Pancreatic lymphoma

Last revised by Mohammad Taghi Niknejad on 22 Jun 2022

Pancreatic lymphoma is most commonly a B-cell subtype of non-Hodgkin lymphoma

Pancreatic lymphoma is typically seen in middle-aged patients with a mean age of around 55 years old and is more common in immunocompromised patients.

Symptoms are often non-specific but may include 1:

The classic B-symptoms of non-Hodgkin lymphoma (i.e. fever, weight lossnight sweats) are present in only 2% of cases 1,2.

It is classified as either primary or secondary:

  • primary pancreatic lymphoma is a rare extranodal manifestation of any histopathologic subtype of B-cell non-Hodgkin lymphoma, representing <2% of extranodal lymphomas and 0.5% of pancreatic tumors 1,2
  • 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

Two morphologic patterns of pancreatic lymphoma are recognized 1:

  • focal form: occurs in the pancreatic head in 80% of cases and has a mean size of 8 cm
  • diffuse form: infiltrative, leading to glandular enlargement and poor definition, features that can simulate the appearance of acute pancreatitis
  • 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

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

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3: multi organ lymphoma
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