A 31-year-old women was admitted to our hospital with a 4-week history of progressive upper abdominal pain. Past medical history was non-contributory. Physical examination was unremarkable. Laboratory examination of the blood showed elevated parenchymateous and cholestatic liver function tests: bilirubin 14.0 µmol/l (n = 322), alkaline phosphatase 870 U/l (n = 50125), -glutamyltransferase 259 U/l (n = 650), aspartate aminotransferase 289 U/l (n = 550), alanine aminotransferase 218 U/l (n = 540), lactate dehydrogenase 636 U/l (n = 200450), C-reactive protein 73 mg/l (n <10) and amylase 884 U/l (n = 30130). Amylase was also elevated in the urine 3190 U/l (n = 50650). Leucocytes were 14.5 x 109/l (n = 312) with normal differentiation, other laboratory findings were normal. Ultrasonographic examination of the abdomen showed a solid multinodular mass in the head of the pancreas 7 x 7 x 8.5 cm, with a normal diameter of the common bile duct. The origin of the mass was not clear; a subsequent computed tomography scan (Figure 1) and magnetic resonance imaging scan of the abdomen did not provide any more information. The differential diagnosis contained a neuro-endocrine tumour, carcinoma or lymphoma. An endoscopic retrograde cholangiopancreatography revealed a normal head of the pancreas and a discontinuation of contrast in the ductus with distension of the ductus pancreaticus in the corpus, probably because of the tumour. Finally, a histological punction from the head of the pancreas revealed a Morbus Hodgkins lymphoma of the mixed cellular type.
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Lymphoma involving the pancreas is rare compared with pancreatic adenocarcinoma [1]. Among malignant neoplasms of the pancreas, lymphoma have a very low incidence [2] at approximately 12%; these are mostly non-Hodgkins lymphomas [3]. The dramatic difference in prognosis [4] and treatment between pancreatic carcinoma and lymphoma makes it important to have a correct diagnosis. Currently, >75% of newly diagnosed patients with Hodgkins lymphoma are cured with radiation therapy and/or chemotherapy. In contrast with pancreatic carcinoma, which has a 5-year survival of 14%. Due to their relatively good prognosis, it is important to consider lymphomas in the differential diagnosis of tumours of the pancreas.
C. T. A. M. Knibbeler-van Rossum1, F. J. P. Peters2, F. L. G. Erdkamp2 & L. P. Bos2
1Department of Internal Medicine, University Hospital Maastricht; 2Department of Internal Medicine, Maasland Hospital Sittard, The Netherlands (E-mail@ Knibbeler-vanrossum@planet.nl)
References
1. Pecorari P, Gorji N, Melato M. Primary non-Hodgkins lymphoma of the head of the pancreas: a case report and review of literature. Oncol Rep 1999; 6: 11111115.[ISI][Medline]
2. Salvatore JR, Cooper B, Shah I, Kummet T. Primary pancreatic lymphoma: a case report, literature review, and proposal for nomenclature. Med Oncol 2000; 17: 237247.[ISI][Medline]
3.
Aisenberg AC. Problems in Hodgkins disease management. Blood 1999; 93: 761779.
4. Rudders RA, Ross ME, DeLellis RA. Primary extranodal lymphoma: response to treatment and factors influencing prognosis. Cancer 1978; 42: 406416.[ISI][Medline]