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Mayo Clin Proc. 2010 January; 85(1): 11.
PMCID: PMC2800279

Pancreatic Adenocarcinoma?

Sudha Akkinepally, MD* and Vijayarama Poreddy, MD*

A 48-year-old man with cirrhosis secondary to chronic hepatitis C and alcoholic liver disease presented with abdominal pain, hematemesis, and melena. Physical examination showed that the patient had jaundice with epigastric tenderness. Laboratory results yielded the following values: total bilirubin, 11 mg/dL; direct bilirubin, 8.5 mg/dL; alkaline phosphatase, 164 U/L; aspartate aminotransferase, 99 U/L; alanine aminotransferase, 72 U/L; and carbohydrate antigen 19-9, 86 U/mL. Computed tomography of the abdomen showed a large mass involving the head of the pancreas. Magnetic resonance cholangiopancreatography revealed a large heterogeneous mass arising from the pancreatic head and compressing the common bile duct. Endoscopic retrograde cholangiopancreatography showed a large ulcerative mass in the second part of the duodenum. Cholangiography revealed narrowing of the common bile duct and common hepatic duct. Symptoms, imaging studies, and tumor markers mimicked pancreatic adenocarcinoma, but duodenal mucosa biopsies showed diffuse large B-cell lymphoma. Computed tomography—guided biopsy of the pancreatic mass (hematoxylin-eosin, original magnification, ×20) revealed the same pathologic findings.

Primary pancreatic lymphoma is a rare nonepithelial tumor that arises from the lymphatic tissue of the pancreas. These lymphomas constitute less than 1% of all extralymphatic lymphomas and 0.7% of all pancreatic malignancies.1 Most patients present with nonspecific and vague abdominal symptoms.2 Because of difficulty distinguishing primary pancreatic lymphoma from pancreatic adenocarcinoma, biopsy of all pancreatic masses is essential to establish a definitive diagnosis and exclude potentially curable conditions like primary pancreatic lymphoma.3 Treatment is mainly with chemotherapy (rituximab, cyclophosphamide, hydroxydaunomycin [doxorubicin], vincristine [Oncovin], prednisone [R-CHOP]), with or without adjuvant radiotherapy.2

figure 11fig

References

1. Battula N, Srinivasan P, Prachalias A, Rela M, Heaton N. Primary pancreatic lymphoma: diagnostic and therapeutic dilemma. Pancreas 2006. August;33(2):192-194 [PubMed]
2. Basu A, Patil N, Mohindra P, et al. Isolated non-Hodgkin's lymphoma of the pancreas: case report and review of literature. J Cancer Res Ther. 2007. Oct–Dec;3(4):236-239 [PubMed]
3. Grimison PS, Chin MT, Harrison ML, Goldstein D. Primary pancreatic lymphoma—pancreatic tumours that are potentially curable without resection, a retrospective review of four cases. BMC Cancer 2006. May4;6:117 [PMC free article] [PubMed]

Articles from Mayo Clinic Proceedings are provided here courtesy of The Mayo Foundation for Medical Education and Research