The Spectrum of Hematologic Malignancies Involving the Pancreas: Potential Clinical Mimics of Adenocarcinoma.
Jonathan B Rock, Theodore S Chang, Gerard Lozanski, Mark P Bloomston, Wendy L Frankel. The Ohio State University Medical Center, Columbus
Background: Hematologic malignancies (HM) often involve the pancreas including up to 1/3 of lymphoma patients. HM may present as a solitary mass and as the initial manifestation of disease, leading to diagnostic pitfalls. Histologic distinction between HM and pancreatic adenocarcinoma (PAC) is usually straightforward, but resections may occur based on clinical suspicion without tissue diagnosis. We reviewed HM involving the pancreas to describe the spectrum of disease and determine features useful in distinction from PAC.
Design: Archived material (1965 to present) was retrieved for HM involving the pancreas, and clinical, pathologic and radiologic data was reviewed. Data from 157 PAC was evaluated for comparison. Student's t-test and Fisher's exact test were used for comparisons.
Results: 42 HM of the pancreas included 29 High Grade B-Cell Lymphomas (HGBCL; Diffuse Large B-Cell and Grade 3 Follicular), 6 Low Grade B-Cell Lymphomas (LGBCL; Small Lymphocytic, Grade 1-2 Follicular, Marginal Zone), 2 Myeloid Sarcomas, 2 EBV-related Post-Transplant B-Cell Lymphomas, and one each of Plasma Cell Myeloma, Chronic Myelomonocytic Leukemia, and Nodular Sclerosing Hodgkin Lymphoma (Other).
|M:F Ratio||Mean Age (yrs)||Mean Size (cm)||Localized to Pancreas||HM History||HM Suspected||# Resected|
|Myeloid Sarcoma (n=2)||2:0||70||0.9||1||2||1||1|
|M:F Ratio||Age (yrs)||Size (cm)||CA 19-9 (U/mL)|
|HM||1.2:1||58 ± 15*||7.3 ± 3.8**||118 ± 158**|
|PAC||1.3:1||65 ± 11*||3.9 ± 1.6**||1162 ± 3426**|