CLINICAL CHALLENGES AND IMAGES IN GI An Unusual Cause of a Pancreatic Mass Robert T. Lapp and Richard S. Kwon Department of Internal Medicine, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan
Question: An 88-year-old man with a past medical history of melanoma presented for evaluation of a pancreatic tail mass found on routine imaging follow-up of a stable lung nodule (Figure A). He was asymptomatic and his physical examination revealed no lymphadenopathy, jaundice, or abdominal masses. Laboratory examination demonstrated a carbohydrate antigen (CA)19-9 level of 14 U/mL (normal, 0-40). Endoscopic ultrasonography (EUS) demonstrated a 1.9 0.9-cm hypoechoic pancreatic tail lesion with irregular margins (Figure B). The pancreas was otherwise normal without pancreatic duct dilation or findings of chronic pancreatitis. There was no peripancreatic or celiac lymphadenopathy. Fine-needle aspiration (FNA) was performed. Bedside cytology demonstrated numerous lymphocytes (Figure C). What is your diagnosis? Look on page 38 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.
Conflicts of interest The authors disclose no conflicts. © 2015 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2015.03.047
Gastroenterology 2015;149:37–38
CLINICAL CHALLENGES AND IMAGES IN GI Answer to: Image 4 (page 37): Primary Pancreatic Lymphoma The preliminary results from the fine needle aspiration were consistent with benign lymphocytes without evidence of malignant cells. Flow cytometry revealed CD5þ, CD20 dim, CD23þ, FMC7- and lambda-restricted B-cell population consisting primarily of small cells. Phenotypic analysis detected a lambda-restricted monoclonal B-cell population comprising 54% of the nucleated cells. The phenotypic profile is consistent with involvement by small lymphocytic lymphoma. Primary pancreatic lymphoma (PPL) is a rare tumor of the pancreas. representing 50% of cases, whereas small lymphocytic lymphoma represents
Question: An 88-year-old man with a past medical history of melanoma presented for evaluation of a pancreatic tail mass found on routine imaging follow-up of a stable lung nodule (Figure A). He was asymptomatic and his physical examination revealed no lymphadenopathy, jaundice, or abdominal masses. Laboratory examination demonstrated a carbohydrate antigen (CA)19-9 level of 14 U/mL (normal, 0-40). Endoscopic ultrasonography (EUS) demonstrated a 1.9 0.9-cm hypoechoic pancreatic tail lesion with irregular margins (Figure B). The pancreas was otherwise normal without pancreatic duct dilation or findings of chronic pancreatitis. There was no peripancreatic or celiac lymphadenopathy. Fine-needle aspiration (FNA) was performed. Bedside cytology demonstrated numerous lymphocytes (Figure C). What is your diagnosis? Look on page 38 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.
Conflicts of interest The authors disclose no conflicts. © 2015 by the AGA Institute 0016-5085/$36.00 http://dx.doi.org/10.1053/j.gastro.2015.03.047
Gastroenterology 2015;149:37–38
CLINICAL CHALLENGES AND IMAGES IN GI Answer to: Image 4 (page 37): Primary Pancreatic Lymphoma The preliminary results from the fine needle aspiration were consistent with benign lymphocytes without evidence of malignant cells. Flow cytometry revealed CD5þ, CD20 dim, CD23þ, FMC7- and lambda-restricted B-cell population consisting primarily of small cells. Phenotypic analysis detected a lambda-restricted monoclonal B-cell population comprising 54% of the nucleated cells. The phenotypic profile is consistent with involvement by small lymphocytic lymphoma. Primary pancreatic lymphoma (PPL) is a rare tumor of the pancreas. representing 50% of cases, whereas small lymphocytic lymphoma represents
