Mark Podberezin
University of Saskatchewan, Canada
Title: Pancreatic lymphomas: primary pancreatic lymphoma versus extranodal involvement by systemic lymphomas
Biography
Biography: Mark Podberezin
Abstract
Pancreas can be involved in about 30-40% of patients with non-Hodgkin lymphoma. However, primary pancreatic lymphomas (PPL) are exquisitely rare and comprise less than 1% of extranodal lymphomas and approximately 0.5% of all pancreatic malignancies. PPLs are most commonly located in head of the pancreas and, therefore, they can present with symptoms similar to those of pancreatic adenocarcinomas, i.e. abdominal pain, jaundice, and weight loss. Invasive tumor growth not respecting anatomic boundaries, as well as absence of significant dilatation of main pancreatic duct, raise degree of suspicion for PPL rather than adenocarcinoma. However, systemic and extra-pancreatic lymphomas, with involvement of pancreas, are much more common than PPLs. We observed a case of 78 y/o man who presented with rapidly progressive weight loss and jaundice. CT scan demonstrated ill-defined lesion in pancreatic head, 2 cm in size, with massive peripancreatic lymphadenopathy and 6 cm splenic mass. Core needle biopsy led to the diagnosis of high grade diffuse large B-cell lymphoma (DLBCL). Patient’s status progressively deteriorated, and he expired before initiation of chemotherapy. Autopsy demonstrated involvement of pancreas, spleen, and peripancreatic lymph nodes by lymphoma. However, due to presence of splenic involvement, with dominant mass in the spleen, DLBCL of spleen with secondary pancreatic involvement was diagnosed. Diagnostic criteria, which favor PPL, vs. secondary pancreatic involvement by lymphoma, are following: No superficial or mediastinal lymphadenopathy; Normal leukocyte count; Main mass in the pancreas with lymph node involvement confined to peripancreatic region; and no hepatic or splenic involvement.