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.