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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, biopsy-proven follicular lymphoma. a Axial fat-suppressed T2-weighted image shows invasively spreading hyperintense retropancreatic mass (white arrowheads) and heterogeneously hyperintense pancreas (white arrow). b Axial fat-suppressed T1-weighted image shows hypointense retropancreatic mass (white arrowheads) pushes pancreatic parenchyma anteriorly. Involved pancreatic parenchyma is seen as a heterogeneously hypointense area (white arrow). c Haematoxylin-eosin-stained histologic section (original magnification, ×200) shows the tumour with atypical large lymphoid cells aggregated focally (white small arrows). The tumour cells are stained positive for CD10 antigen and bcl2 gene by immunohistochemical analysis (not shown)
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Fig9: A 56-year-old man with secondary pancreatic lymphoma, biopsy-proven follicular lymphoma. a Axial fat-suppressed T2-weighted image shows invasively spreading hyperintense retropancreatic mass (white arrowheads) and heterogeneously hyperintense pancreas (white arrow). b Axial fat-suppressed T1-weighted image shows hypointense retropancreatic mass (white arrowheads) pushes pancreatic parenchyma anteriorly. Involved pancreatic parenchyma is seen as a heterogeneously hypointense area (white arrow). c Haematoxylin-eosin-stained histologic section (original magnification, ×200) shows the tumour with atypical large lymphoid cells aggregated focally (white small arrows). The tumour cells are stained positive for CD10 antigen and bcl2 gene by immunohistochemical analysis (not shown)

Mentions: Malignant lymphoma usually appears as a well-circumscribed bulky mass, but can rarely present as invasive tumour [42]. In this situation, an extra-pancreatic lymphoma may directly extend or infiltrate into the adjacent pancreatic parenchyma, and the pancreatic lesion is recognised as a secondary malignant lymphoma. The signal of pancreatic parenchyma is focally and heterogeneously decreased on FST1WI and increased on T2WI (Fig. 9). Under these circumstances, detecting the primary location may become challenging; however, it is noted that invasion of the pancreas is fairly common with contiguous duodenal and other retroperitoneal lymphomas. Associated lymphadenopathy elsewhere in the abdomen is also fairly usual. CT-guided biopsy is recommended for retroperitoneal lesions for accurate and quick diagnosis if primary lesions are not found.Fig. 9


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, biopsy-proven follicular lymphoma. a Axial fat-suppressed T2-weighted image shows invasively spreading hyperintense retropancreatic mass (white arrowheads) and heterogeneously hyperintense pancreas (white arrow). b Axial fat-suppressed T1-weighted image shows hypointense retropancreatic mass (white arrowheads) pushes pancreatic parenchyma anteriorly. Involved pancreatic parenchyma is seen as a heterogeneously hypointense area (white arrow). c Haematoxylin-eosin-stained histologic section (original magnification, ×200) shows the tumour with atypical large lymphoid cells aggregated focally (white small arrows). The tumour cells are stained positive for CD10 antigen and bcl2 gene by immunohistochemical analysis (not shown)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig9: A 56-year-old man with secondary pancreatic lymphoma, biopsy-proven follicular lymphoma. a Axial fat-suppressed T2-weighted image shows invasively spreading hyperintense retropancreatic mass (white arrowheads) and heterogeneously hyperintense pancreas (white arrow). b Axial fat-suppressed T1-weighted image shows hypointense retropancreatic mass (white arrowheads) pushes pancreatic parenchyma anteriorly. Involved pancreatic parenchyma is seen as a heterogeneously hypointense area (white arrow). c Haematoxylin-eosin-stained histologic section (original magnification, ×200) shows the tumour with atypical large lymphoid cells aggregated focally (white small arrows). The tumour cells are stained positive for CD10 antigen and bcl2 gene by immunohistochemical analysis (not shown)
Mentions: Malignant lymphoma usually appears as a well-circumscribed bulky mass, but can rarely present as invasive tumour [42]. In this situation, an extra-pancreatic lymphoma may directly extend or infiltrate into the adjacent pancreatic parenchyma, and the pancreatic lesion is recognised as a secondary malignant lymphoma. The signal of pancreatic parenchyma is focally and heterogeneously decreased on FST1WI and increased on T2WI (Fig. 9). Under these circumstances, detecting the primary location may become challenging; however, it is noted that invasion of the pancreas is fairly common with contiguous duodenal and other retroperitoneal lymphomas. Associated lymphadenopathy elsewhere in the abdomen is also fairly usual. CT-guided biopsy is recommended for retroperitoneal lesions for accurate and quick diagnosis if primary lesions are not found.Fig. 9

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