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18F-FDG PET/CT showed increased glucose metabolism in a larger lesion in the head of pancreas (Figure 1A), as well as in one more smaller area in the tail of the pancreas (pointed by the arrow) and in one lymph node in the hepato-gastric ligament (Figure 1B).
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Fluorine-18-Fluoro-deoxy-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed using a hybrid scanner (Philips Gemini GXL) and showed increased glucose metabolism in the known lesion in the head of pancreas (Figure 1A), as well as in one more smaller area in the tail of pancreas and in one lymph node in the hepato-gastric ligament (Figure 1B).
A) Endoscopic ultrasound (EUS) of the pancreatic lesion; B) hematoxylin and eosin staining of pancreatic bioptic specimen; C) CD20 immunostaining; D) BCL-6 immunostaining.
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CD20, PAX-5, CD10, BCL-6 and MIB-1 proliferative index of 70%, suggestive of Diffuse Large B Cell Lymphoma (DLBCL) of the pancreas (Figure 2). Considering the extensive and multifocal pancreatic involvement associated with the involvement of peripancreatic lymph nodes, the final diagnosis was primary pancreatic DLBCL, stage IVEA, age-adjusted International Prognostic Index (I.P.I.) 2 (stage IV, elevated LDH).