B-cell lymphoma presenting as acute pancreatitis.
BACKGROUND
Pancreatic lymphoma is uncommon, representing less than 0.5% of pancreatic tumors, with diffuse large B-cell lymphoma being the predominant histotype. Acute pancreatitis associated with pancreatic lymphoma is rare.


METHODS
We describe a case of synchronous pancreatic and pulmonary localizations of non-Hodgkin's lymphoma in a 42-year-old man who presented with acute pancreatitis. Acute pancreatitis resolved after standard treatment with a fasting regimen, gabexate mesilate and parenteral nutrition. However, ultrasound scan and abdominal computed tomography revealed two hypoechogenic areas within the pancreas, and chest X-ray film showed a pulmonary infiltrate in the right basal field. A percutaneous fine-needle aspiration biopsy of the pulmonary infiltrate under computed tomography guidance demonstrated a diffuse infiltration by atypical lymphoid cells positive for leukocyte common antigen, CD20 and CD30. Percutaneous fine-needle aspiration biopsy under ultrasound guidance of the pancreatic mass confirmed the diagnosis of diffuse large B-cell lymphoma. The patient was classified as stage IV-A, low-intermediate risk and received 6 cycles of chemotherapy.


CONCLUSIONS
This is the first case of large B-cell lymphoma presenting with concomitant primary pancreatic and pulmonary involvement. Pancreatic lymphoma is uncommon and represents a rare cause of acute pancreatitis. The discovery of a pancreatic mass needs pathologic diagnosis to distinguish lymphoma from carcinoma or autoimmune pancreatitis. and IAP.
Department of Internal Medicine, University Hospital of Udine, Udine, Italy.
Edda
E
Federico
Massimo
M
Falconi
Gianni
G
Zuodar
Giovanni
G
Falconieri
Fabio
F
Puglisi
D000208:Acute Disease; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000378:metabolism; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004317:Doxorubicin / Q000627:therapeutic use; D006801:Humans; D017730:Ki-1 Antigen / Q000378:metabolism; D017493:Leukocyte Common Antigens / Q000378:metabolism; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D008297:Male; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D010195:Pancreatitis / Q000175:diagnosis* / Q000628:therapy; D011241:Prednisone / Q000627:therapeutic use; D013902:Radiography, Thoracic; D000069283:Rituximab; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D014408:Biomarkers, Tumor; D017730:Ki-1 Antigen; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D017493:Leukocyte Common Antigens; D011241:Prednisone