Primary Pancreatic Lymphoma Diagnosed by Ultrasound Guided Fine Needle Aspiration Cytology, Flowcytometry and Immunohistochemistry : Analysis of 12 cases

Ram Nawal Rao; Bitan Naik; Rajesh Kashyap

Volume : VII, Issue : V, May - 2018

Primary Pancreatic Lymphoma Diagnosed by Ultrasound Guided Fine Needle Aspiration Cytology, Flowcytometry and Immunohistochemistry : Analysis of 12 cases

Ram Nawal Rao, Bitan Naik, Rajesh Kashyap

Abstract :

Primary pancreatic lymphomas (PPL) are extremely rare neoplasm. Radiologicaly, PPL usually situated in the region of head of pancreas. An accurate cytopathologic diagnosis by USG guided fine–needle aspiration (USG–FNA) is indispensable, because the primary treatment is nonsurgical, based on a combination of chemotherapy and radiation therapy.

METHODS. Twelvecases of PPL were identified from the cytology division of pathology department over a 10 year period. All cases were diagnosed on USG–FNA performed under radiologic guidance.

RESULTS. The patients ranged in age from 14–75 years. The tumors varied in size from 2–10.2 cm, as evaluated on the radiologic scans (mean dimension of 8.0 cm). Abdominal pain was the most common presenting symptom (Nine patients) followed by jaundice (5case), acute pancreatiti(1case), Fever (1case), small bowel obstruction (1case), anorexia (2cases)and diarrhea (1case). The cytomorphologic features showed singly dispersed cells with round irregular nuclei, prominent nucleoli, mitoses, and scant to moderate cytoplasm. FC analysis in all seven cases demonstrated a monoclonal pattern of immunoglobulin light chain expression.The patients were treated with either chemotherapy alone or in conjunction with radiation therapy or stem cell transplantation.

CONCLUSIONS. PPL is a very rare neoplastic entity. USG–FNA with FC analysis appears to be highly accurate in the diagnosis of PPL and is the sole diagnostic modality used clinically.