B-Cell Lymphoma Presenting as Acute Pancreatitis

Background: Pancreatic lymphoma is uncommon, representing less than 0.5% of pancreatic tumors, with diffuse large B-cell lymphoma being the predominant histotype. Acute pancreatitis associated with pancreatic lymphoma is rare. Case Report: We describe a case of synchronous pancreatic and pulmonary localizations of non-Hodgkin’s lymphoma in a 42-year-old man who presented with acute pancreatitis. Acute pancreatitis resolved after standard treatment with a fasting regimen, gabexate mesilate and parenteral nutrition. However, ultrasound scan and abdominal computed tomography revealed two hypoechogenic areas within the pancreas, and chest X-ray film showed a pulmonary infiltrate in the right basal field. A percutaneous fine-needle aspiration biopsy of the pulmonary infiltrate under computed tomography guidance demonstrated a diffuse infiltration by atypical lymphoid cells positive for leukocyte common antigen, CD20 and CD30. Percutaneous fine-needle aspiration biopsy under ultrasound guidance of the pancreatic mass confirmed the diagnosis of diffuse large B-cell lymphoma. The patient was classified as stage IV-A, low-intermediate risk and received 6 cycles of chemotherapy. Conclusion: This is the first case of large B-cell lymphoma presenting with concomitant primary pancreatic and pulmonary involvement. Pancreatic lymphoma is uncommon and represents a rare cause of acute pancreatitis. The discovery of a pancreatic mass needs pathologic diagnosis to distinguish lymphoma from carcinoma or autoimmune pancreatitis.