Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2015

01-04-2015 | Pancreatic Tumors

Clinical Features and Outcome of Primary Pancreatic Lymphoma

Authors: Eran Sadot, MD, Joachim Yahalom, MD, Richard Kinh Gian Do, MD, PhD, Julie Teruya-Feldstein, MD, Peter J. Allen, MD, Mithat Gönen, PhD, Michael I. D’Angelica, MD, T. Peter Kingham, MD, William R. Jarnagin, MD, Ronald P. DeMatteo, MD

Published in: Annals of Surgical Oncology | Issue 4/2015

Login to get access

Abstract

Introduction

Primary pancreatic lymphoma (PPL) is a rare tumor that is often misdiagnosed. Clinicopathologic features, optimal therapy, and outcomes are not well defined. We reviewed our institutional experience with PPL.

Methods

Search of our institutional database identified that between 1987–2012, 21,760 patients with lymphoma and 11,286 patients with a primary pancreatic tumor were evaluated. There were 44 patients with pathologically confirmed PPL. Clinical data were obtained by chart review and survival distributions were estimated using the Kaplan–Meier method and compared using the log-rank test.

Results

At baseline, LDH was elevated in 55 % of the patients, CA 19-9 in 25 %, and CEA in 20 %. Imaging characteristics included large, unresectable tumors (67 %), and lymphadenopathy inferior to the renal vein (50 %). Twenty-three patients underwent surgery for resection (5), diagnosis (13), or palliation (5). Chemotherapy alone achieved a 75 % complete response rate. Eight patients experienced relapse, 88 % of which occurred at distant sites. Median overall survival was 6.1 years and 10-year disease-specific survival (DSS) was 69 %. Patients with a low risk International Prognostic Index (IPI) and those with a follicular histologic subtype demonstrated 5-year DSS of 100 %.

