A Rare Case of Multiple Primary Malignancy Diagnosed with Pancreatic Adenocarcinoma After Diffuse Large B Cell Lymphoma

The presence of at least two non-related malignancies in one patient is defined as Multiple Primer Maliginity. Diffuse large B-cell lymphoma (DLBCL) is the most common histopathological subtype of NHLs. Although many secondary malignancies have been reported with DLBCL, the association of DBBHL with pancreatic cancer is a very rare clinical entity. We report a rare case of multiple primary malignancies diagnosed as pancreatic cancer after remission of DBBHL. A 68-year-old man was diagnosed with DLBCL in another hospital and was in remission after eight cycles of chemotherapy. Approximately five months after the end of chemotherapy, weight loss, abdominal pain, loss of appetite, general state disorders appeared. The patient was admitted to our clinic with a mass in the pancreas and a metastatic lesion in the liver. Immunohistochemical findings of liver lesion were evaluated as adenocarcinoma metastasis. The patient was diagnosed with pancreatic cancer with clinical, pathological and laboratory findings. We think that differential diagnosis of newly developed secondary malignancies should be made when additional findings appear during the treatment and follow-up of primary malignancies.

Diffüz Büyük B Hücreli Lenfoma Sonrasý Pankreas Adenokarsinomu Tanýsý Alan Nadir Multipl Primer Malignite Olgusu

Bir hastada birbiri ile iliþkisiz en az iki malignite görülmesi, ‘Multipl Primer Maliginite’ olarak tanýmlanmaktadýr. Diffüz büyük B hücreli lenfoma (DBBHL), NHL’larýn en sýk görülen histopatolojik alt tipidir. DBBHL ile birçok ikincil malignite bildirilmesine raðmen, DBBHL ile pankreas kanseri birlikteliði çok nadir bir klinik tablodur. Biz burada multipl primer malignite olarak, DBBHL remisyonu sonrasý pankreas kanseri tanýsý alan nadir bir olguyu sunduk. Altmýþ sekiz yaþýnda erkek hasta dýþ merkezde DBBHL tanýsý alýp, sekiz kür kemoterapi sonrasý remisyona girmiþ. Kemoterapisi bittikten yaklaþýk beþ ay sonraki kontrollerinde kilo kaybý, karýn aðrýsý, iþtahsýzlýk, genel durum bozukluðu þikayetleri ortaya çýkmýþ. Kliniðimize baþvuran hastada pankreasta kitle ve karaciðerde metastatik lezyon saptandý. Karaciðerdeki lezyonun immünohistokimyasal bulgularý adenokarsinom metaztazý olarak deðerlendirildi. Klinik, patolojik, laboratuar bulgularý ile pankreas kanseri tanýsý konulmuþtur. Primer malignitelerin tedavisi ve takibinde ek bulgular ortaya çýktýðýnda, yeni geliþen ikincil malignitelerin ayýrýcý tanýsýnýn yapýlmasý gerektiðini düþünüyoruz.