P2988 - A Case of Pancreatic Follicular Type B-Cell Lymphoma

Courtney Rizk, MD, Stephanie M. Woo, MD, Mark Real, MD
MedStar Georgetown University Hospital, Washington, DC

Introduction: Primary pancreatic lymphomas are rare, accounting for less than 0.5% of all pancreatic malignancies. The follicular type is particularly rare, with only a few cases reported in the literature. Here, we present the case of a patient who was found to have pancreatic follicular B-cell lymphoma.

Case Description/Methods: A 62-year-old male with a history of obesity and recent elective surgery presented to the emergency department several weeks post-operatively following a syncopal episode. He was found to have a lower extremity DVT and bilateral PEs for which CT incidentally revealed a large mass in the head of the pancreas.
Although the patient reported being in good health the year prior, he noted increased "acid reflux" sensation over the last six months. Laboratory tests revealed a mildly elevated ALP but were otherwise unremarkable.
The mass was PET-positive, and the patient underwent endoscopic ultrasound (EUS) with fine-needle biopsy (FNB) with the mass measuring 6 x 5.8 cm and appearing large, well-circumscribed, homogeneous, and hypoechoic. Pathology from the sample revealed small fragments of atypical lymphoid tissue consistent with B-cell lymphoma of follicle center origin. The patient is now awaiting induction of chemotherapy.

Discussion: Pancreatic lymphoma is a rare diagnosis, and the symptoms are often non-specific, which can lead to delays in diagnosis and treatment. In this case, the patient was relatively asymptomatic but presented with thromboembolic events due to cancer-related hypercoagulability, which led to incidental detection of the mass on CT. Ultimately, EUS with FNB was used to establish a definitive diagnosis. This case emphasizes the importance of considering primary pancreatic lymphoma in the differential diagnosis for pancreatic mass and highlights the valuable diagnostic role of EUS with FNB.

References:
Okamoto T, Sasaki T, Nishimura N, Takamatsu M, Mori C, Mie T, Furukawa T, Yamada Y, Takeda T, Kasuga A, Matsuyama M, Ozaka M, Maruyama D, Sasahira N. Pancreatic follicular lymphoma: a report of two cases and literature review. Clin J Gastroenterol. 2021 Dec;14(6):1756-1765. doi: 10.1007/s12328-021-01507-2. Epub 2021 Aug 27. PMID: 34453279; PMCID: PMC8395385.

Arcari A, Anselmi E, Bernuzzi P, Bertè R, Lazzaro A, Moroni CF, Trabacchi E, Vallisa D, Vercelli A, Cavanna L. Primary pancreatic lymphoma. Report of five cases. Haematologica. 2005 Feb;90(2):ECR09. PMID: 15713583.


Disclosures:


Courtney Rizk, MD, Stephanie M. Woo, MD, Mark Real, MD. P2988 - A Case of Pancreatic Follicular Type B-Cell Lymphoma, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.