A Case of Primary Pancreatic Non-Hodgkin's Lymphoma
A 61-year old female was admitted to the hospital with the complaint of right upper abdominal pain in February 2003. On admission, the patient had a temperature of 36.9℃, blood pressure of 115/58 mmHg, and a pulse of 68 beats per minute. Physical examination revealed a palpable non-tender mass in the right upper abdomen and icteric sclera. The hemoglobin was 8.2 g/dL with 6,400 leukocytes/mm3 and 247,000 platelets/mm3. The alanine aminotransferase was 129 U/L (normal range (NR), 5-40 U/L) and aspartate aminotransferase was 65 U/L (NR, 5-33 U/L). The alkaline phosphatase was 615 U/L (NR, 35-129 U/L) and gamma-glutamyltranspeptidase was 212 U/L (NR, 8-61 U/L). The total bilirubin was 16 mg/dL with 12 mg/dL of direct bilirubin. The serum carbohydrate antigen 19-9 (CA19-9) was 36.9 U/mL (NR, 0-37 U/mL). The abdominal ultrasound demonstrated a hypoechoic 3.4 cm sized mass located at the head of pancreas; there was dilatation of the bile duct and the gallbladder appeared to be filled with sludge. Computed tomography (CT) of the abdomen showed a well defined mass located at the head of the pancreas which was slightly enhanced during the arterial phase (). Endoscopic retrograde cholangiopancreatography (ERCP) revealed stenosis of the distal common bile duct by extrinsic compression. Percutaneous transhepatic biliary drainage was performed because of the clinical signs of fever and leukocytosis, suggesting acute cholangitis.\nLaparotomy was performed, revealing a prominent mass located at the head of the pancreas accumulated with the duodenum and the portal area. A frozen section of pancreas revealed lymphoma and partial excision of the mass located at the pancreatic head was performed instead of the Whipple procedure. Microscopic examination revealed a malignant lymphoma which consisted of large anaplastic lymphocytes (). The round or oval nuclei showed condensation of chromatin patterns with nucleoli. The cytoplasm was scanty or eosinophilic. Mitotic figures were easily identified. Tumor cells showed strong membrane staining for the B cell marker protein (CD20) and were negative for the T cell marker protein (CD3) (). Therefore, according to the Ann Arbor classification, the patient had stage IE disease.\nSix cycles of CHOP chemotherapy (cyclophophamide, doxorubicin, vincristine, and prednisone) were administered without any further complications. Follow-up abdominal CT showed no visible mass in the pancreas (). The patient is currently in complete remission and in good general condition.