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Primary pancreatic lymphoma: Report of three cases with review of literature.

Haji AG, Sharma S, Majeed KA, Vijaykumar DK, Pavithran K, Dinesh M - Indian J Med Paediatr Oncol (2009)

Bottom Line: All the patients presented with vague abdominal pain of duration ranging from 1(1/2) months to 3 months.Two patients had diagnosis confirmed histologically by CT-guided core biopsy or Fine needle aspiration procedure.We were able to avoid unnecessary laparotomy in 2 patients using preoperative guided Fine needle aspiration Cytology, although the third patient did undergo a Whipple's procedure as the diagnosis of PPL was not considered during the initial workup.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Amrita Institute of Medical Sciences and Research Center, Ernakulam, Kerala, India.

ABSTRACT

Background: Primary pancreatic lymphoma (PPL) is an extremely rare neoplasm, which may be confused with pancreatic adenocarcinoma. So far only about 150 cases of PPL have been reported.

Materials and methods: We present our experience of 3 cases of PPL over a 4-year period.

Results: All the patients presented with vague abdominal pain of duration ranging from 1(1/2) months to 3 months. Two patients had diagnosis confirmed histologically by CT-guided core biopsy or Fine needle aspiration procedure. We were able to avoid unnecessary laparotomy in 2 patients using preoperative guided Fine needle aspiration Cytology, although the third patient did undergo a Whipple's procedure as the diagnosis of PPL was not considered during the initial workup.

Conclusions: There is no significant difference noted with regard to patient's age or duration of symptoms between patients with either pancreatic adenocarcinoma or PPL. The differential diagnosis of PPL includes pancreatic adenocarcinoma and secondary involvement of pancreas from extra-nodal lymphoma. Combination of two things is suggestive of Pancreatic lymphoma: (1) Bulky localized tumor in pancreatic head (2) Absence of significant dilatation of main pancreatic duct strengthens a diagnosis of pancreatic lymphoma over adenocarcinoma. Majority of patients can be managed with chemotherapy with much better prognosis compared to patients with pancreatic adenocarcinoma. Larger series of patients are needed to evaluate whether chemotherapy, eventually followed by involved-field radiation therapy, is the treatment of choice for PPL.

No MeSH data available.


Related in: MedlinePlus

Photomicrograph of (a) H and E, ×40 section and (b) immunohistochemistry, ×100 of CD 20 from tumor showing monotonous population of small round cells with scanty cytoplasm, coarse nuclear chromatin and prominent nucleoli in the pancreatic parenchyma
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Figure 0002: Photomicrograph of (a) H and E, ×40 section and (b) immunohistochemistry, ×100 of CD 20 from tumor showing monotonous population of small round cells with scanty cytoplasm, coarse nuclear chromatin and prominent nucleoli in the pancreatic parenchyma

Mentions: Hematoxylin and eosin-stained sections from tumor in all the 3 patients showed monotonous population of small round cells in sheets separated by sparse fibrous septae infiltrating the pancreatic parenchyma [Figure 2]. Neoplastic cells had scanty cytoplasm, coarse nuclear chromatin and prominent nucleoli. On immunohistochemistry, all the tumors were positive for CD 20 and negative for CD 3 and were typed as a diffuse large B cell lymphoma of the pancreas.


Primary pancreatic lymphoma: Report of three cases with review of literature.

Haji AG, Sharma S, Majeed KA, Vijaykumar DK, Pavithran K, Dinesh M - Indian J Med Paediatr Oncol (2009)

Photomicrograph of (a) H and E, ×40 section and (b) immunohistochemistry, ×100 of CD 20 from tumor showing monotonous population of small round cells with scanty cytoplasm, coarse nuclear chromatin and prominent nucleoli in the pancreatic parenchyma
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2902210&req=5

Figure 0002: Photomicrograph of (a) H and E, ×40 section and (b) immunohistochemistry, ×100 of CD 20 from tumor showing monotonous population of small round cells with scanty cytoplasm, coarse nuclear chromatin and prominent nucleoli in the pancreatic parenchyma
Mentions: Hematoxylin and eosin-stained sections from tumor in all the 3 patients showed monotonous population of small round cells in sheets separated by sparse fibrous septae infiltrating the pancreatic parenchyma [Figure 2]. Neoplastic cells had scanty cytoplasm, coarse nuclear chromatin and prominent nucleoli. On immunohistochemistry, all the tumors were positive for CD 20 and negative for CD 3 and were typed as a diffuse large B cell lymphoma of the pancreas.

Bottom Line: All the patients presented with vague abdominal pain of duration ranging from 1(1/2) months to 3 months.Two patients had diagnosis confirmed histologically by CT-guided core biopsy or Fine needle aspiration procedure.We were able to avoid unnecessary laparotomy in 2 patients using preoperative guided Fine needle aspiration Cytology, although the third patient did undergo a Whipple's procedure as the diagnosis of PPL was not considered during the initial workup.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Amrita Institute of Medical Sciences and Research Center, Ernakulam, Kerala, India.

ABSTRACT

Background: Primary pancreatic lymphoma (PPL) is an extremely rare neoplasm, which may be confused with pancreatic adenocarcinoma. So far only about 150 cases of PPL have been reported.

Materials and methods: We present our experience of 3 cases of PPL over a 4-year period.

Results: All the patients presented with vague abdominal pain of duration ranging from 1(1/2) months to 3 months. Two patients had diagnosis confirmed histologically by CT-guided core biopsy or Fine needle aspiration procedure. We were able to avoid unnecessary laparotomy in 2 patients using preoperative guided Fine needle aspiration Cytology, although the third patient did undergo a Whipple's procedure as the diagnosis of PPL was not considered during the initial workup.

Conclusions: There is no significant difference noted with regard to patient's age or duration of symptoms between patients with either pancreatic adenocarcinoma or PPL. The differential diagnosis of PPL includes pancreatic adenocarcinoma and secondary involvement of pancreas from extra-nodal lymphoma. Combination of two things is suggestive of Pancreatic lymphoma: (1) Bulky localized tumor in pancreatic head (2) Absence of significant dilatation of main pancreatic duct strengthens a diagnosis of pancreatic lymphoma over adenocarcinoma. Majority of patients can be managed with chemotherapy with much better prognosis compared to patients with pancreatic adenocarcinoma. Larger series of patients are needed to evaluate whether chemotherapy, eventually followed by involved-field radiation therapy, is the treatment of choice for PPL.

No MeSH data available.


Related in: MedlinePlus