Keywords
PPL
B-cell lymphoma
melena
laparotomy
B-cell lymphoma
melena
laparotomy
How to Cite
Andrea, G., Beqiri, H., Ferizaj, S., Mulgeci, F., & Dogjani, A. (2024). Primary Pancreatic Lymphoma with Active Gastric Bleeding. A Clinical Case and Review Literature. Albanian Journal of Trauma and Emergency Surgery, 8(2), 1563-1567. https://doi.org/10.32391/ajtes.v8i2.400
Abstract
Introduction: Primary pancreatic lymphoma is a rare clinical entity representing <0.5% of pancreatic cancers and 1% of extranodal lymphomas. Due to the lack of evidence of cases in the literature, their clinicopathological features, differential diagnosis, optimal therapy, and outcomes should be better defined.
We will present a case of a 41-year-old woman who presented symptoms such as nausea, epigastric pain, red blood vomiting, and melena.
At laparotomy, a large necrotic mass was found in the body and tail of the pancreas, infiltrating the stomach and spleen. A biopsy of the mass confirmed large B-cell lymphoma. The patient was diagnosed and started chemotherapy.
Conclusion: Primary pancreatic lymphoma is a rare clinical entity often misdiagnosed as pancreatic adenocarcinoma on presentation. Its clinical manifestations, radiological features, and biochemical signs are usually non-specific. It is based on a precise diagnosis made possible by histologic examination. Combined therapy remains the most optimal treatment approach for PPL but needs further evaluation.
References
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17. Boninsegna, E., Zamboni, G.A., Facchinelli, D. et al. CT imaging of primary pancreatic lymphoma: experience from three referral centers for pancreatic diseases. Insights Imaging 9, 17–24 (2018). https://doi.org/10.1007/s13244-017-0585-y
18. Salvatore, J. R., Cooper, B., Shah, I., & Kummet, T. (2000). Primary pancreatic lymphoma: a case report, literature review, and proposal for nomenclature. Medical oncology (Northwood, London, England), 17(3), 237–247. https://doi.org/10.1007/BF02780536
19. Yu, L., Chen, Y., & Xing, L. (2017). Primary pancreatic lymphoma: two case reports and a literature review. OncoTargets and therapy, 10, 1687–1694. https://doi.org/10.2147/OTT.S121521
20. Behrns, K. E., Sarr, M. G., & Strickler, J. G. (1994). Pancreatic lymphoma: Is it a surgical disease? Pancreas, 9(5), 662–667.
21. Grimison, P. S., Chin, M. T., Harrison, M. L., & Goldstein, D. (2006). Primary pancreatic lymphoma--pancreatic tumors that are potentially curable without resection, a retrospective review of four cases. BMC cancer, 6, 117. https://doi.org/10.1186/1471-2407-6-117
22. Hiddemann, W., Kneba, M., Dreyling, M., Schmitz, N., Lengfelder, E., Schmits, R., Reiser, M., Metzner, B., Harder, H., Hegewisch-Becker, S., Fischer, T., Kropff, M., Reis, H. E., Freund, M., Wörmann, B., Fuchs, R., Planker, M., Schimke, J., Eimermacher, H., Trümper, L., … Unterhalt, M. (2005). Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood, 106(12), 3725–3732. https://doi.org/10.1182/blood-2005-01-0016
23. Tuchek, J. M., De Jong, S. A., & Pickleman, J. (1993). Diagnosis, surgical intervention, and prognosis of primary pancreatic lymphoma. The American Surgeon, 59(8), 513–518.
24. Liakakos, T., Misiakos, E. P., Tsapralis, D., Nikolaou, I., Karatzas, G., & Macheras, A. (2008). A role for surgery in primary pancreatic B-cell lymphoma: a case report. Journal of Medical Case Reports, 2, 167. https://doi.org/10.1186/1752-1947-2-167
2. Mishra, M. V., Keith, S. W., Shen, X., Bar Ad, V., Champ, C. E., & Biswas, T. (2013). Primary pancreatic lymphoma: a population-based analysis using the SEER program. American journal of clinical oncology, 36(1), 38–43. https://doi.org/10.1097/COC.0b013e3182354bbb
3. Haji, A. G., Sharma, S., Majeed, K. A., Vijaykumar, D. K., Pavithran, K., & Dinesh, M. (2009). Primary pancreatic lymphoma: Report of three cases with review of the literature. Indian journal of medical and pediatric oncology: official journal of Indian Society of Medical & Paediatric Oncology, 30(1), 20–23. https://doi.org/10.4103/0971-5851.56331
4. Facchinelli, D., Boninsegna, E., Visco, C., & Tecchio, C. (2021). Primary Pancreatic Lymphoma: Recommendations for Diagnosis and Management. Journal of blood medicine, 12, 257–267. https://doi.org/10.2147/JBM.S273095
5. Nishimura, R., Takakuwa, T., Hoshida, Y., Tsujimoto, M., & Aozasa, K. (2001). Primary pancreatic lymphoma: clinicopathological analysis of 19 cases from Japan and review of the literature. Oncology, 60(4), 322–329. https://doi.org/10.1159/000058528
6. Zhu, N. X., Wang, X. Y., Tong, T., Xu, J. H., Yang, Y. Y., & Tian, L. (2022). Primary pancreatic lymphoma diagnosed by endoscopic ultrasound-guided fine needle biopsy. Hepatobiliary & pancreatic diseases international: HBPD INT, 21(1), 99–102. https://doi.org/10.1016/j.hbpd.2021.05.001
7. Gök, A. F. K., Sönmez, R. E., Kantarcı, T. R., Bayraktar, A., Emiroğlu, S., İlhan, M., & Güloğlu, R. (2019). Discussing treatment strategies for acute mechanical intestinal obstruction caused by phytobezoar: A single-center retrospective study. Fitobezoara bağlı akut mekanik intestinal obstrüksiyon için tedavi stratejilerinin tartışılması: Tek merkezli geriye dönük bir çalışma. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 25(5), 503–509. https://doi.org/10.14744/tjtes.2019.24557
8. Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2023 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559328/
9. DAWSON, I. M., CORNES, J. S., & MORSON, B. C. (1961). Primary malignant lymphoid tumors of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. The British Journal of Surgery, pp. 49, 80–89. https://doi.org/10.1002/bjs.18004921319
10. Wallace, D., Dang, N., Dhawan, M., & Kulkarni, A. (2012). Diagnosis of a patient with primary pancreatic lymphoma. Gastroenterology & hepatology, 8(12), 850–852.
