Bradley Aaron Cagle, Brenda L

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Volume 154, Issue 2, Pages (August 2019)

Presentation transcript:

Knife wielding radiologist: A case report of primary pancreatic lymphoma Bradley Aaron Cagle, Brenda L. Holbert, Stephanie Wolanin, Rafel Tappouni, Neeraj Lalwani European Journal of Radiology Open Volume 5, Pages 141-146 (January 2018) DOI: 10.1016/j.ejro.2018.08.007 Copyright © 2018 The Authors Terms and Conditions

Fig. 1 (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). European Journal of Radiology Open 2018 5, 141-146DOI: (10.1016/j.ejro.2018.08.007) Copyright © 2018 The Authors Terms and Conditions

Fig. 2 Targeted US shows a complex avascular cystic lesion (star) surrounded by thick soft tissue rim (arrow). European Journal of Radiology Open 2018 5, 141-146DOI: (10.1016/j.ejro.2018.08.007) Copyright © 2018 The Authors Terms and Conditions

Fig. 3 (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). European Journal of Radiology Open 2018 5, 141-146DOI: (10.1016/j.ejro.2018.08.007) Copyright © 2018 The Authors Terms and Conditions

Fig. 4 (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). European Journal of Radiology Open 2018 5, 141-146DOI: (10.1016/j.ejro.2018.08.007) Copyright © 2018 The Authors Terms and Conditions

Fig. 5 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 (400×). European Journal of Radiology Open 2018 5, 141-146DOI: (10.1016/j.ejro.2018.08.007) Copyright © 2018 The Authors Terms and Conditions

Fig. 6 Immunoperoxidase studies on the cell block material demonstrates the pleomorphic neoplastic cells are strongly positive for ALK (A, 100×) and CD30 (B, 100×) with no expression of cytokeratin AE1/AE3 (C, 100×) and CD3 (D, 100×) which is consistent with an anaplastic large cell lymphoma. Additional molecular cytogenetic studies revealed a t(2;5) NPM/ALK fusion gene, found in 30–50% of anaplastic large cell lymphomas. European Journal of Radiology Open 2018 5, 141-146DOI: (10.1016/j.ejro.2018.08.007) Copyright © 2018 The Authors Terms and Conditions

Fig. 7 (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. European Journal of Radiology Open 2018 5, 141-146DOI: (10.1016/j.ejro.2018.08.007) Copyright © 2018 The Authors Terms and Conditions