Primary pancreatic lymphoma: diagnostic pitfall of an uncommon medical entity mimicking operable pancreatic carcinoma: case report and review of literature

Authors

  • Dinesh Manchikanti Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India
  • Manisha Aggarwal Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India
  • Janitta Kundaikar Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India
  • Shaji Thomas Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India
  • Ashish Arsia Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India
  • Rahul Pusuluri Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India
  • Kusum Meena Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India
  • Sanjay Kumar Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20212742

Keywords:

Primary pancreatic lymphoma, Non-Hodgkin lymphoma, Obstructive jaundice, Pancreas, Adenocarcinoma pancreas

Abstract

Almost all pancreatic neoplasms, including the commonest pancreatic ductal adenocarcinoma (PDAC) are derived from pancreatic epithelial components. Primary pancreatic lymphoma (PPL) is rare, accounting for less than 0.5% of all primary pancreatic tumours and presents a diagnostic and therapeutic challenge owing to their rarity, difficult access, and clinical and imaging features, which can mimic PDAC. A 26-year-old man presented with pain abdomen, jaundice, anorexia and weight loss for two months, along with two episodes of hematemesis and melena. Examination revealed an icteric patient with no palpable abdominal lump. His had a serum bilirubin of 13.6 mg/dl. His ultrasound abdomen, CT scan and MRCP showed a mass in the head and uncinate process of the pancreas with circumferential nodular thickening in second part of duodenum. Side viewing endoscopy was suggestive of carcinoma head of pancreas with duodenal infiltration, for which endoscopic biopsy was taken which revealed non-Hodgkin's lymphoma B cell type. A PET CT showed a metabolically active mass lesion in the head of pancreas, with no other focus of disease anywhere else, suggestive of primary pancreatic lymphoma. This patient was referred to Medical oncology and started on chemotherapy. Lymphoma should be considered when a large, homogeneous, hypoenhancing mass is encountered in the pancreatic head, and with bulky lymphadenopathy. Preoperative tissue diagnosis such as fine needle aspiration cytology with or without flow cytometry and/or laparoscopy/endoscopy guided tissue biopsy may be necessary. It is crucial to differentiate PPL from pancreatic adenocarcinoma since their treatment is primarily medical and prognosis differs considerably.

Author Biographies

Dinesh Manchikanti, Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India

Junior Resident,

Department of Surgery

Manisha Aggarwal, Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India

Junior Resident,

Department of Surgery

Janitta Kundaikar, Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India

Junior Resident,

Department of Surgery

Shaji Thomas, Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India

Director-Professor of Surgery,

Department of Surgery,

Lady Hardinge Medical College,

New Delhi 110001, India

Ashish Arsia, Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India

Professor of Surgery.

Rahul Pusuluri, Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India

Professor of Surgery.

Kusum Meena, Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India

Professor of Surgery.

Sanjay Kumar, Department of Surgery, Lady Hardinge Medical College and Dr. RML Hospital, New Delhi, India

Professor of Surgery.

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Published

2021-06-28

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Section

Case Reports