Skip to main content

Advertisement

Log in

Current update on primary pancreatic lymphoma

  • Pictorial Essay
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

This article reviews the computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) CT findings of primary and secondary pancreatic lymphomas and discusses the role of endoscopic ultrasound-guided fine needle aspiration in diagnosis and management.

Conclusion

Pancreatic lymphoma has certain characteristic imaging features which may help distinguish it from the more common pancreatic adenocarcinoma. It is critical to make an accurate diagnosis, as the management of these two conditions is vastly different.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Behrns KE, Sarr MG, Strickler JG (1994) Pancreatic lymphoma: is it a surgical disease? Pancreas 9(5):662–667

    Article  CAS  PubMed  Google Scholar 

  2. Hamilton SR, Aaltonen AL (eds) (2000) World Health Organization classification of tumours. Pathology and genetics of tumours of the digestive system. Lyon: IARC Press

    Google Scholar 

  3. Sadot E, Yahalom J, Do RK, et al. (2015) Clinical features and outcome of primary pancreatic lymphoma. Ann Surg Oncol 22(4):1176–1184. doi:10.1245/s10434-014-4176-6

    Article  PubMed  Google Scholar 

  4. Cario E, Runzi M, Metz K, Layer P, Goebell H (1997) Diagnostic dilemma in pancreatic lymphoma. Case report and review. Int J Pancreatol 22(1):67–71. doi:10.1007/bf02803907

    Article  CAS  PubMed  Google Scholar 

  5. Joly I, David A, Payan MJ, Sahel J, Sarles H (1992) A case of primary non-Hodgkin lymphoma of the pancreas. Pancreas 7(1):118–120

    Article  CAS  PubMed  Google Scholar 

  6. Neef B, Kunzig B, Sinn I, Kieninger G, von Gaisberg U (1997) Primary pancreatic lymphoma. A rare cause of pain-free icterus. Dtsch Med Wochenschr 122(1–2):12–17. doi:10.1055/s-2008-1047570

    Article  CAS  PubMed  Google Scholar 

  7. Teefey SA, Stephens DH, Sheedy PF 2nd (1986) CT appearance of primary pancreatic lymphoma. Gastrointest Radiol 11(1):41–43. doi:10.1007/bf02035029

    Article  CAS  PubMed  Google Scholar 

  8. Tuchek JM, De Jong SA, Pickleman J (1993) Diagnosis, surgical intervention, and prognosis of primary pancreatic lymphoma. Am Surg 59(8):513–518

    CAS  PubMed  Google Scholar 

  9. Baylor SM, Berg JW (1973) Cross-classification and survival characteristics of 5000 cases of cancer of the pancreas. J Surg Oncol 5(4):335–358

    Article  CAS  PubMed  Google Scholar 

  10. Mishra MV, Keith SW, Shen X, et al. (2013) Primary pancreatic lymphoma: a population-based analysis using the SEER program. Am J Clin Oncol 36(1):38–43. doi:10.1097/COC.0b013e3182354bbb

    Article  PubMed  Google Scholar 

  11. Jones WF, Sheikh MY, McClave SA (1997) AIDS-related non-Hodgkin’s lymphoma of the pancreas. Am J Gastroenterol 92(2):335–338

    CAS  PubMed  Google Scholar 

  12. Johnson EA, Benson ME, Guda N, et al. (2014) Differentiating primary pancreatic lymphoma from adenocarcinoma using endoscopic ultrasound characteristics and flow cytometry: A case-control study. Endosc Ultrasound 3(4):221–225. doi:10.4103/2303-9027.144530

    Article  PubMed Central  PubMed  Google Scholar 

  13. Merkle EM, Bender GN, Brambs HJ (2000) Imaging findings in pancreatic lymphoma: differential aspects. AJR Am J Roentgenol 174(3):671–675. doi:10.2214/ajr.174.3.1740671

    Article  CAS  PubMed  Google Scholar 

  14. Maruyama H, Nakatsuji N, Sugihara S, et al. (1997) Anaplastic Ki-1-positive large cell lymphoma of the pancreas: a case report and review of the literature. Jpn J Clin Oncol 27(1):51–57

    Article  CAS  PubMed  Google Scholar 

  15. Kalra MK, Maher MM, Mueller PR, Saini S (2003) State-of-the-art imaging of pancreatic neoplasms. Br J Radiol 76(912):857–865. doi:10.1259/bjr/16642775

