Pancreatic lymphoma, diagnosis and management

Eleven cases of non-Hodgkin's lymphoma were referred as patients thought to have pancreatic cancer. It was impossible to make the diagnosis in this particular group of patients preoperatively, by imaging techniques and needle biopsy. For this reason we favor laparotomy for staging followed by Roux-en-Y choledochojejunostomy for those patients with obstructive jaundice because this approach both rapidly resolves the jaundice and enables a more accurate diagnosis. We do not feel that non-surgical means of decompression of the biliary tree by transhepatic or endoscopically placed stents are as safe or effective for patients who are potentially curable because the diagnosis may not be made early enough. We call this group of patients to your attention because recent reports indicate that over 30% of such patients can be cured by chemotherapy. Thus these lesions should be differentiated from others at this location.