DIAGNOSIS, SURGICAL INTERVENTION, AND PROGNOSIS OF PRIMARY PANCREATICLYMPHOMA

Primary pancreatic lymphoma is a rare but treatable malignancy that ma y present as an isolated pancreatic mass. Most of these patients are a ssumed to have ductal malignancies of the pancreas and are denied surg ical intervention. Controversy exists concerning the method of diagnos is and the need for and extent of surgical intervention for these mali gnancies. Over the past 15 years, from 1976-1991, we have treated seve n patients with pancreatic lymphoma who initially presented with a pan creatic mass. There were five females and two males ranging in age fro m 60-86 years (XBAR = 68). All patients were symptomatic and complaine d of epigastric pain, jaundice, anorexia, or early satiety. The interv al between onset of symptoms and treatment averaged 6 weeks. Over half of these patients presented with an epigastric mass and/or jaundice. Abdominal CT scan was accurate in identifying and localizing the pancr eatic mass in all patients. The diameter of the pancreatic mass ranged from 3-12 cm (XBAR = 8.1 cm) and the mass was located in the head of the pancreas in five patients. All attempted percutaneous needle biops ies of the pancreatic mass were non-diagnostic. Operative lymph node b iopsy or transduodenal/wedge biopsy of the pancreatic mass was success ful in demonstrating pancreatic lymphoma in all patients. Two of the s even patients underwent biliary bypass. One of the seven patients died in the postoperative period. Three of these seven patients received c hemotherapy and survived an average of 6.3 years. One patient is alive 8 years after diagnosis and treatment and is currently asymptomatic. Patients who did not receive postoperative chemotherapy survived an av erage of 5 months. In conclusion, the diagnosis of pancreatic lymphoma should be considered in older, symptomatic patients with a large panc reatic mass. Patient age, tumor size, palpable mass, and duration of s ymptoms may facilitate the differentiation of pancreatic lymphoma from ductal tumors of the pancreas. Operative intervention may be necessar y to obtain an accurate diagnosis, which may affect the treatment and prognosis of this disease. Biliary bypass and/or postoperative chemoth erapy seemed to improve outcome and survival in this patient populatio n.