11. Ballehaninna, U. K., & Chamberlain, R. S. (2012). The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: An evidence based appraisal. Journal of Gastrointestinal Oncology, 3(2), 105–119. https://doi.org/10.3978/j.issn.2078-6891.2011.021
12. Poruk, K. E., Gay, D. Z., Brown, K., Mulvihill, J. D., Boucher, K. M., Scaife, C. L., Firpo, M. A., & Mulvihill, S. J. (2013). The clinical utility of CA 19-9 in pancreatic adenocarcinoma: diagnostic and prognostic updates. Current molecular medicine, 13(3), 340–351. https://doi.org/10.2174/1566524011313030003
13. Chen, W., Luo, R. C., Fan, W. W., & Ma, S. D. (2006). Nan fang yi ke da xue xue bao = Journal of Southern Medical University, 26(2), 227–230.
14. Merkle, E. M., Bender, G. N., & Brambs, H. J. (2000). Imaging findings in pancreatic lymphoma: differential aspects. AJR. American Journal of roentgenology, 174(3), 671–675. https://doi.org/10.2214/ajr.174.3.1740671
15. Rose, J. F., Jie, T., Usera, P., & Ong, E. S. (2012). Pancreaticoduodenectomy for primary pancreatic lymphoma. Gastrointestinal cancer research: GCR, 5(1), 32–34.
16. Nakaoka K, Ohno E, Kawabe N, Kuzuya T, Funasaka K, Nakagawa Y, Nagasaka M, Ishikawa T, Watanabe A, Tochio T, et al. Current Status of the Diagnosis of Early-Stage Pancreatic Ductal Adenocarcinoma. Diagnostics. 2023; 13(2):215. https://doi.org/10.3390/diagnostics13020215
17. Boninsegna, E., Zamboni, G.A., Facchinelli, D. et al. CT imaging of primary pancreatic lymphoma: experience from three referral centers for pancreatic diseases. Insights Imaging 9, 17–24 (2018). https://doi.org/10.1007/s13244-017-0585-y
18. Salvatore, J. R., Cooper, B., Shah, I., & Kummet, T. (2000). Primary pancreatic lymphoma: a case report, literature review, and proposal for nomenclature. Medical oncology (Northwood, London, England), 17(3), 237–247. https://doi.org/10.1007/BF02780536
19. Yu, L., Chen, Y., & Xing, L. (2017). Primary pancreatic lymphoma: two case reports and a literature review. OncoTargets and therapy, 10, 1687–1694. https://doi.org/10.2147/OTT.S121521
20. Behrns, K. E., Sarr, M. G., & Strickler, J. G. (1994). Pancreatic lymphoma: Is it a surgical disease? Pancreas, 9(5), 662–667.
21. Grimison, P. S., Chin, M. T., Harrison, M. L., & Goldstein, D. (2006). Primary pancreatic lymphoma--pancreatic tumors that are potentially curable without resection, a retrospective review of four cases. BMC cancer, 6, 117. https://doi.org/10.1186/1471-2407-6-117
22. Hiddemann, W., Kneba, M., Dreyling, M., Schmitz, N., Lengfelder, E., Schmits, R., Reiser, M., Metzner, B., Harder, H., Hegewisch-Becker, S., Fischer, T., Kropff, M., Reis, H. E., Freund, M., Wörmann, B., Fuchs, R., Planker, M., Schimke, J., Eimermacher, H., Trümper, L., … Unterhalt, M. (2005). Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood, 106(12), 3725–3732. https://doi.org/10.1182/blood-2005-01-0016
23. Tuchek, J. M., De Jong, S. A., & Pickleman, J. (1993). Diagnosis, surgical intervention, and prognosis of primary pancreatic lymphoma. The American Surgeon, 59(8), 513–518.
24. Liakakos, T., Misiakos, E. P., Tsapralis, D., Nikolaou, I., Karatzas, G., & Macheras, A. (2008). A role for surgery in primary pancreatic B-cell lymphoma: a case report. Journal of Medical Case Reports, 2, 167. https://doi.org/10.1186/1752-1947-2-167
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