SHM Converge Scientific Abstract ePoster Gallery-Diffuse Large B Cell Lymphoma Masquerading as Pancreatic Cancer

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This case describes a 73-year-old man whose new jaundice, abdominal pain, decreased appetite, and weight loss initially raised concern for pancreatic cancer. His labs showed cholestatic liver injury and elevated CA 19-9, and CT imaging suggested an infiltrative mass arising from the pancreatic head with biliary obstruction and surrounding lymphadenopathy. He was referred for surgical evaluation as a presumed pancreatic malignancy.<br /><br />However, further workup changed the diagnosis. Endoscopic ultrasound and ERCP showed that the “pancreatic mass” was actually a conglomeration of lymph nodes. After he developed atrial fibrillation with rapid ventricular response, CT angiography also revealed axillary lymphadenopathy. Biopsies from both abdominal and axillary nodes confirmed diffuse large B-cell lymphoma (DLBCL) and showed no carcinoma. A percutaneous biliary drain improved liver function tests, and the patient was started on Pola-R-CHP chemotherapy.<br /><br />The report emphasizes that DLBCL is the most common type of non-Hodgkin lymphoma and often presents as a rapidly enlarging mass in the neck, abdomen, or mediastinum. Although B symptoms occur in only about 30% of patients, DLBCL can present atypically, including as extranodal disease. This case highlights the importance of keeping lymphoma in the differential diagnosis for pancreatic or gastrointestinal masses, even when tumor markers such as CA 19-9 are elevated. CA 19-9 is not specific for pancreatic cancer and may also rise in benign conditions like cholestasis or pancreatitis. Careful multidisciplinary evaluation and tissue diagnosis are essential to avoid delayed or incorrect treatment.

Asset Subtitle

Matthew Onders

Meta Tag

Author List Jay Anderson, Matthew Onders

Category Clinical Vignettes

Concept Diffuse Large B-Cell Lymphoma

Concept Tissue Diagnosis

Concept Pancreatic Mass

Concept Abdominal Mass

Concept Pancreatic Cancer

Distinguished Non-Finalist

Presenter Organization OhioHealth Riverside Methodist Hospital

Presenting Author Matthew Onders

Track Adult

Keywords

diffuse large B-cell lymphoma

DLBCL

pancreatic mass

jaundice

CA 19-9

biliary obstruction

lymphadenopathy

ERCP

endoscopic ultrasound

Pola-R-CHP

Diffuse Large B-Cell Lymphoma

Tissue Diagnosis

Pancreatic Mass

Abdominal Mass

Pancreatic Cancer