PMC3075159_01
Baseline multidetector computer tomography. a Mass of the head of the pancreas. b Dilatation of the main pancreatic duct due to the head pancreatic mass.
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F1
Computer tomography confirmed the echographic findings and also showed involvement of the duodenum, superior mesenteric artery, and splenic and portal veins; the lesion remained hypodense after contrast medium injection (fig. 1).
a Pancreatic tissue with lymphoid aggregates and fibrotic bundles (haematoxylin-eosin, original magnification 100x). b Lymphoid nodules contain small lymphocytes with rare mast cells and plasma cells (Giemsa stain, original magnification 200x).
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F2
The latter was organized in aggregates, mostly composed of small lymphocytes with regular nuclear profile and partially arranged in reactive looking follicles with prominent germinal centres; few mast cells and eosinophils were interspersed, while plasma cells were rare and located around the lymphoid foci (fig. 2).
a CD3 staining in the follicle (EnVision++, original magnification 200x). b CD20 positivity in the same follicle (EnVision++, original magnification 200x). c Ki-67 staining: high proliferation index in the germinal centre (EnVision++, original magnification 200x). d Bcl-2 negativity in the germinal centre (APAAP, original magnification 400x).
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F3
Immunohistochemistry proved the mixed reactive nature of the intra-pancreatic lymphoid infiltrate (CD3-/+, CD20+/-) with benign follicular structures that strongly expressed CD20, Bcl-6 and CD10, but not Bcl-2 (fig. 3) with high proliferation index in the germinal centres (Ki-67/Mib1), as expected.
Multidetector computer tomography carried out six months after steroid treatment showing the normalization of the pancreatic gland.
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F4
Six months after steroid treatment, the patient was in good general condition and the contrast enhanced CT showed a complete disappearance of the pancreatic mass (fig. 4).