Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (6)
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Maruyama, H
Right arrow Articles by Konishi, Y
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Maruyama, H
Right arrow Articles by Konishi, Y
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Japanese Journal of Clinical Oncology Pages 51-57

Anaplastic Ki-1-positive Large Cell Lymphoma of the Pancreas: a Case Report and Review of the Literature
Introduction
Case Report
   Pathologic Findings
Discussion
Acknowledgments
   References

Anaplastic Ki-1-positive Large Cell Lymphoma of the Pancreas: a Case Report and Review of the Literature

Anaplastic Ki-1-positive Large Cell Lymphoma of the Pancreas: a Case Report and Review of the Literature Hiroshi Maruyama1, Naoyuki Nakatsuji2, Seiichi Sugihara2, Masahide Atsumi3, Kazuhiko Shimamoto3, Kunio Hayashi3, Masahiro Tsutsumi4 and Yoichi Konishi4

Departments of 1Pathology, 2Surgery and 3Internal Medicine, Hoshigaoka Koseinenkin Hospital, Hirakata, Osaka; 4Department of Oncological Pathology, Cancer Center, Nara Medical University, Kashihara, Nara, Japan

A case of Ki-1-positive anaplastic large cell lymphoma of the pancreas is presented. The patient complained of abdominal pain and was jaundiced. Examination of a biopsy specimen obtained by duodenal endoscopy revealed malignant lymphoma, and surgery confirmed a large mass located in the region from the intra-pancreatic tissue around the lower common bile duct to the peri-pancreatic lymph nodes. Histologically, this tumor was composed mainly of large and giant neoplastic cells. Immunohistochemically, these cells were diffusely positive for Ki-1 and CD45RO antigens, indicating the features of Ki-1 anaplastic large cell lymphoma with a T-cell phenotype among non-Hodgkin's lymphoma. The histologic types of the majority of malignant lymphomas of the pancreas reported previously were considered to be diffuse-type non-Hodgkin lymphoma (probably with predominance of the B-cell phenotype), except for a single Japanese lymphoma case with a T-cell phenotype. This is therefore the first known case of Ki-1 anaplastic large cell lymphoma of the pancreas.

Key words: pancreas - malignant lymphoma - Ki-1 antigen - anaplastic large cell lymphoma - surgery

Introduction

Malignant lymphomas arising primarily in the pancreas, involving only the pancreatic parenchyma and/or peri-pancreatic lymph nodes, are rare, constituting less than 0.7% of all pancreatic malignancies (1) and 1% of non-Hodgkin's lymphomas (2). Ki-1-positive anaplastic large cell lymphoma (Ki-1 ALCL) is an uncommon type of non-Hodgkin's malignant lymphoma first described by Stein et al. (3) in 1985. Since then, following the description in the updated Kiel classification (4) of 1988, the criteria for this tumor have been added to the recently published Revised European-American Classification of Lymphoid Neoplasms (REAL classification) (5). Morphologically, this tumor is composed mainly of large blastic cells, often with horseshoe-shaped or multiple nuclei and multiple or single prominent nucleoli. Moreover, the tumor cells grow in a cohesive pattern and often preferentially involve the lymph node sinuses, as well as extranodal sites such as soft tissue, bone and skin.

Here we report the first known case of Ki-1 ALCL of the pancreas and review the literature concerning pancreatic lymphomas.

Case Report

A 46-year-old woman was admitted to the Medical Department of Hoshigaoka Koseinenkin Hospital in May 1994, complaining of right lumbar back pain and anorexia of one week's duration. Abdominal ultrasonography revealed a hypoechoic mass in the pancreatic head with a mildly dilated common bile duct (CBD). Physical examination demonstrated no superficial lymphadenopathy or anemia, but icteric conjunctivae, a flat and soft abdomen, and mild tenderness in the right upper quadrant. The RBC count was 479 * 104/mm3 and Hb level 12.0 g/dl. The WBC count was 5900/mm3 with a normal lymphocyte percentage (23%). Aspiration of bone marrow cells revealed no abnormality (nucleocyte count: 30.7 * 104/mm3). The level of total protein was 6.7 g/dl. The total bilirubin level was 4.5 mg/dl (normal range 0.2-1.0 mg dl) with a direct bilirubin volume of 2.9 mg/dl. Other values included GOT 110 IU, GPT 182 IU, alkaline phosphatase 26.3 King-Armstrong units (KAU) (normal range 2-10 KAU), LAP 441 Goldbarg-Rutenberg units (GR), [gamma]-GTP 145 IU/L and cholinesterase of 0.57 [Delta]pH. All these were abnormal, suggesting obstructive jaundice. Serum amylase was low at 100 IU (normal range 150-400) and urinary amylase was normal at 644 IU (normal range 100-1000). Although the serum levels of carbohydrate antigen 19-9, CEA, AFP and elastase 1 were all within normal limits at 6 U/ml, 1.7 ng/ml, 1 ng/ml and 270 U/ml respectively, serum carbohydrate antigen 125, normal value <35, was mildly elevated at 40 U/ml. Serum was negative for HTLV-1 antibody.


