Shinoda M, Nagura E, Uchida K, Kimura M, Mukoyama M, Yamada H
Dept. of Internal Medicine, National Chuba Hospital.
Gan To Kagaku Ryoho. 1994 Oct;21(14):2517-20.
We reported a rare case of malignant lymphoma, highly suspected to be of pancreas origin with multiple nodular hepatic invasions. A 63-year-old man visited our hospital on May 24 1990, complaining of anorexia. In spite of high serum levels of LDH and amylase, abdominal ultrasonography (US) showed no significant lesions. Forty days later, he was admitted because of the loss of weight and the appearance of abdominal pain with marked hepatomegaly, exhibiting cachexia. Abdominal US and computed tomography visualized a tumor of pancreas with multiple nodular space-occupying lesions in the liver. In several days, jaundice and ascites appeared with progressive deterioration. Angiography showed no tumor vascularity nor vascular stain in pancreas and liver, suggesting a non-epithelial malignancy. Mitomycin C and Epi-adriamycin, given to the patient via the celiac artery, brought about a remarkable shrinkage of the abdominal tumor. Subsequent systemic chemotherapies and occasional intra-arterial chemotherapies resulted in the disappearance of abdominal tumor clinically. However, at the end of April 1991, signs of CNS involvement were observed, and he died on June 7, 1991. Autopsy revealed that malignant lymphoma, of diffuse large cell type, had invaded the subarachnoidal cavity without any evidence of invasion of the abdomen or other sites except regional necrotic lesion in the pancreas. These findings strongly suggested that the patient suffered from malignant lymphoma of pancreas origin with multiple nodular hepatic invasions.
