Diffuse Large B-Cell Lymphoma With Striking Intrasinusoidal Pseudoglandular Growth Pattern as a Diagnostic Dilemma Mimicking Metastatic Poorly Differentiated Pancreatic Adenocarcinoma in an Intraabdominal Lymph Node

Abstract

A 66-year-old woman with no significant medical history presented with acute-onset abdominal pain for 10 days and diffuse jaundice involving the conjunctiva, oral mucosa, and skin for 3 to 4 days. Initial laboratory studies demonstrated total bilirubin of 12.1 mg/dL, aspartate aminotransferase of 179 U/L, alanine aminotransferase of 180 U/L, and alkaline phosphatase of 959 U/L. An abdominal ultrasound scan showed common bile duct dilatation of 1.4 cm and pancreatic duct dilatation of 3.0 cm. A computed tomography scan of the abdomen-pelvis was performed, which showed severe intrahepatic and extrahepatic biliary dilatation and pancreatic ductal dilatation as well as extensive periportal, retroperitoneal, and mesenteric lymphadenopathy suspicious for an occult periampullary malignancy, as no tumor was identified. A computed tomography scan of the chest showed numerous bilateral ground-glass and solid pulmonary nodules within all lung lobes measuring up to 5 mm in greatest dimension. An endoscopic retrograde cholangiopancreatography was performed, which demonstrated a giant periampullary diverticulum with a high-grade distal biliary stricture. A sphincterotomy was performed, cytologic brushings were obtained, and the stricture was stented. On pathology, the brushing demonstrated ductal epithelial cells with mild atypia.

Plastin-3 is a diagnostic and prognostic marker for pancreatic adenocarcinoma and distinguishes from diffuse large B-cell lymphoma

“…Similarly to stage-matched DLBCL in the other organs, the condition can be treated with CHOP chemotherapy, which achieves equivalent outcomes [ 8 ]. One previous case report described the challenges in diagnosing DLBCL with an intra-sinusoidal pseudoglandular growth that mimicked poorly differentiated metastatic PDA in an intra-abdominal lymph node [ 38 ]. It is difficult to differentiate these DLBCLs from PDA [ 39 , 40 ].…”

The clinicopathological and molecular features of sinusoidal large B-cell lymphoma

“…Their study highlighted the distinctiveness of A-DLBCL with a sinusoidal pattern [4]. However, only limited genetic information has been reported in previous studies describing these tumors [5][6][7][8][9][10].…”