Carlos Marra-López Valenciano, Tania Hernaez Alsina, Maria Begoña Atares,Virginia Moreno Nieto, Leire Urtasun Arlegui, Francisco J Zozaya-Larequi, Ana Belen Fernandez Laso, Daniela Fernández de la Hoz Múgica, Carlos Enciso Coloma, Begoña Sacristan Terroba, Aitor Orive-Calzada
Context Non-Hodgkin's lymphoma is a common complication in HIV-patients that most frequently affects the gastrointestinal tract. Primary pancreatic lymphomas and Burkitt Lymphoma involving the pancreas are uncommon. It is important to recognize them because can mimic an adenocarcinoma or pancreatitis, but their management is completely different. Case report We report a case of a forty-seven-year-old man who presented with an AIDS-related Burkitt Lymphoma with acute pancreatitis as initial manifestation. Initially patient was admitted with abdominal pain and high amylase levels. Computed tomography imaging was suggestive of acute pancreatitis. Later was found to be human immunodeficiency virus seropositive. 4-weeks later, a control computed tomography scan revealed growth of a well-defined large pancreatic mass, with diffuse enlargement of the gland, and a normal-appearing pancreatic duct. Consequently an endoscopic ultrasound-guided fine needle aspiration was performed with a 19-gauge needle and revealed a proliferation of medium lymphocytes, inconspicuous cytoplasm and frequent mitosis. The lymphocytes were positive for CD20 and CD10. The Ki-67 labeling index was almost 80%. BCL-2 and MYC FISH molecular analysis was performed and confirmed t(8;14)(q24;q32). On the basis of these results, pancreatic Burkitt's lymphoma was diagnosed. Positive emission tomography scan completed staging and showed uptake in the pancreas and multiple metastasis. Accordingly patient received chemotherapy by PHETEMA BURKIMAB protocol, obtaining complete remission. Conclusion Pancreatic Lymphoma should be considered in differential diagnosis of pancreatic masses. EUS-FNA including flow cytometry and molecular analysis are useful techniques that may help to establish early diagnosis and prompt treatment avoiding unnecessary surgery.
