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. 1989 Jan;209(1):25–30. doi: 10.1097/00000658-198901000-00003

Pancreatic lymphoma. Is surgery mandatory for diagnosis or treatment?

T H Webb 1, K D Lillemoe 1, H A Pitt 1, R J Jones 1, J L Cameron 1
PMCID: PMC1493876  PMID: 2910212

Abstract

From 1982 to 1986, nine patients with non-Hodgkin's lymphoma primarily involving the pancreas were managed at the Johns Hopkins Medical Institutions. This group of nine patients represents 2.2% of patients with non-Hodgkin's lymphoma (nine of 402) and 4.9% of all patients presenting with pancreatic malignancies (nine of 182) at the Johns Hopkins Medical Institutions during this period. Computed tomography (CT) scan findings of a large pancreatic mass (6 cm) with extrapancreatic extension and significant retroperitoneal lymph node enlargement suggested lymphoma. Diagnosis was established by radiographically-guided needle biopsy in four patients, by laparotomy in four, and by peripheral lymph node biopsy in one. In five jaundiced patients, initial chemotherapy with the nonhepatotoxic agents cyclophosphamide and prednisone resulted in marked tumor regression, allowing for early resolution of jaundice and subsequent addition of more aggressive adriamycin containing combination chemotherapy. Overall, complete remission has occurred in six of nine patients, with a median survival of 24 months (range 4-69 months). It is concluded from this experience that the majority of patients with pancreatic lymphoma can be managed without surgery. Excellent control of symptoms, including jaundice, as well as long-term remission, can be obtained with chemotherapy alone. The only role for surgery in this setting may be to aid in establishing the diagnosis when percutaneous biopsy is nondiagnostic.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALLEN A. W., DONALDSON G., SNIFFEN R. C., GOODALE F., Jr Primary malignant lymphoma of the gastro-intestinal tract. Ann Surg. 1954 Sep;140(3):428–438. doi: 10.1097/00000658-195409000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ackerman N. B., Aust J. C., Bredenberg C. E., Hanson V. A., Jr, Rogers L. S. Problems in differentiating between pancreatic lymphoma and anaplastic carcinoma and their management. Ann Surg. 1976 Dec;184(6):705–708. doi: 10.1097/00000658-197612000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Boddie A. W., Jr, Eisenberg B. L., Mullins J. D., Schlichtemeier A. L. The diagnosis and treatment of obstructive jaundice secondary to malignant lymphoma: a problem in multidisciplinary management. J Surg Oncol. 1980;14(2):111–123. doi: 10.1002/jso.2930140204. [DOI] [PubMed] [Google Scholar]
  4. Chabner B. A., Johnson R. E., Young R. C., Canellos G. P., Hubbard S. P., Johnson S. K., DeVita V. T., Jr Sequential nonsurgical and surgical staging of non-Hodgkin's lymphoma. Ann Intern Med. 1976 Aug;85(2):149–154. doi: 10.7326/0003-4819-85-2-149. [DOI] [PubMed] [Google Scholar]
  5. Coller B. S., Chabner B. A., Gralnick H. R. Frequencies and patterns of bone marrow involvement in non-Hodgkin lymphomas: observations on the value of bilateral biopsies. Am J Hematol. 1977;3:105–119. doi: 10.1002/ajh.2830030201. [DOI] [PubMed] [Google Scholar]
  6. DeVita V. T., Jr, Canellos G. P., Chabner B., Schein P., Hubbard S. P., Young R. C. Advanced diffuse histiocytic lymphoma, a potentially curable disease. Lancet. 1975 Feb 1;1(7901):248–250. doi: 10.1016/s0140-6736(75)91142-3. [DOI] [PubMed] [Google Scholar]
