case_images: PMC10702951_01
case_images: Imaging results of the abdomen. The results of CT showed a pancreatic head mass (size approximately 8.6 x 7.1 cm) (A), with intrahepatic metastasis, ascitic fluid (B); multiple enlarged peripancreatic and retroperitoneal lymph nodes, ascitic fluid (C); and dilatation of intrahepatic bile duct (D).
case_images: fonc-13-1294385-g001.jpg
case_images: PMC10702951_01_fonc-13-1294385-g001.jpg
case_images: f1
case_images: CT also showed multiple enlarged peripancreatic and retroperitoneal lymph nodes, possible peritonitis, gallbladder cholestasis, dilatation of intrahepatic bile duct, unclear display of extrahepatic bile duct, and fluid in both the abdomen and pelvis ( Figure 1 ).
case_images: The results of MRI+MRCP showed that the tumor contained blood vessels (A) and biliary obstruction (B). MRCP, magnetic resonance cholangiopancreatography.
case_images: fonc-13-1294385-g002.jpg
case_images: PMC10702951_01_fonc-13-1294385-g002.jpg
case_images: f2
case_images: The gallbladder was slightly enlarged, the intrahepatic and extrahepatic bile ducts were slightly dilated, and the lower segment of the common bile duct was unclear ( Figure 2 ).
case_images: The gastroscope showed a submucosal uplift in the fundus of the stomach (A). Endoscopic ultrasound showed phrenogastric ligament (B) and multiple hypoechoic masses in the liver (C) and a mixed rising mass in the head of the pancreas with poorly defined boundaries. The measured cross-sectional size of the mass was 4.9 cm x 4.8 cm (D).
case_images: fonc-13-1294385-g003.jpg
case_images: PMC10702951_01_fonc-13-1294385-g003.jpg
case_images: f3
case_images: The pancreatic duct was not dilated, and the parenchymal echo of the pancreatic body and tail was uniform ( Figure 3 ).
case_images: Pancreas biopsy (H&E staining, 20-fold) (A). Immunohistochemical CD20 staining showed positive tissue cells (EnVision staining, 200-fold) (B). Immunohistochemical CD10 staining showed negative tissue cells (EnVision staining, 200-fold) (C). Immunohistochemical Ki-67 staining showed positive tissue cells (EnVision staining, 200-fold) (D).
case_images: fonc-13-1294385-g004.jpg
case_images: PMC10702951_01_fonc-13-1294385-g004.jpg
case_images: f4
case_images: On October 12, a postoperative puncture biopsy of the pancreatic mass, combined with immunohistochemistry, revealed non-Hodgkin's lymphoma, consistent with DLBCL of central germinal origin ( Figure 4 ). The results of the immunohistochemistry analysis were as follows: Bcl2 (+), Bcl6 (-), CD10 (+), CD20 (+), CD21 (-), CD23 (-), CD3 (-), CD5 (-), CyclinD1 (-), Ki-67 (80% positive), and EBER (-) ( Figure 4 ).