A 46-year-old patient with a history of hypertension, smoking, psoriasis, presented to the internal medicine service with epigastric discomfort radiating to the right hypochondrium and both renal fossae.
Physical examination revealed no relevant data.
Laboratory tests showed normal blood count, ESR: 89; fibrinogen: 726.07; platelets: 527.000; biochemical tests with PCR: 94, IgG: 1690; C3: 193; PSA Ca4: 46.1; thyroid markers were normal.
Imaging tests reported a tumor in the head of the pancreas suggestive of adenocarcinoma, with signs suggestive of medial duodenal wall adenocarcinoma and superior mesenteric vein.
A bilateral subcostal laparotomy was performed, finding a tumor in the root of the mesentery of about 7-8 cm in diameter that included the outflow of the artery and vein suggestive of lymphomatous process.
Intraoperative ultrasound revealed no tumor lesions in the pancreas.
Histological examination revealed nongranulocyte histiocytic necrotizing lymphadenitis with the presence of Langhans cells in a lymph node at the root of the mesentery.
The patient remains asymptomatic at 24 months of follow-up, with negative radiological study.
