Primary pancreatic lymphoma: two case reports and a literature review

Figures & data

Figure 1 Abdominal CT findings. A CT scan showing diffuse hypodense enlargement of the pancreatic head (arrow).

Notes: (A–B) unenhanced and (C–D) arterial phase.
Abbreviation: CT, computed tomography.

Figure 2 A gross pathological examination revealed a 3.0 × 4.0 cm multiseptated mass in the pancreatic head (arrow). The cut surface of the tumor was yellowish (arrow).

Figure 3 Histopathology showed small tumor cells without cell adhesion or tissue structure proliferation (A), and HE immunochemical staining was positive for B-cell markers CD20 and CD79a (B, C), compatible with the diagnosis of diffuse large B-cell non-Hodgkin lymphoma. HE immunochemical staining confirmed a proliferative index of over 50–60% (D). (A–C ×400; D ×200).

Abbreviation: HE, hematoxylin and eosin.

Figure 4 A PET-CT did not detect any signs of disease recurrence after 16 months.

Notes: A and B represent different planes on PET-CT.

Abbreviations: R, right; L, left; PET-CT, positron emission tomography-computed tomography.

Figure 5 (A, B) A CT scan showing diffuse hypodense enlargement of the pancreatic tail (arrow).

Figure 6 Pathological findings. (A) HE shows irregularly-shaped, atypical lymphocyte infiltration (×40). (B) CD20 positive atypical lymphocytic cells (×400). (C) A high Ki-67 proliferation index (80%; ×200).

Abbreviation: HE, hematoxylin and eosin.

Figure 7 Lesions were significantly reduced after 2 cycles of CHOP chemotherapy regimen (A, B). After 4 cycles of CHOP chemotherapy regimen (C, D).

Table 1 Reported cases of primary pancreatic leiomyosarcoma in the English literature of our review

Author	Year	Sex/age, year (mean)	Location in pancreas (number)	Pathology (number)	Treatment (number)	Outcome/follow-up, months (number)
Shtamler et al^Citation8	1988	Female/31	Head	DHL	PD+CMT	ANED/14 months
Hirabayashi et al^Citation9	1991	Male/74	Head	B-cell lymphoma	DP	AWD
Joly et al^Citation10	1992	Female/23	Head	B-cell lymphoma	PD+CMT	DOD
Van Beers et al^Citation11	1993	5 males and 3 females/26–77 (58)	Head (5), body and tail (3)	NBL (8)	NA	NA
Behrns et al^Citation5	1994	8 males and 4 females/NR	Head (6), body (3), tail (2), whole (1)	DLBCL (7), mixed (2), and small cleaved lymphoma (2)	RT (5), CMT (2), RT+CMT (3), PD (2)	Survival (mean) RT/22 months, CMT/13 months, RT+CMT/26 months
Ezzat et al^Citation12	1996	4 males and 1 female/38–51 (43)	Head (4), body and tail (1)	DLBCL (3) and diffuse large B-cell lymphoma (2)	CMT (3), CMT+RT (2)	ANED/21, 24, 26, 84 months (4); AWD/23 months (1)
Salvatore et al^Citation13	2000	Male/59	Whole	DLBCL	CMT	NA
Nayer et al^Citation15	2004	7 males and 1 female/35–75 (55)	Head (7), body and tail (1)	LBCL (4), follicular lymphoma (1), small lymphocytic lymphoma (1), suspicious (1)	RT+CMT (3), CMT (4), NA (2)	AWD/72 months (1), ANED/2, 5, 6, 7, 72 months (5), NA (2)
Volmar et al^Citation14	2004	7 males and 3 females/46–86 (65)	Head (12), body (1), and tail (1)	LBCL (6), FCL (3), and unclassified B-cell lymphoma (1)	CMT	DOD (2), AWD (12)
Ji et al^Citation16	2005	Male/46	Head	DLBCL	PD	NA
Arcari et al^Citation17	2005	4 males and 1 female/58–71 (65)	Head (5)	Large B-cell (3) and lymphoplasmacytic lymphoma (2)	PD+CMT (2), CMT+RT (2), CMT (1)	ANED/78 months (range 8–160 months)
Lee et al^Citation18	2006	Female/61	Head	B-cell lymphoma	DP+CMT	ANED
Wang et al^Citation19	2006	Male/49	Head	Burkitt lymphoma		DOD
Lin et al^Citation4	2006	5 males and 1 female/16–65 (45)	Head (3), body and tail (2), whole (1)	B-cell lymphoma (3) and NBL (3)	PD+CMT (2), CMT+RT (1), CMT (2)	DOD/0.5, 37, 49 months (3), ANED (1), NA (2)
Basu et al^Citation20	2007	Male/42	Body	DLBCL	CMT+RT	ANED
Saif et al^Citation21	2007	Female/57	Whole	LBCL	CMT	NA
Liakakos et al^Citation22	2008	Male/65	Head	NBL	PD+CMT	ANED/21 months
Hashimoto et al^Citation23	2008	Male/50	Head	DLBCL	CMT+PD	ANED/7 months
Sağlam et al^Citation24	2009	Male/20		Burkitt lymphoma	CMT	DOD
Bautista et al^Citation25	2009	Male/13	Tail	NBL	CMT	ANED/15 months
Haji et al^Citation26	2009	Not mention	Head (2) and tail (1)	DLBCL	CMT+RT (2) and PD+CMT (1)	NA
Sugishita et al^Citation27	2010	Male/16	Head	DBCL	PD+CMT	ANED/48 months
Abe et al^Citation28	2010	Male/56	Head	B-cell lymphoma	PD+CMT	NA
Alexander et al^Citation29	2011	Male/61	Head	DLBCL	PD+CMT	ANED/18 months
Anderloni et al^Citation30	2015	Female/33	Head	NBL	CMT	ANED/18 months
Fukuba et al^Citation31	2016	Female/60	Head	DLBCL	CMT	NA

Abbreviations: ANED, alive and no evidence of disease; AWD, alive with disease; cm, centimeters; CMT, chemotherapy; DHL, diffuse histiocytic lymphoma; DLBCL, diffuse large B cell lymphoma; DOD, died of disease; DP, distal pancreatectomy; FCL, follicular cell lymphoma; LBCL, large B cell lymphoma; n, number of cases; NA, not available; NBL, non-Hodgkin B lymphomas; PD, pancreatico-duodenectomy; RT, radiotherapy.

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