    Article  CAS  PubMed  Google Scholar 

  16. Basu A, Patil N, Mohindra P, et al. (2007) Isolated non-Hodgkin’s lymphoma of the pancreas: case report and review of literature. J Cancer Res Ther 3(4):236–239

    Article  PubMed  Google Scholar 

  17. Battula N, Srinivasan P, Prachalias A, Rela M, Heaton N (2006) Primary pancreatic lymphoma: diagnostic and therapeutic dilemma. Pancreas 33(2):192–194. doi:10.1097/01.mpa.0000227910.63579.15

    Article  PubMed  Google Scholar 

  18. Boni L, Benevento A, Dionigi G, Cabrini L, Dionigi R (2002) Primary pancreatic lymphoma. Surg Endosc 16(7):1107–1108. doi:10.1007/s00464-001-4247-1

    Article  CAS  PubMed  Google Scholar 

  19. Grimison PS, Chin MT, Harrison ML, Goldstein D (2006) Primary pancreatic lymphoma–pancreatic tumours that are potentially curable without resection, a retrospective review of four cases. BMC Cancer 6:117. doi:10.1186/1471-2407-6-117

    Article  PubMed Central  PubMed  Google Scholar 

  20. Prayer L, Schurawitzki H, Mallek R, Mostbeck G (1992) CT in pancreatic involvement of non-Hodgkin lymphoma. Acta Radiol 33(2):123–127

    Article  CAS  PubMed  Google Scholar 

  21. Salvatore JR, Cooper B, Shah I, Kummet T (2000) Primary pancreatic lymphoma: a case report, literature review, and proposal for nomenclature. Med Oncol 17(3):237–247

    Article  CAS  PubMed  Google Scholar 

  22. Van Beers B, Lalonde L, Soyer P, et al. (1993) Dynamic CT in pancreatic lymphoma. J Comput Assist Tomogr 17(1):94–97

    Article  PubMed  Google Scholar 

  23. Mergo PJ, Helmberger TK, Buetow PC, Helmberger RC, Ros PR (1997) Pancreatic neoplasms: MR imaging and pathologic correlation. Radiographics 17(2):281–301. doi:10.1148/radiographics.17.2.9084072

    Article  CAS  PubMed  Google Scholar 

  24. Sandrasegaran K, Lin C, Akisik FM, Tann M (2010) State-of-the-art pancreatic MRI. AJR Am J Roentgenol 195(1):42–53. doi:10.2214/ajr.10.4421

    Article  PubMed  Google Scholar 

  25. Schima W, Ba-Ssalamah A, Goetzinger P, Scharitzer M, Koelblinger C (2007) State-of-the-art magnetic resonance imaging of pancreatic cancer. Top Magn Reson Imaging TMRI 18(6):421–429. doi:10.1097/rmr.0b013e31816459e0

    Article  PubMed  Google Scholar 

  26. Fujinaga Y, Lall C, Patel A, et al. (2013) MR features of primary and secondary malignant lymphoma of the pancreas: a pictorial review. Insights Imaging 4(3):321–329. doi:10.1007/s13244-013-0242-z

    Article  PubMed Central  PubMed  Google Scholar 

  27. Ishigami K, Tajima T, Nishie A, et al. (2010) MRI findings of pancreatic lymphoma and autoimmune pancreatitis: a comparative study. Eur J Radiol 74(3):e22–e28. doi:10.1016/j.ejrad.2009.03.022

    Article  PubMed  Google Scholar 

  28. Masui T, Katayama M, Kobayashi S, Shimizu S (2005) MR imaging of primary malignant lymphoma of the pancreas. Radiat Med 23(3):213–215

    PubMed  Google Scholar 

  29. Lin H, Li SD, Hu XG, Li ZS (2006) Primary pancreatic lymphoma: report of six cases. World J Gastroenterol 12(31):5064–5067

    PubMed Central  PubMed  Google Scholar 

  30. Cappell MS, Yao F, Cho KC, Axiotis CA (1989) Lymphoma predominantly involving the pancreas. Dig Dis Sci 34(6):942–947

