Shirai Yoshihiro, Okamoto Tomoyoshi, Kanehira Masaru, Onda Shinji, Suzuki Fumitake, Ito Ryusuke, Fujioka Shuichi, Yanaga Katsuhiko
1 Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan.
2 Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Int Surg. 2015 Jun;100(6):1078-83. doi: 10.9738/INTSURG-D-14-00132.1.
Pancreatic B-cell lymphoma is rare; it accounts for 0.2% to 2.0% of extranodal non-Hodgkin lymphoma, and constitutes less than 0.5% of all pancreatic malignancies. Most histologic types of the pancreatic lymphoma are diffuse large B-cell lymphoma, and follicular lymphoma is quite rare. We report here a case of pancreatic follicular lymphoma that was initially detected by acute pancreatitis. This is the first reported case of pancreatic follicular lymphoma presenting with acute pancreatitis. A 71-year-old woman had epigastric and left upper quadrant abdominal pain. Computed tomography (CT) revealed features of acute pancreatitis. After standard therapy for pancreatitis, enhanced CT showed a pancreatic tumor (50 × 35 mm) in the body of the pancreas with gradual enhancement. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography showed a complete interruption of the pancreatic duct in the body, with mild dilation of the duct in the tail of the pancreas. Endoscopic ultrasonography revealed hypervascularity of the pancreatic tumor. The patient underwent distal pancreatectomy to remove the cause of pancreatitis and to disclose the diagnosis. Histologic examination revealed follicular lymphoma of pancreas. Despite recent improvement in clinical strategies, differential diagnosis between pancreatic lymphoma and pancreatic cancer is still difficult without histologic information. Pancreatic lymphoma should be considered as a differential diagnosis in a patient who initially presents with acute pancreatitis.
胰腺B细胞淋巴瘤较为罕见；它占结外非霍奇金淋巴瘤的0.2%至2.0%，占所有胰腺恶性肿瘤的比例不到0.5%。胰腺淋巴瘤的大多数组织学类型为弥漫性大B细胞淋巴瘤，滤泡性淋巴瘤相当罕见。我们在此报告一例最初由急性胰腺炎检测出的胰腺滤泡性淋巴瘤病例。这是首例报告的以急性胰腺炎为表现的胰腺滤泡性淋巴瘤病例。一名71岁女性出现上腹部和左上腹疼痛。计算机断层扫描（CT）显示急性胰腺炎的特征。在对胰腺炎进行标准治疗后，增强CT显示胰腺体部有一个胰腺肿瘤（50×35mm），呈渐进性强化。内镜逆行胰胆管造影和磁共振胰胆管造影显示胰腺体部胰管完全中断，胰腺尾部胰管轻度扩张。内镜超声显示胰腺肿瘤血管丰富。患者接受了远端胰腺切除术以消除胰腺炎病因并明确诊断。组织学检查显示为胰腺滤泡性淋巴瘤。尽管近期临床策略有所改进，但在没有组织学信息的情况下，胰腺淋巴瘤与胰腺癌的鉴别诊断仍然困难。对于最初表现为急性胰腺炎的患者，应考虑胰腺淋巴瘤作为鉴别诊断。
