[1583] 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).

Hematologic Malignancies in the Pancreas
 M:F RatioMean Age (yrs)Mean Size (cm)Localized to PancreasHM HistoryHM Suspected# Resected
HGBCL (n=29)0.8:1586.575167
LGBCL (n=6)2:1583.91353
Myeloid Sarcoma (n=2)2:0700.91211
Transplant (n=2)2:04012.31022
Other (n=3)2:1623.11230

HM was diagnosed by FNA in 4 cases, biopsy in 27 and resection in 11. Clinical/radiologic data led to suspicion of HM in 27 patients (64%). Of 15 with no suspicion for HM or tissue diagnosis, 4 had resection for presumed PAC. Remaining resections were clinically indicated even with suspicion or diagnosis of HM. Diagnoses were confirmed in all with preoperative diagnosis. Patients with HM were significantly younger with larger tumors and lower CA 19-9 than those with PAC.

Hematologic Malignancies of Pancreas vs. Adenocarcinoma
 M:F RatioAge (yrs)Size (cm)CA 19-9 (U/mL)
HM1.2:158 ± 15*7.3 ± 3.8**118 ± 158**
PAC1.3:165 ± 11*3.9 ± 1.6**1162 ± 3426**
*p<0.05; **p<0.001

Conclusions: A variety of HM involve the pancreas, most commonly HGBCL. Surprisingly, 11/42 cases were localized to the pancreas and 15/42 were not suspected prior to tissue diagnosis, resulting in 4 resections for presumed PAC. Age, tumor size and CA 19-9 may be useful in distinguishing PAC from HM or may suggest the need for tissue or FNA diagnosis.
Category: Liver & Pancreas

Monday, February 28, 2011 2:15 PM

Platform Session: Section D, Monday Afternoon


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