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Problems in diagnosing lymphoma of the pancreas with computed tomography. A case report
Venkataraman Jayanthi1, Jesudoss Randhir, Natrayan Rajesh
1Department of Gastroenterology, Stanley Medical College and Hospital, Chennai, India. drjayanthi35@yahoo.co.in
Insights
Primary pancreatic lymphoma, a rare cancer, was diagnosed in a 73-year-old male using fine-needle aspiration and immunohistochemistry. Early chemotherapy was initiated for this undifferentiated lymphoma.
Area of Science:
- Oncology
- Hematology
- Diagnostic Pathology
Background:
- Primary pancreatic lymphoma is an exceptionally rare extranodal non-Hodgkin lymphoma, constituting less than 0.5% of all pancreatic malignancies.
- Diagnosis typically relies on percutaneous fine-needle aspiration, histopathology, and immunohistochemistry.
Observation:
- A 73-year-old male presented with chronic abdominal pain and significant weight loss.
- Imaging revealed an ill-defined pancreatic mass; tumor markers (CA 19-9) were normal.
- CT-guided fine-needle aspiration suggested hemolymphoid malignancy.
Findings:
- Immunohistochemistry confirmed an undifferentiated lymphoma, positive for Leukocyte Common Antigen and CD34, but negative for CD3 and CD20.
- This profile is characteristic of certain aggressive lymphomas.
Implications:
- This case highlights the importance of considering lymphoma in the differential diagnosis of pancreatic masses, even with normal tumor markers.
- Accurate diagnosis through specialized techniques is crucial for appropriate treatment and patient management.
- Further research into the optimal management of primary pancreatic lymphoma is warranted.
Abstract:
Primary lymphoma of the pancreas is a rare form of extranodal lymphoma accounting for less than 0.5% of pancreatic tumors. Percutaneous fine-needle aspiration of the pancreas with histopathological examination and immunohistochemical assay confirm the diagnosis. A 73 year old male presented with recurrent pancreatic type abdominal pain with significant weight loss over 1 year. He was pale with ill defined epigastric mass. Contrast enhanced CT showed an ill defined poorly marginated non enhancing hypodense mass lesion involving the body of the pancreas. CA 19-9 was normal. CT guided aspiration cytology was suggestive of hemolymphoid malignancy. Immunohistochemistry was positive for Leukocyte Common Antigen and CD 34. It was negative for CD3 and CD 20 indicating an undifferentiated lymphoma. Patient received two sessions of chemotherapy and was followed-up.
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