Download PDF
CC BY-NC-ND 4.0 · World J Nucl Med 2020; 19(03): 306-309
DOI: 10.4103/wjnm.WJNM_96_19
Case Report

Primary pancreatic lymphoma camouflaged under the umbrella of spectrum of neuroendocrine tumors in somatostatin receptor imaging

Nikita Sampathirao
Department of Nuclear Medicine and PET/CT, Apollo Hospitals, Chennai, Tamil Nadu, India
,
M Indirani
Department of Nuclear Medicine and PET/CT, Apollo Hospitals, Chennai, Tamil Nadu, India
,
S Shelley
Department of Nuclear Medicine and PET/CT, Apollo Hospitals, Chennai, Tamil Nadu, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Primary pancreatic lymphomas are very rare as compared to other pancreatic neoplasms. However, unlike carcinomas, pancreatic lymphoma is treatable with satisfactory cure rates. Somatostatin receptor (SSTR) positron emission tomography/computed tomography (PET/CT) with 68Ga-DOTANOC is a well-established diagnostic modality in the management of neuroendocrine tumors (NETs). Over the years, it has been evident that any neoplasm with SSTR expression shows increased tracer uptake, lymphoma, being the most prominent one. Herein, we report a case of pancreatic mass, suggested as NET on fine-needle aspiration cytology referred to us for staging. Whole-body 68Ga-DOTANOC PET/CT scan showed a large pancreatic mass with peripancreatic nodes, level I cervical nodes, cardiac, and left testicular masses which were initially thought to be possibly metastatic from pancreatic NET. However, immunohistochemistry (IHC) of the specimen was suggestive of B-cell Non-Hodgkin's Lymphoma. The present case emphasizes that pancreatic lymphoma is one of the potential differentials for pancreatic masses apart from NET on SSTR imaging. Noteworthy is the fact, that IHC plays a poignant role in the evaluation and is a mandatory tool for the management of tumors. Moreover, the whole imaging picture and clinical scenario ought to be given utmost importance for giving an affirmative diagnosis on imaging. SSTR expression in lymphomas may further obviate a remote fact that peptide receptor radionuclide therapy can be considered as an end of the line treatment for refractory lymphomas.

Keywords

Pancreatic neuroendocrine tumors - primary pancreatic lymphoma - somatostatin receptor expression in lymphoma - somatostatin receptor imaging

Financial support and sponsorship

Nil.




Publication History

Received: 28 December 2019

Accepted: 29 January 2020

Article published online:
19 April 2022

© 2020. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Baysal B, Kayar Y, Ince AT, Arici S, Türkmen I, Şentürk H. Primary pancreatic lymphoma: A rare cause of pancreatic mass. Oncol Lett 2015;10:1701-3.
  • 2 Ruuska T, Ramírez Escalante Y, Vaittinen S, Gardberg M, Kiviniemi A, Marjamäki P, et al. Somatostatin receptor expression in lymphomas: A source of false diagnosis of neuroendocrine tumor at 68Ga-DOTANOC PET/CT imaging. Acta Oncol 2018;57:283-9.
  • 3 Saif MW. Primary pancreatic lymphomas. JOP 2006;7:262-73.
  • 4 Raderer M, Traub T, Formanek M, Virgolini I, Osterreicher C, Fiebiger W, et al. Somatostatin-receptor scintigraphy for staging and follow-up of patients with extraintestinal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT)-type. Br J Cancer 2001;85:1462-6.
  • 5 Merkle EM, Bender GN, Brambs HJ. Imaging findings in pancreatic lymphoma: Differential aspects. AJR Am J Roentgenol 2000;174:671-5.
  • 6 Lewis RB, Lattin GE Jr., Paal E. Pancreatic endocrine tumors: Radiologic-clinicopathologic correlation. Radiographics 2010;30:1445-64.
  • 7 Cormio L, Sanguedolce F, Massenio P, Di Fino G, Bruno M. Testicular metastasis as the first clinical manifestation of pancreatic adenocarcinoma: A case report. J Med Case Rep 2015;2015:139-41.
  • 8 Dalm VA, Hofland LJ, Mooy CM, Waaijers MA. Somatostatin Receptors in Malignant Lymphomas: Targets for Radiotherapy?. J Nucl Med 2004;45:8-16.