure 2.

Esophagogastroduodenoscopy shows a multi-nodular mucosal lesion in the proximal second portion of the duodenum.

Figure 3.

(A) Histological findings from duodenal biopsy specimens. The glandular portion was diagnosed as adenocarcinoma, which was positive for p53 (B) and CK7 (C). The lamina propria was diffusely infiltrated by atypical small lymphoid cells, which were positive for CD20 (D) and BCL2 (E). The Ki67-labeling index was high in the glandular portion and low in the lymphoid cells (F) (magnification, all ×100).

Figure 4.

Gross examination of the surgically resected specimen revealed an ill-defined, grayish-white firm mass located in the head of the pancreas. The second portion of the duodenum, located just above the pancreatic cancer, exhibited multiple nodular lesions in the mucosal layer. The red dashed circle indicates the mass.

Figure 5.

(A) The mass comprised 2 different tumors (magnification, ×10). (B) Diffuse proliferation of small lymphoid cells was observed within the duodenal mucosa adjacent to the pancreatic carcinoma (magnification, ×100). (C) The major component was well-differentiated atypical glands, a finding compatible with a diagnosis of pancreatic ductal adenocarcinoma (magnification, ×100). The borders of each tumor component are marked in red and black, respectively.

Figure 6.

Immunohistochemical staining revealed that the adenocarcinoma component was positive for p53 (A) and CK7 (B). The MALT lymphoma component was diffusely positive for CD20 (C) and BCL2 (D) (magnification, all × 400). MALT = mucosa-associated lymphoid tissue.