  7. Dick F., Bloomfield C. D., Brunning R. D. Incidence cytology, and histopathology of non-Hodgkin's lymphomas in the bone marrow. Cancer. 1974 May;33(5):1382–1398. doi: 10.1002/1097-0142(197405)33:5<1382::aid-cncr2820330525>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  8. Erwin B. C., Brynes R. K., Chan W. C., Keller J. W., Phillips V. M., Gedgaudas-McClees R. K., Torres W. E., Bernardino M. E. Percutaneous needle biopsy in the diagnosis and classification of lymphoma. Cancer. 1986 Mar 1;57(5):1074–1078. doi: 10.1002/1097-0142(19860301)57:5<1074::aid-cncr2820570535>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  9. Freeman C., Berg J. W., Cutler S. J. Occurrence and prognosis of extranodal lymphomas. Cancer. 1972 Jan;29(1):252–260. doi: 10.1002/1097-0142(197201)29:1<252::aid-cncr2820290138>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  10. Goffinet D. R., Warnke R., Dunnick N. R., Castellino R., Glatstein E., Nelsen T. S., Dorfman R. F., Rosenberg S. A., Kaplan H. S. Clinical and surgical (laparotomy) evaluation of patients with non-Hodgkin's lymphomas. Cancer Treat Rep. 1977 Sep;61(6):981–992. [PubMed] [Google Scholar]
  11. Hande K. R., Fisher R. I., DeVita V. T., Chabner B. A., Young R. C. Diffuse histiocytic lymphoma involving the gastrointestinal tract. Cancer. 1978 May;41(5):1984–1989. doi: 10.1002/1097-0142(197805)41:5<1984::aid-cncr2820410544>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  12. Hart M. J., White T. T., Brown P. C., Freeny P. C. Potentially curable masses in the pancreas. Am J Surg. 1987 Jul;154(1):134–136. doi: 10.1016/0002-9610(87)90303-5. [DOI] [PubMed] [Google Scholar]
  13. Hu E., Horning S., Flynn S., Brown S., Warnke R., Sklar J. Diagnosis of B cell lymphoma by analysis of immunoglobulin gene rearrangements in biopsy specimens obtained by fine needle aspiration. J Clin Oncol. 1986 Mar;4(3):278–283. doi: 10.1200/JCO.1986.4.3.278. [DOI] [PubMed] [Google Scholar]
  14. Jones S. E., Rosenberg S. A., Kaplan H. S. Non-Hodgkin's lymphomas. I. Bone marrow involvement. Cancer. 1972 Apr;29(4):954–960. doi: 10.1002/1097-0142(197204)29:4<954::aid-cncr2820290442>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  15. Lee J. K., Stanley R. J., Sagel S. S., Levitt R. G. Accuracy of computed tomography in detecting intraabdominal and pelvic adenopathy in lymphoma. AJR Am J Roentgenol. 1978 Aug;131(2):311–315. doi: 10.2214/ajr.131.2.311. [DOI] [PubMed] [Google Scholar]
  16. ROSENBERG S. A., DIAMOND H. D., JASLOWITZ B., CRAVER L. F. Lymphosarcoma: a review of 1269 cases. Medicine (Baltimore) 1961 Feb;40:31–84. doi: 10.1097/00005792-196102000-00002. [DOI] [PubMed] [Google Scholar]
  17. Reed K., Vose P. C., Jarstfer B. S. Pancreatic cancer: 30 year review (1947 to 1977). Am J Surg. 1979 Dec;138(6):929–933. doi: 10.1016/0002-9610(79)90324-6. [DOI] [PubMed] [Google Scholar]
  18. Rosenfelt F., Rosenberg S. A. Diffuse histiocytic lymphoma presenting with gastrointestinal tract lesions. The Stanford experience. Cancer. 1980 Apr 15;45(8):2188–2193. doi: 10.1002/1097-0142(19800415)45:8<2188::aid-cncr2820450830>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  19. Russell J., Orell S., Skinner J., Seshadri R. Fine needle aspiration cytology in the management of lymphoma. Aust N Z J Med. 1983 Aug;13(4):365–368. doi: 10.1111/j.1445-5994.1983.tb04482.x. [DOI] [PubMed] [Google Scholar]

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