Top

Published in:

Open Access 01-02-2018 | Original Article

CT imaging of primary pancreatic lymphoma: experience from three referral centres for pancreatic diseases

Authors: Enrico Boninsegna, Giulia A. Zamboni, Davide Facchinelli, Charikleia Triantopoulou, Sofia Gourtsoyianni, Maria Chiara Ambrosetti, Dino Veneri, Achille Ambrosetti, Roberto Pozzi Mucelli

Published in: Insights into Imaging | Issue 1/2018

Abstract

Purpose

To describe CT characteristics of primary pancreatic lymphoma (PPL), a rare disease with features in common with adenocarcinoma.

Materials and methods

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.

Results

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.

Conclusions

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.

Key points

• 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

Baylor SM, Berg JW (1973) Cross-classification and survival characteristics of 5,000 cases of cancer of the pancreas. J Surg Oncol 5:335–358CrossRefPubMed

Freeman C, Berg JW, Cutler SJ (1972) Occurrence and prognosis of extranodal lymphomas. Cancer 29:252–260CrossRefPubMed

Flejou JF (2011) WHO classification of digestive tumors: the fourth edition. Ann Pathol 31:S27–S31CrossRefPubMed

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 36:38–43CrossRefPubMed

Sadot E, Yahalom J, Do RK et al (2015) Clinical features and outcome of primary pancreatic lymphoma. Ann Surg Oncol 22:1176–1184CrossRefPubMed

Anand D, Lall C, Bhosale P, Ganeshan D, Qayyum A (2016) Current update on primary pancreatic lymphoma. Abdom Radiol (NY) 41:347–355CrossRef

Baysal B, Kayar Y, Ince AT, Arici S, Turkmen I, Senturk H (2015) Primary pancreatic lymphoma: a rare cause of pancreatic mass. Oncol Lett 10:1701–1703CrossRefPubMedPubMedCentral

Carbonetti F, Iannicelli E, Federici M et al (2014) Primary pancreatic Burkitt lymphoma presenting as acute pancreatitis. J Gastrointest Cancer 45(Suppl 1):265–269CrossRefPubMed

Fukuba N, Moriyama I, Ishihara S et al (2016) Primary pancreatic malignant lymphoma diagnosed from endoscopic ultrasound-guided fine-needle aspiration findings. Intern Med 55:31–35CrossRefPubMed

10.

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

11.

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 16:818–831CrossRefPubMedPubMedCentral

12.

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 155:267–270CrossRefPubMed

13.

Thornton E, Mendiratta-Lala M, Siewert B, Eisenberg RL (2011) Patterns of fat stranding. AJR Am J Roentgenol 197:W1–14CrossRefPubMed

14.

Mortele KJ, Rocha TC, Streeter JL, Taylor AJ (2006) Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics 26:715–731CrossRefPubMed

15.

Swerdlow SH, Campo E, Pileri SA et al (2016) The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 127:2375–2390CrossRefPubMedPubMedCentral

16.

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 41:137–143CrossRefPubMed

17.

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 4:321–329CrossRefPubMedPubMedCentral

18.

O JH, Lodge MA, Wahl RL (2016) Practical PERCIST: a simplified guide to PET response criteria in solid tumors 1.0. Radiology 280:576–584CrossRefPubMedPubMedCentral

19.

Negrelli R, Manfredi R, Pedrinolla B et al (2015) Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings. Eur Radiol 25:359–367CrossRefPubMed

Title: CT imaging of primary pancreatic lymphoma: experience from three referral centres for pancreatic diseases
Authors: Enrico Boninsegna
Giulia A. Zamboni
Davide Facchinelli
Charikleia Triantopoulou
Sofia Gourtsoyianni
Maria Chiara Ambrosetti
Dino Veneri
Achille Ambrosetti
Roberto Pozzi Mucelli
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Insights into Imaging / Issue 1/2018
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1007/s13244-017-0585-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

CT imaging of primary pancreatic lymphoma: experience from three referral centres for pancreatic diseases

Abstract

Purpose

Materials and methods

Results

Conclusions

Key points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Key points

Please log in to get access to this content

Other articles of this Issue 1/2018

Mechanical birth-related trauma to the neonate: An imaging perspective

Role of magnetic resonance imaging in the management of perianal Crohn’s disease

Body composition determinants of radiation dose during abdominopelvic CT

Delineation of two intracranial areas and the perpendicular intracranial width is sufficient for intracranial volume estimation

ESR paper on structured reporting in radiology

Evaluation of the solitary pulmonary nodule: size matters, but do not ignore the power of morphology