Figure 1. CT scan. The pancreatic head contains a large low-density mass.


Figure 2. ERP. MPD is almost normal.


Figure 3. Macroscopic and panoramic view of the pancreatic tumor. (a) Cut surface of the tumor shows small masses involving the pancreatic tissue and associated lymph nodes; (b) Intra- and peri-pancreatic tumors ( blank arrow) are observed. MPD is shown with an arrow, and CBD is shown with an arrow head.

Abdominal ultrasonography and endoscopic ultrasonography revealed a swelling in the pancreatic head (approximately 41 * 39 mm) with invasion of the wall of the CBD, but a normal main pancreatic duct (MPD). Computed tomography (CT) of the abdomen showed a low-density mass, 4 cm in diameter, in the pancreatic head (Fig. 1). Endoscopic retrograde pancreatography (ERP) showed no remarkable change in the MPD (Fig. 2). Duodenal endoscopy revealed submucosal protrusion with erosion in the second portion of the duodenum, and a mucosal biopsy was performed. The biopsied specimen was diagnosed as malignant lymphoma. Abdominal angiography revealed mild dilatation of the anterior superior pancreaticoduodenal artery and encasement of the posterior superior pancreaticoduodenal artery.

With a diagnosis of a pancreatic malignancy, possibly lymphoma, pancreaticoduodenectomy and partial gastrectomy were performed at the Surgical Department of our hospital on June 20th, 1994. Postoperatively, the patient underwent combination chemotherapy (MACOP-P) consisting of one course of methotrexate (MTX), adriamycin (ADR), cyclophosphamide (CPM), vincristine (oncovin), prednisolone and peplomycin. The patient was alive and free of disease 1 year and 6 months after surgery.

Pathologic Findings

Grossly, the resected tumor involving the posterior pancreatic head measured approximately 4 * 4 * 3 cm, was soft in consistency with good movability, and had invaded part of the duodenal wall. The cut surface of the tumor demonstrated a white-colored solid mass with a yellowish necrotic area [Fig. 3 (a)]. No other lymph nodes showed swelling.


Figure 4. ALCL involving CBD. The tumor has destroyed the integrity of the wall of the lower CBD.


Figure 5. Histology of the tumor. The tumor is composed of pleomorphic large and giant neoplastic cells with nucleoli.

Histologically, the tumor was multinodular and located in the region from the pancreatic head around the lower CBD to the peri-pancreatic lymph nodes [Figs 3 (b) and 4]. Nodular growth patterns were present in the pancreatic tissues. The tumor was not observed in the mucosa and submucosa of the duodenal wall in the surgical specimen. The tumor was composed predominantly of atypical large and giant cells with irregular and lobulated nuclei (Figs 5 and 6), sometimes horseshoe-shaped nuclei [Fig. 7 (a)] with nucleoli, without obvious Hodgkin cells or Reed-Sternberg cells. Mitotic figures were frequently found. Immunohistochemically, on paraffin sections using the labeled streptavidin biotin (L-SAB) method (6), the large and giant neoplastic cells were diffusely positive for antigens Ki-1 [Fig. 7 (a)], CD45 (leukocyte common antigen), CD45RO [Fig. 7 (b)], and CD43. However, they were negative for antigens CD20, CD45R, CD15 and CD68 as well as for lysozyme, cytokeratin (broad), epithelial membrane antigen (EMA) and S-100 protein. (All primary antibodies used and the resulting immunoreactions are listed in Table 1.) Since serum antibody against HTLV-1 (a marker of adult T-cell leukemia) was negative in this patient, and Hodgkin's disease was excluded both histologically and immunohistochemically, this tumor was diagnosed as Ki-1 ALCL.


Figure 6. Cytological details of the tumor cells. The large and giant neoplastic cells have lobulated or multiple nuclei.


