B Cell Lymphoma in an Intrapancreatic Accessory Spleen

Excerpt

A 72-year-old male with a past medical history significant for ischemic heart disease, prostatic adenocarcinoma, arterial hypertension, and diabetes mellitus type 2 was referred for the surgical treatment of a 2-cm tumor of the left pancreas incidentally discovered during the follow-up of his prostatic malignancy. A thoraco-abdomino-pelvic computed tomography (Fig.  1A) and an abdominal magnetic resonance imaging (Fig.  1B) showed a 2-cm lesion contrast-enhancing on the arterial phase. PET (positron emission tomography) scanner Gallium DOTA-TOC showed focal accumulation of the tracer on the tumor suggestive for pancreatic neuoroendocrine tumor (p-NET) (Fig.  1C). A left pancreatectomy with splenic vessels and spleen preservation was performed. A postoperative course was complicated by functional ileus that regressed spontaneously. At macroscopic examination, the tumor was hemorrhagic (Fig.  1D). Pathology showed a B cell lymphoma developed in an intrapancreatic spleen. Immunohistochemistry showed the lymphocytes being of phenotype: CD20 + (clone L26) (Fig.  2E), CD5 + (clone 4C7) (Fig.  2F), CD23 + (clone 1B12) (Fig.  2G), Bcl-2 + (clone 124), CD10 − (clone 56C6), CD3 − (clone SP7), Cycline D1 − (clone SP4), bcl-6 − (clone GT191E/A8) with a weak (< 5%) index of proliferation ki67 (clone MIB-1) (Fig.  2H).

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