    Article  CAS  PubMed  Google Scholar 

  31. Pasanen PA, Eskelinen M, Vornanen M, Partanen K (1993) Pancreatic lymphoma. Ann Chir Gynaecol 82(3):207–209

    CAS  PubMed  Google Scholar 

  32. Abedi SH, Ahmadzadeh A, Nikmanesh A, Mohammad Alizadeh AH (2014) The role of endoscopic ultrasound in primary pancreatic lymphoma presented with acute pancreatitis: a case report. JOP 15(5):493–496

    PubMed  Google Scholar 

  33. Carbonetti F, Iannicelli E, Federici M, et al. (2014) Primary pancreatic Burkitt lymphoma presenting as acute pancreatitis. J Gastrointest Cancer 45(Suppl 1):265–269. doi:10.1007/s12029-014-9657-0

    Article  PubMed  Google Scholar 

  34. Federico E, Falconi M, Zuodar G, Falconieri G, Puglisi F (2011) B-cell lymphoma presenting as acute pancreatitis. Pancreatology 11(6):553–556. doi:10.1159/000332038

    Article  PubMed  Google Scholar 

  35. Furuhashi N, Suzuki K, Sakurai Y, et al. (2014) Differentiation of focal-type autoimmune pancreatitis from pancreatic carcinoma: assessment by multiphase contrast-enhanced CT. Eur Radiol . doi:10.1007/s00330-014-3512-3

    PubMed  Google Scholar 

  36. Takahashi N, Fletcher JG, Fidler JL, et al. (2008) Dual-phase CT of autoimmune pancreatitis: a multireader study. AJR Am J Roentgenol 190(2):280–286. doi:10.2214/ajr.07.2309

    Article  PubMed  Google Scholar 

  37. Hur BY, Lee JM, Lee JE, et al. (2012) Magnetic resonance imaging findings of the mass-forming type of autoimmune pancreatitis: comparison with pancreatic adenocarcinoma. J Magn Reson Imaging JMRI 36(1):188–197. doi:10.1002/jmri.23609

    Article  PubMed  Google Scholar 

  38. Low G, Panu A, Millo N, Leen E (2011) Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics 31(4):993–1015. doi:10.1148/rg.314105731

    Article  PubMed  Google Scholar 

  39. Kwee TC, Kwee RM, Nievelstein RA (2008) Imaging in staging of malignant lymphoma: a systematic review. Blood 111(2):504–516. doi:10.1182/blood-2007-07-101899

    Article  CAS  PubMed  Google Scholar 

  40. Metser U, Goor O, Lerman H, Naparstek E, Even-Sapir E (2004) PET-CT of extranodal lymphoma. AJR Am J Roentgenol 182(6):1579–1586. doi:10.2214/ajr.182.6.1821579

    Article  PubMed  Google Scholar 

  41. Moog F, Bangerter M, Diederichs CG, et al. (1998) Extranodal malignant lymphoma: detection with FDG PET versus CT. Radiology 206(2):475–481. doi:10.1148/radiology.206.2.9457202

    Article  CAS  PubMed  Google Scholar 

  42. Even-Sapir E, Lievshitz G, Perry C, et al. (2007) Fluorine-18 fluorodeoxyglucose PET/CT patterns of extranodal involvement in patients with non-Hodgkin lymphoma and Hodgkin’s disease. Radiol Clin N Am 45(4):697–709, vii. doi:10.1016/j.rcl.2007.05.009

  43. Ngeow JY, Quek RH, Ng DC, et al. (2009) High SUV uptake on FDG-PET/CT predicts for an aggressive B-cell lymphoma in a prospective study of primary FDG-PET/CT staging in lymphoma. Ann Oncol 20(9):1543–1547. doi:10.1093/annonc/mdp030

    Article  CAS  PubMed  Google Scholar 

  44. Okada M, Sato N, Ishii K, et al. (2010) FDG PET/CT versus CT, MR imaging, and 67 Ga scintigraphy in the posttherapy evaluation of malignant lymphoma. Radiographics 30(4):939–957. doi:10.1148/rg.304095150

    Article  PubMed  Google Scholar 

  45. Paes FM, Kalkanis DG, Sideras PA, Serafini AN (2010) FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. Radiographics 30(1):269–291. doi:10.1148/rg.301095088

    Article  PubMed  Google Scholar 

  46. Dong A, Cui Y, Gao L, et al. (2014) Patterns of FDG uptake in pancreatic non-Hodgkin’s lymphoma lesions. Abdom Imaging 39(1):175–186. doi:10.1007/s00261-013-0041-5

