Ultrasound Journal 7 - ?? ??? ?? ???(Rare Primary Pancreatic Lymphoma)? ??? ?? ??? ??(CEUS) ??

2022-11-15

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? ??? ?????(Primary Pancreatic lymphoma)? ???? ??? ?? ???????.
CEUS??? ??? ?????(PPL) ??? ??? ??? ? ? ????.

Case Description:

64?? ? ??? ?? ?? ???(left upper quadrant) ???? ????? ????? ??? ????? ??? B ?? ???? "???? ????? ???(heterogeneous hypoechogenicit) ? ?? ?? ?? ?? "? ?????. ?? ??? ?????? ??? CT? MRI ??? ?? ?? ?? ????, ??, ?? ?? ???????. ???? ???? ? ?, ?? ??, ?????(TMs) ??? ?? ???????. ??? ?? Zhejiang ?? ???? ?2 ?????? ??? ?? ??? ?????.

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??? US, CEUS, CT ? ?? PET/CT ??? ???? ? ??? Fig 1-3? ????.

??1: B-?? ??? ????? ????(splenic parenchyma)? ???? ???(splenic hilum)? ??? ???? ??(heterogeneous mass)? ?? ??(pancreatic tail)???? ??? ?? ???? ??(heterogeneous pancreas)? ???????. (Fig 1 A). ????? ??(Color Doppler imaging ; CDI) ? ?? ??(mass)? ??? ????? (Fig 1 B). ?? ??(pancreatic mass)? ??? CEUS ??? ???(arterial phase)?? ???? ????(heterogeneous hyperenchancement)? ???(delayed phase)?? ?? ??(rapid fading)? ?? ??(sieve-like) ??? ???? ????. (Fig 1 C-F)

??2: CT ???? ?? ?? ??? ??? ?? ??(pancreatic tail)?? ???? ??, ??(spleen)?? ??? ???? ???? ?? ???(splenic hilum), ?? ?? ??? ?? ??? ?? ???. (Fig 2 A). ??? ???? ?? ??? ??? ?? (Fig 2 B-C). ??(spleen), ?? ?? ? ??(intestinal tract) ??? ?? ??? ???(coronal plane)?? ???. (Fig 2 D)

??3: ?? PET/CT?? ????(pancreatic tail), ??, ?? ??, ?? ??(splenorenal space), ?? ? ??(splenogastric space)? ??? ??(soft tissue masses )? ?????? ??? ??? ??? ?? ???

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?? ?? ??? ??????? ????(nonspecific) ??? ???(primary pancreatic cancer)?? ????? ??? ?? ???(primary pancreatic lymphoma)? ?????(Burkitt lymphoma)? ???? ??? ?? ?? ??(pancreatic mass)? ?? ???????(ultrasound guided biopsy)? ???????.

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??? ?????? R-Hyper-CVAD-A ????? ???? ??? CT ??? ?? ?? ??? ??? ??? ?? ?? ? ? ????. (Fig 4 A-C). ??? ???? ??? ?? ??? ??????.

??4. ??? CT?? ?? ??? ?? ???(A) ?? ? (B) ?????? 1?? ?, (C) ???? ?? 2?? ?

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??? ?????? ?? ?? ? ?? ???? ?????? ?? ?? ?? ? 0.5%, ?? ???????(extranodal lymphomas )? 2%? ?????. [1] ????? ??? ??? ????(non-specific)?? ????? ???(pancreatic ductal adenocarcinoma) ? ?? ?? ????? ???? ?? ??? ???? ??????^[2].

?? ????, Resona ???? ??? CEUS ???? Pintong ??? ?? ?? ? ?? ??? ?? ???? ??? ???? ???? ? ?????. ? ????, CEUS ???(delayed phase)? ?? ??(sieve-like) ??? ??? ??? ?? ???? CEUS ??? ??? ?? ???? CEUS ??? ??? ??? ? ? ????. ?? ??? ??? ????(Ultra-guided biopsy) ?? ??? ???(exploratory laparotomy)? ?? ?????? ??(histopathological examination)? ?? ??? ? ????.

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[1] K Blouhos, K A Boulas, A Paraskeva, et al. Obstructive jaundice as primary presentation of a stage IIE Non-Hodgkin lymphoma: A decision making process between advanced lymphoma and locally advanced/metastatic pancreatic adenocarcinoma [J]. International Journal of Surgery Case Reports. 2018,44:226-229.
[2] Han Huan, Wang Yuanchen, Zheng Jianming. A nine-case report of clinicopathological analysis of primary pancreatic lymphoma [J]. Chinese Journal of Pancreatology, 2018,18(1):51-53.