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DOI: 10.1055/s-0034-1377597
Mantle cell lymphoma masked by posttraumatic pancreatic hematoma
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Publication History
Publication Date:
19 November 2014 (online)
Pelvic computed tomography revealed a 15-cm peripancreatic mass in a 73-year-old man undergoing an operation for appendicitis associated with a periappendiceal abscess. The patient had been hospitalized 18 months previously for blunt abdominal trauma sustained during a motor vehicle collision. At that time, hemoperitoneum and a peripancreatic hematoma were diagnosed ([Fig. 1 a]). The hematoma decreased in size within 1 week, and there was no evidence of major pancreatic duct injury; thus, he was managed conservatively. The lesion continued to shrink for 6 months after the injury ([Fig. 1 b]), but the volume had increased at the time of the appendectomy, as shown by computed tomography ([Fig. 1 c]). Endoscopic ultrasound-guided biopsy with a 19-gauge needle (ProCore; Cook Medical, Bloomington, Indiana, USA) was used to identify the lesion. Pathologic examination and immunohistochemical staining of the specimen yielded a diagnosis of mantle cell lymphoma ([Fig. 2 a – c]).
Fig. 1 Evolving peripancreatic lesion. a Abdominal computed tomography immediately after a car accident shows an enhancing peripancreatic mass. b After 6 months, the lesion has shrunk. c A huge peripancreatic mass is incidentally identified following appendectomy 18 months after the injury.
Fig. 2 Pathologic examination and immunohistochemical staining of mantle cell lymphoma. a The specimen contains small lymphocytes with irregular nuclei. b, c Immunohistochemical staining reveals positivity for cyclin D1 and CD5.
Pancreatic injury, which occurs in approximately 5 % of patients who sustain blunt abdominal trauma, is associated with a morbidity rate of up to 45 % and a mortality rate of up to 30 % [1]. Low grade blunt injuries without main pancreatic ductal damage are initially managed nonoperatively rather than through operative exploration and repair [2]. The differentiation between an organizing hematoma and a mass like a lymphoma is not always straightforward [3] [4]. Notably, the mass in this case became smaller during the first 6 months. The mantle cell lymphoma, which presented as a slowly growing mass, was stationary in the early stage, and absorption of the hematoma occurred more quickly than growth of the lymphoma [5].
This case highlights the fact that clinicians should continue observation until a hematoma that has arisen at an unusual site completely disappears. If the behavior of a lesion does not correspond to the patient’s clinical presentation or exhibits an unusual course, the patient must be evaluated to establish the correct diagnosis.
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Competing interests: None
Acknowledgment
This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A100054). The source of the grant had no role in the design, practice, or analysis of the study.
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References
- 1 Subramanian A, Dente CJ, Feliciano DV. The management of pancreatic trauma in the modern era. Surg Clin North Am 2007; 87: 1515-1532
- 2 Lee PH, Lee SK, Kim GU et al. Outcomes of hemodynamically stable patients with pancreatic injury after blunt abdominal trauma. Pancreatology 2012; 12: 487-492
- 3 Iaccarino C, Schiavi P, Crafa P et al. Primary dural lymphoma mimicking a chronic epidural hematoma. Differential diagnosis of two rare conditions. Clin Neurol Neurosurg 2013; 115: 1510-1513
- 4 Dedekam E, Graham J, Strenge K et al. Primary renal lymphoma mimicking a subcapsular hematoma: a case report. J Radiol Case Rep 2013; 7: 18-26
- 5 Argatoff LH, Connors JM, Klasa RJ et al. Mantle cell lymphoma: a clinicopathologic study of 80 cases. Blood 1997; 89: 2067-2078
Corresponding author
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References
- 1 Subramanian A, Dente CJ, Feliciano DV. The management of pancreatic trauma in the modern era. Surg Clin North Am 2007; 87: 1515-1532
- 2 Lee PH, Lee SK, Kim GU et al. Outcomes of hemodynamically stable patients with pancreatic injury after blunt abdominal trauma. Pancreatology 2012; 12: 487-492
- 3 Iaccarino C, Schiavi P, Crafa P et al. Primary dural lymphoma mimicking a chronic epidural hematoma. Differential diagnosis of two rare conditions. Clin Neurol Neurosurg 2013; 115: 1510-1513
- 4 Dedekam E, Graham J, Strenge K et al. Primary renal lymphoma mimicking a subcapsular hematoma: a case report. J Radiol Case Rep 2013; 7: 18-26
- 5 Argatoff LH, Connors JM, Klasa RJ et al. Mantle cell lymphoma: a clinicopathologic study of 80 cases. Blood 1997; 89: 2067-2078