From 1982 to 1986, nine patients with
non-Hodgkin's lymphoma primarily involving the pancreas were managed at the Johns Hopkins Medical Institutions. This group of nine patients represents 2.2% of patients with
non-Hodgkin's lymphoma (nine of 402) and 4.9% of all patients presenting with pancreatic
malignancies (nine of 182) at the Johns Hopkins Medical Institutions during this period. Computed tomography (CT) scan findings of a large pancreatic mass (6 cm) with extrapancreatic extension and significant retroperitoneal lymph node enlargement suggested
lymphoma. Diagnosis was established by radiographically-guided needle biopsy in four patients, by
laparotomy in four, and by peripheral lymph node biopsy in one. In five jaundiced patients, initial
chemotherapy with the nonhepatotoxic agents
cyclophosphamide and
prednisone resulted in marked
tumor regression, allowing for early resolution of
jaundice and subsequent addition of more aggressive
adriamycin containing
combination chemotherapy. Overall, complete remission has occurred in six of nine patients, with a median survival of 24 months (range 4-69 months). It is concluded from this experience that the majority of patients with pancreatic
lymphoma can be managed without surgery. Excellent control of symptoms, including
jaundice, as well as long-term remission, can be obtained with
chemotherapy alone. The only role for surgery in this setting may be to aid in establishing the diagnosis when percutaneous biopsy is nondiagnostic.