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. Case Report: 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. Conclusion: 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.

Keywords:
Pancreatic lymphoma, Acute pancreatitis, Pulmonary lymphoma
1.
Kiresi DA, Kivrak AS, Ecirli S, Toy H: Secondary breast, pancreatic, and renal involvement with non-Hodgkin’s lymphoma: Imaging findings. Breast 2006;15:106–110.
2.
Freeman C, Berg JW, Cutler SJ: Occurrence and prognosis of extranodal lymphomas. Cancer 1972;29:252–260.
3.
Mortenson MM, Katz MH, Tamm EP, Bhutani MS, Wang H, Evans DB, Fleming JB: Current diagnosis and management of unusual pancreatic tumors. Am J Surg 2008;196:100–113.
4.
Bernardeau M, Auroux J, Cavicchi M, Haioun C, Tsakiris L, Delchier JC: Secondary pancreatic involvement by diffuse large B-cell lymphoma presenting as acute pancreatitis: treatment and outcome. Pancreatology 2002;2:427–430.
5.
Saif MW, Khubchandani S, Walczak M: Secondary pancreatic involvement by a diffuse large B-cell lymphoma presenting as acute pancreatitis. World J Gastroenterol 2007;13:4909–4911.
6.
Saif MW: Primary pancreatic lymphomas. JOP 2006;7:262–273.
7.
Tuchek JM, De Jong SA, Pickleman J: Diagnosis, surgical intervention, and prognosis of primary pancreatic lymphoma. Am Surg 1993;59:513–518.
8.
Buscarini E, Frulloni L, De Lisi S, Falconi M, Testoni PA, Zambelli A: Autoimmune pancreatitis: a challenging diagnostic puzzle for clinicians. Dig Liver Dis 2010;42:92–98.
9.
Frulloni L, Scattolini C, Falconi M, Zamboni G, Capelli P, Manfredi R, Graziani R, D’Onofrio M, Katsotourchi AM, Amodio A, Benini L, Vantini I: Autoimmune pancreatitis: differences between the focal and diffuse forms in 87 patients. Am J Gastroenterol 2009;104:2288–2294.
10.
Behrns KE, Sarr MG, Strickler JG: Pancreatic lymphoma: is it a surgical disease? Pancreas 1994;9:662–667.
11.
Kahl B: Chemotherapy combinations with monoclonal antibodies in non-Hodgkin’s lymphoma. Semin Hematol 2008;45:90–94.
© 2011 S. Karger AG, Basel and IAP
2011
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