Pancreatic lymphoma is most commonly a B-cell sub-type of non-Hodgkin lymphoma and is classified as either primary or secondary.
- primary pancreatic lymphoma is a rare extranodal manifestation of any histopathologic subtype of B-cell non-Hodgkin's lymphoma, representing less than 2% of extranodal lymphomas and 0.5% of pancreatic tumours1-2.
- secondary lymphoma: found in 30% of non-Hodgkin lymphoma patients with widespread disease, it is the dominant form and is the result of direct extension from peripancreatic lymphadenopathy 1.
Typically seen in middle-aged patients: mean of 55 years; range, 35-75 years and in immunocompromised patients.
Presentation is often non-specific. reported symptoms include 1:
- abdominal pain: ~83%
- a mass: ~58%
- weight loss: ~50% 1
- obstructive jaundice: ~37-42% of cases
- acute pancreatitis: 12%
The classic symptoms of non-Hodgkin lymphoma (e.g. fever, chills, night sweats) are present in only 2% of cases1-2.
Two morphologic patterns of pancreatic lymphoma are recognized:
- the focal form occurs in the pancreatic head in 80% of cases and has a mean size of 8 cm 1
- the diffuse form is infiltrative, leading to glandular enlargement and poor definition, features that can simulate the appearance of acute pancreatitis 1
- minimal enhancement
- peripancreatic lymph node enlargement
- it typically has uniform low attenuation
- diffuse enlargement (diffuse form) may simulate acute pancreatitis
- encasement of the peripancreatic vessels may occur. Vascular invasion is less common in lymphoma than in adenocarcinoma 1-2
- focal form: low signal intensity on T1-weighted images and intermediate signal intensity on T2-weighted images (slightly higher signal intensity than the pancreas but lower signal intensity than fluid), and shows faint contrast enhancement 1
- diffuse form: low signal intensity on T1- and T2-weighted MR images and shows homogeneous contrast enhancement, although small foci of reduced or absent enhancement are sometimes seen 1
Treatment and prognosis
Percutaneous or endoscopic core biopsy should be performed to establish the diagnosis 2.
Pancreatic lymphoma carries a better prognosis than adenocarcinoma because first-line treatment with chemotherapy is generally effective in producing long-term disease regression or remission. Surgery is not required in most cases 1.
Using complex treatment approaches, cure rates of up to 30% are reported for patients with primary pancreatic lymphoma. This prognosis is much better than the dismal 5% 5-year survival rate in patients with pancreatic adenocarcinoma 2.
Imaging differential considerations include
For a diffuse bulkiness to the pancreas consider
- 1. Low G, Panu A, Millo N et-al. Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas. Radiographics. 31 (4): 993-1015. doi:10.1148/rg.314105731 - Pubmed citation
- 2. Merkle EM, Bender GN, Brambs HJ. Imaging findings in pancreatic lymphoma: differential aspects. AJR Am J Roentgenol. 2000;174 (3): 671-5. AJR Am J Roentgenol (full text) - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Lymphoma of pancreas||✗|
|Lymphoma of the pancreas||✗|