Conclusions

Chemotherapy for PPL results in a high complete response rate and long DSS, which is similar to nodal non-Hodgkin’s lymphoma (NHL). A favorable outcome is expected for IPI low risk patients and follicular histologic subtype. Systemic therapy should generally be the initial therapy when the diagnosis is known. Prolonged follow up is recommended to detect relapses. Surgery alone should be reserved for non-curative intent (i.e. diagnostic or palliative).
Appendix
Available only for authorised users
Literature
1.
Baylor SM, Berg JW. Cross-classification and survival characteristics of 5,000 cases of cancer of the pancreas. J Surg Oncol. 1973;5(4):335–358.CrossRefPubMed
2.
Freeman C, Berg JW, Cutler SJ. Occurrence and prognosis of extranodal lymphomas. Cancer. 1972;29(1):252–260.CrossRefPubMed
3.
Behrns KE, Sarr MG, Strickler JG. Pancreatic lymphoma: is it a surgical disease? Pancreas. 1994;9(5):662–667.CrossRefPubMed
4.
Dawson IM, Cornes JS, Morson BC. Primary malignant lymphoid tumours of the intestinal tract: report of 37 cases with a study of factors influencing prognosis. Br J Surg. 1961;49:80–89.CrossRefPubMed
5.
6.
Zucca E. Extranodal lymphoma: a reappraisal. Ann Oncol. 2008;19 Suppl 4:iv77–80.PubMed
7.
Seymour JF. X. Extra-nodal lymphoma in rare localisations: bone, breast and testes. Hematol Oncol. 2013;31 Suppl 1:60–63.CrossRefPubMed
8.
Zucca E, Conconi A, Mughal TI, et al. Patterns of outcome and prognostic factors in primary large-cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group. J Clin Oncol. 2003;21(1):20–27.CrossRefPubMed
9.
Gundrum JD, Mathiason MA, Moore DB, Go RS. Primary testicular diffuse large B-cell lymphoma: a population-based study on the incidence, natural history, and survival comparison with primary nodal counterpart before and after the introduction of rituximab. J Clin Oncol. 2009;27(31):5227–5232.CrossRefPubMed
10.
Battula N, Srinivasan P, Prachalias A, Rela M, Heaton N. Primary pancreatic lymphoma: diagnostic and therapeutic dilemma. Pancreas. 2006;33(2):192–194.CrossRefPubMed
11.
12.
Webb TH, Lillemoe KD, Pitt HA, Jones RJ, Cameron JL. Pancreatic lymphoma. Is surgery mandatory for diagnosis or treatment? Ann Surg. 1989;209(1):25–30.CrossRefPubMedCentralPubMed
13.
Koniaris LG, Lillemoe KD, Yeo CJ, et al. Is there a role for surgical resection in the treatment of early-stage pancreatic lymphoma? J Am Coll Surg. 2000;190(3):319–330.CrossRefPubMed
14.
Bouvet M, Staerkel GA, Spitz FR, et al. Primary pancreatic lymphoma. Surgery. 1998;123(4):382–390.CrossRefPubMed
15.
Mishra MV, Keith SW, Shen X, Bar Ad V, Champ CE, Biswas T. Primary pancreatic lymphoma: a population-based analysis using the SEER program. Am J Clin Oncol. 2013;36(1):38–43.CrossRefPubMed
16.
Swerdlow SH, Campo E, Harris NL, et al. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press; 2008.
17.
Lister TA, Crowther D, Sutcliffe SB, et al. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol. 1989;7(11):1630–1636.PubMed
18.
A predictive model for aggressive non-Hodgkin’s lymphoma. The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. N Engl J Med. 1993;329(14):987–994.
19.
Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007;25(5):579–586.CrossRefPubMed
20.
Allen PJ. Pancreatic adenocarcinoma: putting a hump in survival. J Am Coll Surg. 2007;205(4 Suppl):S76–80.CrossRefPubMed
21.
22.
Kamisawa T, Chari ST, Lerch MM, Kim MH, Gress TM, Shimosegawa T. Recent advances in autoimmune pancreatitis: type 1 and type 2. Gut. 2013;62(9):1373–1380.CrossRefPubMed
23.
24.
Ahmad SS, Idris SF, Follows GA, Williams MV. Primary testicular lymphoma. Clin Oncol. 2012;24(5):358–365.CrossRef
25.
26.
Gholam D, Bibeau F, El Weshi A, Bosq J, Ribrag V. Primary breast lymphoma. Leuk Lymphoma. 2003;44(7):1173–1178.CrossRefPubMed
27.
Ferrucci PF, Zucca E. Primary gastric lymphoma pathogenesis and treatment: what has changed over the past 10 years? Br J Haematol. 2007;136(4):521–538.CrossRefPubMed
28.
Habermann TM, Weller EA, Morrison VA, et al. Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. J Clin Oncol. 2006;24(19):3121–3127.CrossRefPubMed
29.
Ziepert M, Hasenclever D, Kuhnt E, et al. Standard International Prognostic Index remains a valid predictor of outcome for patients with aggressive CD20+B-cell lymphoma in the rituximab era. J Clin Oncol. 2010;28(14):2373–2380.CrossRefPubMed
30.
31.
Maurer MJ, Ghesquieres H, Jais JP, et al. Event-free survival at 24 months is a robust end point for disease-related outcome in diffuse large B-cell lymphoma treated with immunochemotherapy. J Clin Oncol. 2014;32(10):1066–1073.CrossRefPubMed
32.
Ryan G, Martinelli G, Kuper-Hommel M, et al. Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group. Ann Oncol. 2008;19(2):233–241.CrossRefPubMed
33.
Lee AY, Connors JM, Klimo P, O’Reilly SE, Gascoyne RD. Late relapse in patients with diffuse large-cell lymphoma treated with MACOP-B. J Clin Oncol. 1997;15(5):1745–1753.PubMed
34.
Larouche JF, Berger F, Chassagne-Clement C, et al. Lymphoma recurrence 5 years or later following diffuse large B-cell lymphoma: clinical characteristics and outcome. J Clin Oncol. 2010;28(12):2094–2100.CrossRefPubMed
Metadata
Title
Clinical Features and Outcome of Primary Pancreatic Lymphoma
Authors
Eran Sadot, MD
Joachim Yahalom, MD
Richard Kinh Gian Do, MD, PhD
Julie Teruya-Feldstein, MD
Peter J. Allen, MD
Mithat Gönen, PhD
Michael I. D’Angelica, MD
T. Peter Kingham, MD
William R. Jarnagin, MD
Ronald P. DeMatteo, MD
Publication date
01-04-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 4/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4176-6

Other articles of this Issue 4/2015

Annals of Surgical Oncology 4/2015 Go to the issue

Breast Oncology

Applicability of the ACOSOG Z0011 Criteria in Women with High-Risk Node-Positive Breast Cancer Undergoing Breast Conserving Surgery

Hepatobiliary Tumors

Using Dynamic 99mTc-GSA SPECT/CT Fusion Images for Hepatectomy Planning and Postoperative Liver Failure Prediction

Breast Oncology

Different Patterns in the Prognostic Value of Age for Breast Cancer-Specific Mortality Depending on Hormone Receptor Status: A SEER Population-Based Analysis

Healthcare Policy and Outcomes

Maintenance of Certification: What Everyone Needs to Know

Endocrine Tumors

Unanticipated Thyroid Cancer in Patients with Substernal Goiters: Are We Underestimating the Risk?

Head and Neck Oncology

Elective Neck Dissection in Patients With Head and Neck Adenoid Cystic Carcinoma: An International Collaborative Study