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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

A 56-year-old man with secondary pancreatic lymphoma. a Fat-suppressed T1-weighted image shows diffuse pancreatic swelling and homogeneously hypointense pancreas. Atrophic pancreatic and residual normal pancreatic parenchyma of the tail are seen. b Pancreatic phase of dynamic contrast-enhanced MR image shows poorly enhanced pancreas head and body. Distal main pancreatic duct dilatation (white arrow) and enhanced normal pancreatic parenchyma are seen. Poorly enhanced right renal lesion (white arrowheads) is also seen
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Fig4: A 56-year-old man with secondary pancreatic lymphoma. a Fat-suppressed T1-weighted image shows diffuse pancreatic swelling and homogeneously hypointense pancreas. Atrophic pancreatic and residual normal pancreatic parenchyma of the tail are seen. b Pancreatic phase of dynamic contrast-enhanced MR image shows poorly enhanced pancreas head and body. Distal main pancreatic duct dilatation (white arrow) and enhanced normal pancreatic parenchyma are seen. Poorly enhanced right renal lesion (white arrowheads) is also seen

Mentions: In the previous studies, 1 of 6 (16.7 %) cases of primary pancreatic lymphoma and 2 of 12 (16.7 %) cases of secondary pancreatic lymphoma were classified into this category [27, 33]. Thus, diffuse pancreatic enlargement with mild MPD dilatation is another presentation of pancreatic lymphoma (Fig. 3). While a distinct nodular mass may not be appreciated, a subtle clue to the diagnosis may simply be upstream MPD dilatation in some cases (Fig. 4). Signal intensity of the pancreas that is involved diffusely with lymphoma is generally diffusely decreased on T1WI and diffusely increased on T2WI. The findings of this type may closely mimic the imaging findings of acute pancreatitis [36, 37]. The key to diagnosis is that peripancreatic inflammation is typically minimal or completely absent without associated fluid collections or extension of inflammation into the retroperitoneal spaces/mesenteric root. When enlarged peripancreatic or retroperitoneal lymph nodes are present, exclusion of acute pancreatitis is much easier.Fig. 3


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)

A 56-year-old man with secondary pancreatic lymphoma. a Fat-suppressed T1-weighted image shows diffuse pancreatic swelling and homogeneously hypointense pancreas. Atrophic pancreatic and residual normal pancreatic parenchyma of the tail are seen. b Pancreatic phase of dynamic contrast-enhanced MR image shows poorly enhanced pancreas head and body. Distal main pancreatic duct dilatation (white arrow) and enhanced normal pancreatic parenchyma are seen. Poorly enhanced right renal lesion (white arrowheads) is also seen
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3675250&req=5

Fig4: A 56-year-old man with secondary pancreatic lymphoma. a Fat-suppressed T1-weighted image shows diffuse pancreatic swelling and homogeneously hypointense pancreas. Atrophic pancreatic and residual normal pancreatic parenchyma of the tail are seen. b Pancreatic phase of dynamic contrast-enhanced MR image shows poorly enhanced pancreas head and body. Distal main pancreatic duct dilatation (white arrow) and enhanced normal pancreatic parenchyma are seen. Poorly enhanced right renal lesion (white arrowheads) is also seen
Mentions: In the previous studies, 1 of 6 (16.7 %) cases of primary pancreatic lymphoma and 2 of 12 (16.7 %) cases of secondary pancreatic lymphoma were classified into this category [27, 33]. Thus, diffuse pancreatic enlargement with mild MPD dilatation is another presentation of pancreatic lymphoma (Fig. 3). While a distinct nodular mass may not be appreciated, a subtle clue to the diagnosis may simply be upstream MPD dilatation in some cases (Fig. 4). Signal intensity of the pancreas that is involved diffusely with lymphoma is generally diffusely decreased on T1WI and diffusely increased on T2WI. The findings of this type may closely mimic the imaging findings of acute pancreatitis [36, 37]. The key to diagnosis is that peripancreatic inflammation is typically minimal or completely absent without associated fluid collections or extension of inflammation into the retroperitoneal spaces/mesenteric root. When enlarged peripancreatic or retroperitoneal lymph nodes are present, exclusion of acute pancreatitis is much easier.Fig. 3

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