Case History/Examination:
A 63-year-old male with a background of treated DLBCL of the pancreatic head presented to the surgical outpatient clinic of an Australian metropolitan hospital with chronic lethargy, weight loss and deranged liver function tests (LFT) for investigation. He was otherwise well, with no local or systemic symptoms of infection, and denied abdominal pain. On examination, the patient appeared well with vital signs within normal limits, and his abdomen was soft and non-tender.
By way of past medical history, in 2014 he was diagnosed with a primary pancreatic lymphoma, an extremely rare lymphoproliferative disorder. This was managed successfully with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone). While undergoing chemotherapy, however, he experienced multiple episodes of sepsis requiring hospital admission for antibiotic therapy. In 2017, he presented with multiple clusters of lesions on the skin of his anterior abdominal wall, with punch biopsies demonstrating an atypical lymphoproliferative process. The differentials included lymphomatoid papulosis and anaplastic large-cell lymphoma (primary cutaneous). Histologically, this was not thought to represent a recurrence of the patient’s previous DLBCL, and he underwent local radiotherapy to good effect.