CT imaging of primary pancreatic lymphoma: experience from three referral centres for pancreatic diseases
Tóm tắt
To describe CT characteristics of primary pancreatic lymphoma (PPL), a rare disease with features in common with adenocarcinoma. Fourteen patients were enrolled. CT: unenhanced scan, contrast-enhanced pancreatic and venous phases. Image analysis: tumour location; peri-pancreatic vessel encasement; necrosis; enlarged lymph nodes; fat stranding; enlarged bile duct and pancreatic duct; neoplasm longest dimension, volume and density. Histopathological diagnoses: follicular non-Hodgkin lymphoma (5/14), diffuse large B-cell lymphoma (6/14) and high-grade B-cell lymphoma not otherwise specified (3/14). Six of 14 PPLs were located in the pancreatic head and 7/14 in the body-tail; 1/14 involved the whole gland. In 5/14 cases the superior mesenteric artery and vein were encased; splenic vein and artery encasement was depicted in 2 PPLs. Necrosis was present in 2/14. Enlarged retroperitoneal lymph nodes were found in 11 cases and fat stranding in all patients. The bile duct was dilated in six cases and the pancreatic duct in five. Mean neoplasm longest diameter and volume were 8.05 cm and 210.8 cm3. Mean tumour attenuation values were 39.1 HU at baseline, 60.6 HU in the pancreatic phase and 71.4 HU in the venous phase. PPL presents as a large mass lesion with delayed homogeneous enhancement; peri-pancreatic fat stranding and vessel encasement are present, without vascular infiltration. Pancreatic duct dilatation is rare. • Primary pancreatic lymphoma (PPL) is a rare haematological disease
• PPL presents imaging features in common with pancreatic carcinoma but also some distinctive findings
• The majority of PPLs are large lesions with delayed homogeneous enhancement • Peri-pancreatic fat stranding and vessel encasement are common in PPL • Vascular infiltration and pancreatic duct dilatation are rare in PPL
Tài liệu tham khảo
Baylor SM, Berg JW (1973) Cross-classification and survival characteristics of 5,000 cases of cancer of the pancreas. J Surg Oncol 5:335–358
Freeman C, Berg JW, Cutler SJ (1972) Occurrence and prognosis of extranodal lymphomas. Cancer 29:252–260
Flejou JF (2011) WHO classification of digestive tumors: the fourth edition. Ann Pathol 31:S27–S31
Mishra MV, Keith SW, Shen X, Bar Ad V, Champ CE, Biswas T (2013) Primary pancreatic lymphoma: a population-based analysis using the SEER program. Am J Clin Oncol 36:38–43
Sadot E, Yahalom J, Do RK et al (2015) Clinical features and outcome of primary pancreatic lymphoma. Ann Surg Oncol 22:1176–1184
Anand D, Lall C, Bhosale P, Ganeshan D, Qayyum A (2016) Current update on primary pancreatic lymphoma. Abdom Radiol (NY) 41:347–355
Baysal B, Kayar Y, Ince AT, Arici S, Turkmen I, Senturk H (2015) Primary pancreatic lymphoma: a rare cause of pancreatic mass. Oncol Lett 10:1701–1703
Carbonetti F, Iannicelli E, Federici M et al (2014) Primary pancreatic Burkitt lymphoma presenting as acute pancreatitis. J Gastrointest Cancer 45(Suppl 1):265–269
Fukuba N, Moriyama I, Ishihara S et al (2016) Primary pancreatic malignant lymphoma diagnosed from endoscopic ultrasound-guided fine-needle aspiration findings. Intern Med 55:31–35
Shapira G, Fisher Y, Ilivitzki A (2016) Bifocal primary pancreatic Burkitt's lymphoma in a 4-year-old child. J Clin Ultrasound. https://doi.org/10.1002/jcu.22372
Buchs NC, Chilcott M, Poletti PA, Buhler LH, Morel P (2010) Vascular invasion in pancreatic cancer: imaging modalities, preoperative diagnosis and surgical management. World J Gastroenterol 16:818–831
Hopper KD, Diehl LF, Cole BA, Lynch JC, Meilstrup JW, McCauslin MA (1990) The significance of necrotic mediastinal lymph nodes on CT in patients with newly diagnosed Hodgkin disease. AJR Am J Roentgenol 155:267–270
Thornton E, Mendiratta-Lala M, Siewert B, Eisenberg RL (2011) Patterns of fat stranding. AJR Am J Roentgenol 197:W1–14
Mortele KJ, Rocha TC, Streeter JL, Taylor AJ (2006) Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics 26:715–731
Swerdlow SH, Campo E, Pileri SA et al (2016) The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 127:2375–2390
Boninsegna E, Manfredi R, Negrelli R, Avesani G, Mehrabi S, Pozzi Mucelli R (2017) Pancreatic duct stenosis: differential diagnosis between malignant and benign conditions at secretin-enhanced MRCP. Clin Imaging 41:137–143
Fujinaga Y, Lall C, Patel A, Matsushita T, Sanyal R, Kadoya M (2013) MR features of primary and secondary malignant lymphoma of the pancreas: a pictorial review. Insights Imaging 4:321–329
O JH, Lodge MA, Wahl RL (2016) Practical PERCIST: a simplified guide to PET response criteria in solid tumors 1.0. Radiology 280:576–584
Negrelli R, Manfredi R, Pedrinolla B et al (2015) Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings. Eur Radiol 25:359–367