PANCREATIC LYMPHOMA

• Clinical presentation is typically abdominal pain with obstructive jaundice +/- hyperbilirubinemia. Males>Female. Rare <1% of pancreatic neoplasms.
• Key point: Diffuse enlargement of the pancreas by infiltrating tumor +/- peri pancreatic fat stranding.
• CT demonstrates a homogeneous, diffusely enlarged pancreas with minimal enhancement. There may or may not be surrounding stranding, referred to as misty mesentery. Abdominal adenopathy is typically present.
• MR demonstrates iso to hyper intense pancreatic parenchyma on T2 with little to no contrast enhancement.
• ERCP or MRCP demonstrates diffuse narrowing of the pancreatic duct with dilatation of the biliary system external to the pancreas.
• Autoimmune pancreatitis can have a very similar appearance and may require a biopsy for definitive diagnosis. Pancreatic adenocarcinoma typically presents as a heterogeneous mass with dilatation of the upstream pancreatic duct due to obstruction.
• Acute pancreatitis can have a similar appearance radiographically but has an acute not indolent presentation. Also, sequela of pancreatitis such as pseudo cysts are not common with lymphoma. Islet cell tumors demonstrate marked enhancement and have a more mass like appearance.
• Treatment is chemotherapy with a 30% cure rate.
• SOURCE: AUNTMINNIE.COM