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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 77-year-old woman with multifocal pancreatic lymphoma. a Axial fat-suppressed T2-weighted image shows multiple heterogeneously hyperintense masses in the pancreas head, body and tail (white arrowheads). b Axial fat-suppressed T1-weighted image shows multiple heterogeneous hypointense masses in the pancreas head, body and tail (white arrowheads)
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Fig7: A 77-year-old woman with multifocal pancreatic lymphoma. a Axial fat-suppressed T2-weighted image shows multiple heterogeneously hyperintense masses in the pancreas head, body and tail (white arrowheads). b Axial fat-suppressed T1-weighted image shows multiple heterogeneous hypointense masses in the pancreas head, body and tail (white arrowheads)

Mentions: Multi-nodular type was seen in 2 of 8 (25 %) patients with primary and secondary pancreatic lymphoma and 1 of 12 (8.3 %) with secondary pancreatic lymphoma [27, 28]. Multiple nodular lesions in the pancreas are seen in this type and every nodular lesion appears quite discrete with similar findings as seen with the well-circumscribed tumoral type (Fig. 7). This type can at times mimic the diffuse type if there are confluent or aggregated tumours. MPD dilatation however is not typical. Differential diagnosis is multiple metastases from hypovascular tumours, such as gallbladder, lung and ovarian cancer [40], and multifocal involvement with AIP (Fig. 8) [41]. Necrosis and cystic change are more likely to be seen in the metastases of epithelial primary tumours. On the other hand, a hypointense/isointense lesion including speckled/dotted hyperintense areas on FST1WI (speckled hyperintensity), and hypointense/isointense areas including speckled/dotted enhanced areas on DCE-MRI (speckled enhancement) are useful findings to diagnose focal AIP [30]. Biopsy is sometimes necessary for accurate diagnosis when there is no typical clinical and radiologic finding.Fig. 7


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 77-year-old woman with multifocal pancreatic lymphoma. a Axial fat-suppressed T2-weighted image shows multiple heterogeneously hyperintense masses in the pancreas head, body and tail (white arrowheads). b Axial fat-suppressed T1-weighted image shows multiple heterogeneous hypointense masses in the pancreas head, body and tail (white arrowheads)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig7: A 77-year-old woman with multifocal pancreatic lymphoma. a Axial fat-suppressed T2-weighted image shows multiple heterogeneously hyperintense masses in the pancreas head, body and tail (white arrowheads). b Axial fat-suppressed T1-weighted image shows multiple heterogeneous hypointense masses in the pancreas head, body and tail (white arrowheads)
Mentions: Multi-nodular type was seen in 2 of 8 (25 %) patients with primary and secondary pancreatic lymphoma and 1 of 12 (8.3 %) with secondary pancreatic lymphoma [27, 28]. Multiple nodular lesions in the pancreas are seen in this type and every nodular lesion appears quite discrete with similar findings as seen with the well-circumscribed tumoral type (Fig. 7). This type can at times mimic the diffuse type if there are confluent or aggregated tumours. MPD dilatation however is not typical. Differential diagnosis is multiple metastases from hypovascular tumours, such as gallbladder, lung and ovarian cancer [40], and multifocal involvement with AIP (Fig. 8) [41]. Necrosis and cystic change are more likely to be seen in the metastases of epithelial primary tumours. On the other hand, a hypointense/isointense lesion including speckled/dotted hyperintense areas on FST1WI (speckled hyperintensity), and hypointense/isointense areas including speckled/dotted enhanced areas on DCE-MRI (speckled enhancement) are useful findings to diagnose focal AIP [30]. Biopsy is sometimes necessary for accurate diagnosis when there is no typical clinical and radiologic finding.Fig. 7

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