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BMJ Case Reports 2017; doi:10.1136/bcr-2017-222643
  • Unusual presentation of more common disease/injury
  • CASE REPORT

Acute pancreatitis as an unusual presentation of primary splenic lymphoma

  1. Luis Tomé2
  1. 1Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  2. 2Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Elisa Gravito-Soares, es18497{at}gmail.com
  • Accepted 28 September 2017
  • Published 10 October 2017

Summary

A 51-year-old man with no relevant medical history presents to the emergency department complaining of a recent worsening of few months upper abdominal pain with back radiation and postprandial fullness, without B symptoms. Laboratory analysis showed hyperamylasaemia, elevated lactate dehydrogenase and inflammatory parameters. Abdominal ultrasonography revealed a heterogeneous solid mass in the spleen/splenic hilum with pancreatic parenchyma continuity and no biliary tract dilation or gallstones. A mild acalculous acute pancreatitis diagnosis was made. Abdominopelvic CT revealed a large heterogeneous mass infiltrating the spleen and pancreas and obstructing the common bile duct at the pancreatic level with upstream dilation of biliary and pancreatic ducts, with splenic vein invasion. Several necrotic, peripancreatic and hepatic hilar adenopathies were also observed. Ultrasound-guided biopsy showed a primary splenic diffuse large B-cell non-Hodgkin’s lymphoma. Chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) was performed with lack of response and the patient died within 10 months of diagnosis onset.

Footnotes

  • Contributors EGS and MGS contributed equally in writing the manuscript and reviewing the literature. EGS is the article guarantor. JEPC and LT reviewed the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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