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(A) Contrast enhanced axial, and (B) Coronal CT scan demonstrates a hypodense mass within the proximal pancreatic body (star). Pancreatic duct is minimally dilated despite the large size of mass (arrow).
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A contrast enhanced CT (CECT) of the abdomen and pelvis was performed with series obtained in the late arterial and delayed phases, revealing a large hypodense lesion centered within the junction of the neck/body of the pancreas with mild dilation of the pancreatic duct (Fig. 1).
Targeted US shows a complex avascular cystic lesion (star) surrounded by thick soft tissue rim (arrow).
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Upon admission to the referring hospital, an abdominal US demonstrated a complex avascular cystic lesion surrounded with thick soft tissue rim (Fig. 2).
(A-B) Axial T1W MR Images shows corresponding hypointense lesion (star) in the pancreas. Lesion appears heterogeneous on T2W images and demonstrates intermediate signal intensity; (C) Axial post contrast fat suppressed T1W image shows mild enhancement; (D) Extensive mesenteric lymphadenopathy surrounding SMA (arrows).
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T2W intermediate lesion corresponding to the cyst seen on US (Fig. 3). There was associated mild dilatation and irregularity of the upstream main pancreatic duct. There were multiple enlarged peripancreatic, periportal, and mesenteric lymph nodes with a conglomerate surrounding the superior mesenteric artery (SMA) (Fig. 3).
(A-B) Axial DWI and corresponding ADC images demonstrate heterogeneous areas of diffusion restriction within the primary mass (star); (C-D) The mesenteric lymphadenopathy demonstrates definitive diffusion restriction (arrows).
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However, the mesenteric lymphadenopathy demonstrated definitive and homogenous diffusion restriction (Fig. 4).
The cell block from the pancreatic neck mass fine needle aspiration shows a neoplastic cell population with increased nuclear to cytoplasmic ratio and marked pleomorphism. Scattered, enlarged, horseshoe-shaped cells (hallmark cells) are present (arrow) and are commonly found in anaplastic large cell lymphomas (400x).
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(A) Pretreatment Coronal fused PET image demonstrates uptake in the region of pancreatic mass (star) and mesenteric adenopathy (adenopathy); (B) PET following once cycle of EPOCH demonstrating complete functional response.
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PET revealed increased FDG uptake corresponding with the pancreatic lymphoma and adjacent lymphadenopathy (Fig. 7).