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MR features of primary and secondary malignant lymphoma of the pancreas: a pictorial review.

Fujinaga Y, Lall C, Patel A, Matsushita T, Sanyal R, Kadoya M - Insights Imaging (2013)

Bottom Line: To describe the imaging findings of primary and secondary pancreatic malignant lymphoma on magnetic resonance imaging (MRI), to help differentiate lymphoma of the pancreas from primary adenocarcinoma and autoimmune pancreatitis among others, and to discuss a few atypical presentations of pancreatitis mimicking lymphoma.Knowledge of these imaging manifestations of lymphoma may be helpful to arrive at an accurate diagnosis and avoid unnecessary morbidity and mortality from inadvertent surgery. • Pancreatic malignant lymphoma is shown as a nodular low-density area with mild enhancement on CT. • It sometimes shows variable manifestations mimicking other tumours and inflammatory conditions. • MRI provides useful information for differentiating malignant lymphoma from other mimickers.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan, fujinaga@shinshu-u.ac.jp.

ABSTRACT

Objective: To describe the imaging findings of primary and secondary pancreatic malignant lymphoma on magnetic resonance imaging (MRI), to help differentiate lymphoma of the pancreas from primary adenocarcinoma and autoimmune pancreatitis among others, and to discuss a few atypical presentations of pancreatitis mimicking lymphoma.

Conclusion: Knowledge of these imaging manifestations of lymphoma may be helpful to arrive at an accurate diagnosis and avoid unnecessary morbidity and mortality from inadvertent surgery.

Main messages: • Pancreatic malignant lymphoma is shown as a nodular low-density area with mild enhancement on CT. • It sometimes shows variable manifestations mimicking other tumours and inflammatory conditions. • MRI provides useful information for differentiating malignant lymphoma from other mimickers.

No MeSH data available.


Related in: MedlinePlus

An 82-year-old woman with primary pancreatic lymphoma, biopsy-proven diffuse large B-cell lymphoma. a Precontrast CT shows ill-defined pancreas head mass (white arrow). b Pancreatic phase dynamic contrast-enhanced CT shows round-shaped and slightly low density mass (white arrow). c Fat-suppressed T2-weighted MR image shows a circumscribed homogeneously hyperintense mass in the pancreatic head (white arrow). d Fat-suppressed T1-weighted MR image shows a hypointense mass in the pancreatic head (white arrow) relative to adjoining normal pancreatic parenchyma. e Pancreatic phase of dynamic contrast-enhanced MR image shows a circumscribed poorly enhanced mass (white arrow) in the pancreatic head with normally enhanced adjacent pancreatic parenchyma. f Haematoxylin-eosin-stained histologic section (original magnification ×200) shows the tumour composed of atypical large lymphoid cells with large nucleus
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Fig1: An 82-year-old woman with primary pancreatic lymphoma, biopsy-proven diffuse large B-cell lymphoma. a Precontrast CT shows ill-defined pancreas head mass (white arrow). b Pancreatic phase dynamic contrast-enhanced CT shows round-shaped and slightly low density mass (white arrow). c Fat-suppressed T2-weighted MR image shows a circumscribed homogeneously hyperintense mass in the pancreatic head (white arrow). d Fat-suppressed T1-weighted MR image shows a hypointense mass in the pancreatic head (white arrow) relative to adjoining normal pancreatic parenchyma. e Pancreatic phase of dynamic contrast-enhanced MR image shows a circumscribed poorly enhanced mass (white arrow) in the pancreatic head with normally enhanced adjacent pancreatic parenchyma. f Haematoxylin-eosin-stained histologic section (original magnification ×200) shows the tumour composed of atypical large lymphoid cells with large nucleus

Mentions: Most of the patients in previous case reports were categorised into this type. In the previous studies comprising a large number of cases, 4 of 6 (66.7 %) cases of primary pancreatic lymphoma and 9 of 12 (75.0 %) cases of secondary pancreatic lymphoma were classified into this type [27, 33]. This type of presentation is the most commonly encountered and is shown as a homogeneous, generally circumscribed, low-signal-intensity area on T1WI, homogeneous or slightly heterogeneous on T2WI, and a distinctly hypovascular area on DCE-MRI compared with surrounding normal parenchyma (Fig. 1). Lymphoma on the whole tends to be better marginated than PAC, with a clearer demarcation of tumour and normal tissue. On rare occasions, the heterogeneous appearance and poor definition on both T1WI and T2WI can lead to misdiagnosis of PAC (Fig. 2) [34, 35]. There are some useful findings to differentiate lymphoma from PAC, as follows: (1) A bulky homogeneous mass without cystic change, necrosis and alteration of MPD; (2) the envelopment of adjacent vessels without evidence of obstruction; (3) the presence of lymphadenopathy below the level of the left renal vein if present is typically in the peripancreatic region [13]. However, CT-guided biopsy or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) may sometimes be needed for accurate diagnosis.Fig. 1


MR features of primary and secondary malignant lymphoma of the pancreas: a pictorial review.

