Year 2016 / Volume 108 / Number 12
Digestive Diseases Image
A diffusely enlarged pancreas: the (un)usual suspect

809-811

Pedro Magalhães-Costa, Maria José Brito, Pedro Pinto-Marques,

Abstract
An 81-years-old female presented with obstructive jaundice and a non-specific clinical picture of nausea and appetite loss. Labs demonstrated a conjugated hyperbilirrubinemia (7.7 mg/dL), increased aspartate aminotransferase and alanine aminotransferase (10xULN and 8xULN, respectively), increased lactate dehydrogenase (10xULN) and serum lipase (3xULN). CA 19.9 was 342 U/mL (Ref value < 37 U/mL). There was no evidence of peripheral lymphadenopathy or hepatosplenomegaly. Imaging (Figure 1A and 1B) revealed a marked homogeneous enlargement of the pancreas (without any well-defined mass), dilation of the extra and intra-hepatic bile ducts and ascites. Endoscopic ultrasound (Figure 1C and 1D) identified an enlarged homogeneous hypoechoic pancreas, without any well-defined lesion, no dilation of the main pancreatic duct, no peripancreatic or celiac enlarged lymph nodes. A fine-needle biopsy was performed yielding, on cytological examination and cell-block technique (Figure 2A and 2B), numerous medium/large sized atypical lymphoid cells that displayed a B-cell lineage immunophenotype (Figure 2A-2F). Even though, further characterization (by flow cytometric immunophenotyping) could not be obtained, a final diagnosis of primary pancreatic lymphoma (PPL) was assumed. Primary pancreatic lymphoma is a remarkably rare tumor of the pancreas, representing approximately 0.5% of all pancreatic neoplasms and <2% of all lymphomas (1,2). A correct diagnosis is crucial because therapeutic management differs from other pancreatic malignancies (pancreatic ductal adenocarcinoma, neuroendocrine tumor and metastases) (2,3). Two morphologic patterns of PPL are recognized: a focal form (occurring in the pancreatic head in 80% of cases) and a rarer diffuse/infiltrative pattern, as depicted herein, emulating an acute/autoimmune pancreatitis (1).
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References
1. Battula N, Srinivasan P, Prachalias A, et al. Primary pancreatic lymphoma: diagnostic and therapeutic dilemma. Pancreas 2006; 33: 192–4.
2. Du X, Zhao Y, Zhang T, et al. Primary pancreatic lymphoma: a clinical quandary of diagnosis and treatment. Pancreas 2011; 40: 30–6.
3. Iglesias García J, Lariño Noia J, Domíngues Muñoz JE. Endoscopic ultrasound in the diagnosis and staging of pancreatic cancer. Rev Esp Enferm Dig 2009; 101: 631–8.
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Magalhães-Costa P, Brito M, Pinto-Marques P. A diffusely enlarged pancreas: the (un)usual suspect. 4096/2015


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Publication history

Received: 10/11/2015

Accepted: 22/12/2015

Published: 30/11/2016

Article revision time: 37 days

Article editing time: 386 days


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