Diffuse large B-cell lymphoma complicated with pancreatic fistula and peritonitis following initial chemotherapy

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  • KATSUKI Kengo
    Department of Hematology, Yokohama City University Medical Center
  • NAKAJIMA Yuki
    Department of Hematology, Yokohama City University Medical Center
  • AKIMOTO Masahiro
    Department of Hematology, Yokohama City University Medical Center
  • SAKUMA Takayuki
    Department of Hematology, Yokohama City University Medical Center
  • MATSUMURA Ayako
    Department of Hematology, Yokohama City University Medical Center
  • MIYAZAKI Takuya
    Department of Hematology, Yokohama City University Medical Center
  • MAEDA Koki
    Department of Pathology, Yokohama City University Medical Center
  • SAWAZUMI Tomoe
    Department of Pathology, Yokohama City University Medical Center
  • FUJISAWA Shin
    Department of Hematology, Yokohama City University Medical Center
  • NAKAJIMA Hideaki
    Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine

Bibliographic Information

Other Title
  • 初回化学療法後に膵液瘻と腹膜炎を発症したびまん性大細胞型B細胞リンパ腫
  • ショカイ カガク リョウホウ ゴ ニ スイエキロウ ト フクマクエン オ ハッショウ シタ ビマンセイ ダイ サイボウガタ Bサイボウ リンパシュ

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Abstract

<p>A 59-year-old-woman complained of weight loss and abdominal pain. A CT scan revealed a 20 cm large retroperitoneal mass, and she was diagnosed with diffuse large B-cell lymphoma via biopsy of the mass. After 75% CHP therapy, she developed an acute abdomen and CT revealed generalized peritonitis. Amylase in the ascites fluid was elevated, and infiltration into the pancreas was suspected on CT before treatment, suggesting a pancreatic fistula caused by tumor shrinkage. Enterobacteria were found in ascites fluid culture, suggesting a gastrointestinal perforation complication. The patient was refractory to treatment, and death was confirmed due to progression of the primary disease. The pathological autopsy revealed diffuse pancreatic infiltration, suggesting that the pancreatic fistula was caused by pancreatic injury. Pancreatic fistula is a known complication of surgical procedures but is rarely caused by tumor shrinkage due to chemotherapy. Since there is no preventive method for pancreatic injury caused by tumor shrinkage, early diagnosis and early treatment of pancreatic fistula are critical, and ascites fluid analysis, including amylase, was thought to be useful for the diagnosis.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 64 (2), 125-129, 2023

    The Japanese Society of Hematology

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