Michael Cox, BS1, Peter Darwin, MD2, Asheesh Sood, MD3, Rebecca Ayre, MA4
1Trinity School of medicine, Oklahoma City, OK; 2University of Maryland Medical System, Baltimore, MD; 3Harford Gastroenterology, Bel Air, MD; 4Hartford Gastroenterology, Bel Air, MD
We present a case of a 42 year old female with Stage IV B cell lymphoma initially presenting with acute pancreatitis.
A 42 year old female presented to the ER with acute pancreatitis. Initial CT Imaging demonstrated a mass in the pancreatic head concerning for pancreatic adenocarcinoma and diffuse lymphadenopathy concerning for metastatic disease. EUS demonstrated peripancreatic lymphadenopathy with invasion into the pancreatic head. After initial treatment of the pancreatitis, diagnostic workup found non-Hodgkin’s lymphoma obstructing the pancreatic duct. Despite her extensive tumor burden the patient had no symptoms prior to her presentation with acute pancreatitis. Her Ca19-9 was elevated, probably secondary to her recent acute pancreatitis. Her tumor responded to dose adjusted R-EPOCH (Rituximab, Etoposide, Prednisone, Oncovin, Cyclophosphamide, and Hydroxydaunorubicin).
Non-Hodgkin's Lymphoma secondarily involving the pancreas initially presenting as acute pancreatitis is extremely rare. Only about 0.5% of all pancreatic tumors are lymphomas, and although 50% of patients with non-Hodgkin’s lymphoma present with extranodal disease, pancreatic involvement represents only about 0.2% to 2% of cases. Primary pancreatic lymphomas are extremely rare but more often present with acute pancreatitis than secondary pancreatic non-Hodgkin’s lymphomas. To our knowledge, there are less than 15 reported cases of non-hodgkin’s lymphoma with secondary involvement of the pancreas presenting as acute pancreatitis. This case demonstrates the need to keep the differential diagnosis broad in the evaluation of pancreatic masses causing pancreatitis even in what seems to be a straightforward case.
Citation: Michael Cox, BS; Peter Darwin, MD; Asheesh Sood, MD; Rebecca Ayre, MA. P0099 - B CELL LYMPHOMA MASQUERADING AS A PANCREATIC MASS WITH PANCREATITIS. Program No. P0099. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.