Boni L, Benevento A, Dionigi G, Cabrini L, Dionigi R
Department of Surgery, University of Insubria, Ospedale di Circolo di Varese, Viale Borri n. 57, 21100 Varese, Italy.
Surg Endosc. 2002 Jul;16(7):1107-8. doi: 10.1007/s00464-001-4247-1. Epub 2002 May 3.
Primary pancreatic lymphoma (PPL) is a rare form of extranodal lymphoma (less than 0.5% of pancreatic tumors) originating from the pancreatic parenchyma. Histopathological examination is usually mandatory to obtain a definitive diagnosis since symptoms and radiological features are quite similar to those of other pancreatic masses. Percutaneous fine-needle aspiration (FNA) of the pancreas requires experienced cytopathologists as well as advanced immunohistochemical assays to obtain a final diagnosis on a small amount of tissue. A 46-year-old man complaining of watery diarrhea and severe weight loss (more than 20 kg) for more than 1 year was admitted to our hospital due to severe diabetic crisis. Enlarged lymph nodes (2.5 x 1 cm) were found at the right axillary stations. Abdominal ultrasound revealed the presence of a large hyperechogenic mass, mainly located at the pancreatic head. Abdominal computed tomography scan confirmed a diffuse enlargement of the head and body of the pancreas associated with lymphadenopathy along the lesser gastric curvature. Percutaneous ultrasound-guided FNA of the pancreas as well as gross biopsy of the axillary lymph nodes were unable to identify the nature of the mass. Diagnostic laparoscopy was performed: several enlarged lymph nodes along the lesser gastric curvature were revealed. Multiple biopsies of the pancreatic head were taken and lymphadenectomy along the lesser curvature and the hepatic hilus was also performed. The definitive histopathological examination of the pancreatic specimen revealed a primary low-grade non-Hodgkin B cell pancreatic lymphoma. The postoperative course was unremarkable; the patient underwent systemic chemotherapy regime for low-grade B cell Hodgkin lymphoma and he was symptom free at 9-month follow-up.
原发性胰腺淋巴瘤（PPL）是一种罕见的结外淋巴瘤（占胰腺肿瘤的比例不到0.5%），起源于胰腺实质。由于症状和影像学特征与其他胰腺肿块非常相似，通常需要进行组织病理学检查以获得明确诊断。胰腺的经皮细针穿刺抽吸活检（FNA）需要经验丰富的细胞病理学家以及先进的免疫组织化学检测方法，才能在少量组织上做出最终诊断。一名46岁男性，因严重糖尿病危象入住我院，他诉说水样腹泻和严重体重减轻（超过20kg）超过1年。在右腋窝处发现肿大淋巴结（2.5×1cm）。腹部超声显示存在一个大的高回声肿块，主要位于胰头。腹部计算机断层扫描证实胰头和胰体弥漫性肿大，并伴有胃小弯处淋巴结肿大。胰腺的经皮超声引导下FNA以及腋窝淋巴结大体活检均无法确定肿块的性质。进行了诊断性腹腔镜检查：发现胃小弯处有几个肿大淋巴结。对胰头进行了多次活检，并沿小弯和肝门进行了淋巴结切除术。胰腺标本的最终组织病理学检查显示为原发性低级别非霍奇金B细胞胰腺淋巴瘤。术后过程顺利；患者接受了针对低级别B细胞霍奇金淋巴瘤的全身化疗方案，在9个月的随访中无症状。
