Diagnostic Criteria and Prognosis of Pancreatic Lymphoma

This entry looks at pancreatic lymphoma, or primary pancreatic lymphoma (PPL), one of the subtypes of lymphoma. 'Lymphoma' is an umbrella term that loosely refers to several dozen independent categorical types and subtypes of cancers of the lymphatic system.

What is Pancreatic Lymphoma?

Primary pancreatic lymphoma is a cancer of the lymphocytes that originates as a pancreatic mass, and is not the result of an invasion from nearby lymph nodes. It is important that a pancreatic mass be quickly identified as either a lymphoma or an adenocarcinoma, since each is approached differently from a treatment perspective and the latter is far more serious.

Primary pancreatic lymphoma appears to be much more common in men than in women, but it is by any standard a very rare disease. It represents about 1 percent of all pancreatic masses, and about 1 percent of extra-nodal non-Hodgkin's lymphomas, making for a rather small number indeed. However, secondary pancreatic lymphoma, in which lymphoma spreads to the pancreas, is a fairly common organ for extra-nodal involvement as a secondary site.

Diagnostic Criteria for Pancreatic Lymphoma

There are three criteria in order to diagnose PPL. They are:

1. No lymph node enlargement of superficial or mediastinal lymph nodes;
2. A normal leukocyte count in the peripheral blood;
3. No involvement of the liver or spleen.

Symptoms of Pancreatic Lymphoma

Signs and symptoms of PPL are generally non-specific, meaning they could indicate many things in addition to PPL. A person could experience abdominal pain of variable severity and small bowel obstruction, along with the constellation of B symptoms, including loss of appetite, unexplained weight loss, fatigue, and night sweats.

Furthermore, patients with pancreatic lymphoma tend to have normal white blood cell counts. A trademark of the disease from the laboratory perspective is elevated LDH.

Treatment and Prognosis for Pancreatic Lymphoma

Treatment for PPL can include surgery (surgical resection), combination chemotherapy, or sometimes radiation along with chemotherapy. Studies suggest that when treated with chemotherapy, prognosis for PPL is very good.

Sources

• Peisman M et al. A Case of Pancreatic Lymphoma Medscape General Medicine.
• Kav T et al. Primary Pancreatic Lymphoma or Secondary Involvement: What Is the Difference? JOP. J Pancreas (Online)
• Nayer H et al. Primary pancreatic lymphomas: a cytopathologic analysis of a rare malignancy Cancer

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