Fujinaga Y, Lall C, Patel A, Matsushita T, Sanyal R, Kadoya M - Insights Imaging (2013)

An 82-year-old woman with primary pancreatic lymphoma, biopsy-proven diffuse large B-cell lymphoma. a Precontrast CT shows ill-defined pancreas head mass (white arrow). b Pancreatic phase dynamic contrast-enhanced CT shows round-shaped and slightly low density mass (white arrow). c Fat-suppressed T2-weighted MR image shows a circumscribed homogeneously hyperintense mass in the pancreatic head (white arrow). d Fat-suppressed T1-weighted MR image shows a hypointense mass in the pancreatic head (white arrow) relative to adjoining normal pancreatic parenchyma. e Pancreatic phase of dynamic contrast-enhanced MR image shows a circumscribed poorly enhanced mass (white arrow) in the pancreatic head with normally enhanced adjacent pancreatic parenchyma. f Haematoxylin-eosin-stained histologic section (original magnification ×200) shows the tumour composed of atypical large lymphoid cells with large nucleus
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3675250&req=5

Fig1: An 82-year-old woman with primary pancreatic lymphoma, biopsy-proven diffuse large B-cell lymphoma. a Precontrast CT shows ill-defined pancreas head mass (white arrow). b Pancreatic phase dynamic contrast-enhanced CT shows round-shaped and slightly low density mass (white arrow). c Fat-suppressed T2-weighted MR image shows a circumscribed homogeneously hyperintense mass in the pancreatic head (white arrow). d Fat-suppressed T1-weighted MR image shows a hypointense mass in the pancreatic head (white arrow) relative to adjoining normal pancreatic parenchyma. e Pancreatic phase of dynamic contrast-enhanced MR image shows a circumscribed poorly enhanced mass (white arrow) in the pancreatic head with normally enhanced adjacent pancreatic parenchyma. f Haematoxylin-eosin-stained histologic section (original magnification ×200) shows the tumour composed of atypical large lymphoid cells with large nucleus
Mentions: Most of the patients in previous case reports were categorised into this type. In the previous studies comprising a large number of cases, 4 of 6 (66.7 %) cases of primary pancreatic lymphoma and 9 of 12 (75.0 %) cases of secondary pancreatic lymphoma were classified into this type [27, 33]. This type of presentation is the most commonly encountered and is shown as a homogeneous, generally circumscribed, low-signal-intensity area on T1WI, homogeneous or slightly heterogeneous on T2WI, and a distinctly hypovascular area on DCE-MRI compared with surrounding normal parenchyma (Fig. 1). Lymphoma on the whole tends to be better marginated than PAC, with a clearer demarcation of tumour and normal tissue. On rare occasions, the heterogeneous appearance and poor definition on both T1WI and T2WI can lead to misdiagnosis of PAC (Fig. 2) [34, 35]. There are some useful findings to differentiate lymphoma from PAC, as follows: (1) A bulky homogeneous mass without cystic change, necrosis and alteration of MPD; (2) the envelopment of adjacent vessels without evidence of obstruction; (3) the presence of lymphadenopathy below the level of the left renal vein if present is typically in the peripancreatic region [13]. However, CT-guided biopsy or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) may sometimes be needed for accurate diagnosis.Fig. 1

Bottom Line: To describe the imaging findings of primary and secondary pancreatic malignant lymphoma on magnetic resonance imaging (MRI), to help differentiate lymphoma of the pancreas from primary adenocarcinoma and autoimmune pancreatitis among others, and to discuss a few atypical presentations of pancreatitis mimicking lymphoma.Knowledge of these imaging manifestations of lymphoma may be helpful to arrive at an accurate diagnosis and avoid unnecessary morbidity and mortality from inadvertent surgery. • Pancreatic malignant lymphoma is shown as a nodular low-density area with mild enhancement on CT. • It sometimes shows variable manifestations mimicking other tumours and inflammatory conditions. • MRI provides useful information for differentiating malignant lymphoma from other mimickers.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan, fujinaga@shinshu-u.ac.jp.

ABSTRACT

Objective: To describe the imaging findings of primary and secondary pancreatic malignant lymphoma on magnetic resonance imaging (MRI), to help differentiate lymphoma of the pancreas from primary adenocarcinoma and autoimmune pancreatitis among others, and to discuss a few atypical presentations of pancreatitis mimicking lymphoma.

Conclusion: Knowledge of these imaging manifestations of lymphoma may be helpful to arrive at an accurate diagnosis and avoid unnecessary morbidity and mortality from inadvertent surgery.

Main messages: • Pancreatic malignant lymphoma is shown as a nodular low-density area with mild enhancement on CT. • It sometimes shows variable manifestations mimicking other tumours and inflammatory conditions. • MRI provides useful information for differentiating malignant lymphoma from other mimickers.

No MeSH data available.


Related in: MedlinePlus