    Article  PubMed  Google Scholar 

  47. Dong A, Dong H, Zhang L, Zuo C (2013) Hypermetabolic lesions of the pancreas on FDG PET/CT. Clin Nucl Med 38(9):e354–e366. doi:10.1097/RLU.0b013e3182708503

    Article  PubMed  Google Scholar 

  48. Sahani DV, Bonaffini PA, Catalano OA, Guimaraes AR, Blake MA (2012) State-of-the-art PET/CT of the pancreas: current role and emerging indications. Radiographics 32(4):1133–1158 ((discussion 1158–1160)). doi:10.1148/rg.324115143

    Article  PubMed  Google Scholar 

  49. Nguyen VX, Nguyen CC, Nguyen BD (2011) (1)(8)F-FDG PET/CT imaging of the pancreas: spectrum of diseases. JOP 12(6):557–566

    PubMed  Google Scholar 

  50. Moon SY, Joo KR, So YR, et al. (2013) Predictive value of maximum standardized uptake value (SUVmax) on 18F-FDG PET/CT in patients with locally advanced or metastatic pancreatic cancer. Clin Nucl Med 38(10):778–783. doi:10.1097/RLU.0b013e31829f8c90

    Article  PubMed  Google Scholar 

  51. Blastik M, Plavecz E, Zalatnai A (2011) Pancreatic carcinomas in a 60-year, institute-based autopsy material with special emphasis of metastatic pattern. Pancreas 40(3):478–480. doi:10.1097/MPA.0b013e318205e332

    Article  PubMed  Google Scholar 

  52. Gagovic V, Spier BJ, DeLee RJ, et al. (2012) Endoscopic ultrasound fine-needle aspiration characteristics of primary adenocarcinoma versus other malignant neoplasms of the pancreas. Can J Gastroenterol = J canadien de gastroenterologie 26(10):691–696

    Google Scholar 

  53. Ramesh J, Hebert-Magee S, Kim H, Trevino J, Varadarajulu S (2014) Frequency of occurrence and characteristics of primary pancreatic lymphoma during endoscopic ultrasound guided fine needle aspiration: a retrospective study. Dig Liver Dis 46(5):470–473. doi:10.1016/j.dld.2013.12.016

    Article  PubMed Central  PubMed  Google Scholar 

  54. Puli SR, Bechtold ML, Buxbaum JL, Eloubeidi MA (2013) How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass?: a meta-analysis and systematic review. Pancreas 42(1):20–26. doi:10.1097/MPA.0b013e3182546e79

    Article  PubMed  Google Scholar 

  55. Khashab M, Mokadem M, DeWitt J, et al. (2010) Endoscopic ultrasound-guided fine-needle aspiration with or without flow cytometry for the diagnosis of primary pancreatic lymphoma—a case series. Endoscopy 42(3):228–231. doi:10.1055/s-0029-1243859

    Article  CAS  PubMed  Google Scholar 

  56. Bouvet M, Staerkel GA, Spitz FR, et al. (1998) Primary pancreatic lymphoma. Surgery 123(4):382–390

    Article  CAS  PubMed  Google Scholar 

  57. Webb TH, Lillemoe KD, Pitt HA, Jones RJ, Cameron JL (1989) Pancreatic lymphoma. Is surgery mandatory for diagnosis or treatment? Ann Surg 209(1):25–30

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  58. Saif MW (2006) Primary pancreatic lymphomas. JOP 7(3):262–273

    PubMed  Google Scholar 

Download references

Funding

This study did not receive any grant funding.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dhakshinamoorthy Ganeshan.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This is a review article. IRB approval was obtained for a waiver of Informed Consent/Authorization because this is a retrospective chart review that involves no diagnostic or therapeutic intervention, as well as no direct patient contact and no patient identifiers.

Additional information

CME activity This article has been selected as the CME activity for the current month. Please visit https://ce.mayo.edu/node/13391 and follow the instructions to complete this CME activity.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anand, D., Lall, C., Bhosale, P. et al. Current update on primary pancreatic lymphoma. Abdom Radiol 41, 347–355 (2016). https://doi.org/10.1007/s00261-015-0620-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-015-0620-8

Keywords

Navigation