An Aggressive Primary Retroperitoneal Diffuse Large B-Cell Lymphoma Mimicking a Pancreatic Neoplasm, Presenting as Duodenal Stenosis
An Aggressive Primary Retroperitoneal Diffuse Large B-Cell Lymphoma Mimicking a Pancreatic Neoplasm, Presenting as Duodenal Stenosis
复制标题
DOI：
10.7860/jcdr/2017/27222.10611
复制
发表时间：
2017-09-01
影响因子：
0.2
通讯作者：
Pavithra, B.
中科院分区：
文献类型：
--
作者：
Ravindhran, Bharadhwaj;Prakash, Clement;Pavithra, B.
弥漫性大B细胞淋巴瘤（DLBCL）是非霍奇金淋巴瘤（NHL）最常见的组织学亚型。原发性腹膜后弥漫性大B细胞淋巴瘤是一种罕见的疾病，很少有报道。由于源自腹膜后的病变而导致的十二指肠的外源性压迫也是罕见的。我们报告一例39岁男性患者，因腹膜后巨大DLBCL导致十二指肠外源性压迫，出现无法耐受口服、腹痛、上腹部肿块和餐后胆汁性呕吐。压迫的原因最初推测是胰腺或十二指肠钩突产生的肿瘤，因为它靠近钩突并且十二指肠C环明显增宽。由于肿块大小迅速增加，肿瘤标志物如癌抗原（CA）19-9、癌胚抗原（CEA）水平正常，尽管肿块较大，但无黄疸迹象，因此进行了重复计算机断层扫描（CT）扫描。结果显示胰腺钩突被包裹，胰腺实质未受累，因此与胰腺肿瘤相似。肿瘤性淋巴细胞的白细胞共同抗原（LCA）、分化簇（CD）20、CD 10、B细胞淋巴瘤2（Bcl-2）呈阳性，肌酸激酶（CK）、CD 23、CD 30、间变性淋巴瘤激酶（ALK）和细胞周期蛋白D1、D3和D5呈阴性。Ki 67增殖指数大于95%。腹膜后DLBCL虽然罕见，但在十二指肠梗阻病例中应考虑。
Diffuse Large B-Cell Lymphoma (DLBCL) is the most common histological subtype of Non-Hodgkin's Lymphoma (NHL). Primary retroperitoneal DLBCL is uncommon and has seldom been reported. Extrinsic compression of the duodenum due to lesions originating from the retroperitoneum is also rare. We present a case of a 39-year-old man who presented with inability to tolerate oral intake, abdominal pain, an upper abdominal mass and postprandial bilious vomiting caused by a large DLBCL arising from the retroperitoneum causing extrinsic compression of the duodenum. The cause of compression was initially presumed to be a neoplasm arising from the uncinate process of the pancreas or duodenum because of its proximity to the uncinate process and apparent widening of the C loop of duodenum. Repeat Computed Tomography (CT) scans were obtained because of the rapid increase in the size of the mass, normal levels of tumour markers such as Cancer Antigen (CA) 19-9, Carcinoembryonic Antigen (CEA) and no evidence of jaundice in spite of the large size of the mass. It revealed encasement of the uncinate process of pancreas with no involvement of parenchyma of the pancreas, thereby mimicking a pancreatic tumour. The neoplastic lymphoid cells were positive for Leukocyte Common Antigen (LCA), Cluster of Differentiation (CD) 20, CD10, B-cell Lymphoma 2 (Bcl-2) and were negative for Creatine Kinase (CK), CD23, CD30, Anaplastic Lymphoma Kinase (ALK) and cyclin D1, D3 and D5. The Ki67 proliferative index was greater than 95%. Retroperitoneal DLBCL although rare should be considered in cases of duodenal obstruction.