Figure 7. Immunohistochemistry of ALCL. (a) Ki-1 antigen. The tumor cells are diffusely and strongly positive along the cell surface (L-SAB method, * 100). (b) CD45RO antigen. Most of the pleomorphic large neoplastic cells are positive (L-SAB method).

Discussion

Non-Hodgkin's lymphoma frequently occurs at extranodal sites, most commonly in the gastrointestinal tract (7) and rarely in the pancreas (8). It has, however, been reported that up to one third of patients with non-Hodgkin's lymphoma show pancreatic involvement at postmortem examination (9). A primary pancreatic lymphoma is strictly localized to pancreatic tissue, with lymph node involvement only in the area of the pancreas; that is, corresponding to clinical stages I and II according to the Ann Arbor classification of malignant lymphoma (2). The present case was confirmed as a localized tumor in the pancreatic head region by surgical observation and examination of histological specimens. Although it was considered to be Ki-1 ALCL with a T-cell phenotype, this tumor might have been derived from activated lymphoid cells rather than from T cells, because further immunohistochemical results showed negative reactivity for CD3 antigen (T-cell marker). It has also been reported by Stein et al. (3) that CD30, a glycoprotein of 105/120 kDa, is expressed mainly on the cell surface and can be detected by the monoclonal antibody Ki-1, which was originally produced by immunization with a cell line derived from Reed-Sternberg cells of Hodgkin's disease. Moreover, it has been stressed by Miyake et al. (10) that CD30 antigen is expressed in various cell lineages such as ALCL, malignant histiocytosis, plasmacytoma, some non-Hodgkin's lymphomas other than ALCL, lymphomatoid papulosis and Hodgkin's disease, and that CD30 may be related in some instances to a cellular activation antigen.

Table 2 reviews the literature concerning pancreatic lymphomas in order to demonstrate the common clinicopathologic features of cases reported previously in the West (11-17) and in Japan (18-22). Webb et al. (15) in 1989 reported nine cases (2.2%) of pancreatic lymphoma among 402 cases of non-Hodgkin's lymphoma.

Of these nine, jaundice was evident in five cases and only two cases were judged to be clinical stage II. Six patients survived for a mean perod of 24 months after obtaining complete remission by chemotherapy. They concluded that the majority of patients with pancreatic lymphoma should be managed with chemotherapy and not surgery. Twelve patients with pancreatic lymphoma were reported by Mansour et al. (16) in 1989. They mentioned that both preoperative cytologic diagnosis and intraoperative frozen section diagnosis were unreliable, but that tumor markers, demonstrating a B-cell phenotype (10/12 cases) by immuno-histochemistry, yielded specific and accurate diagnoses of pancreatic lymphoma.

Table 2 lists the 15 cases of primary pancreatic lymphoma reported previously in Japan. A case of malignant T-cell lymphoma of the pancreas was described by Satake et al. (20). The patient showed diffuse enlargement of the entire pancreas with periaortic lymph node swelling, and histological examination of frozen sections obtained at laparotomy gave a diagnosis of non-Hodgkin's lymphoma (large cell type), immunohistochemically positive for CD3. The patient died 2 months after surgery.

Table 1. Panel of primary antibodies used and details of the immunoreactions
Antibody

 Cluster
designation		 Specificity
of antibody		 Source

 Reactivity*
in this case
Monoclonal antibodies
Leu-M1

 CD15

 Granulocyte,
RS CELL		 BD

 Negative
L-26 CD20 B cell DA Negative
Ber-H2[dagger]
(Ki-1)		 CD30

 RS cell, ALCL

 DA

 Positive
MT-1

 CD43

 T cell, B cell subset,
granulocyte, monocyte,		 BS

 Positive
LCA CD45 Leucocyte DA Positive
UCHL-1 CD45RO T cell, B cell subset DA Positive
MB-1 CD45R T cell, B cell, BS Negative
EMA   plasma cell, ALCL DA Negative
KP-1

 CD68

 Monocyte, macrophage,
granulocyte		 DA

 Negative
Polyclonal antibodies
Lysozyme

   Monocyte, macrophage,
granulocyte		 DA

 Negative
S100 protein

   Neurogenic tumor,
T-zone histiocyte etc.		 DA

 Negative
Cytokeratin   Epithelial cell DA Negative
BD, Becton Dickinson (San Jose,CA,USA); RS cell, Reed Sternberg cell; DA, Dakopatts (Copenhagen, Denmark); ALCL, anaplastic large cell lymphoma; BS, Bio-Science Product AG (Emmenbrücke, Switzerland); LCA, leucocyte common antigen; EMA, epithelial membrane antigen. *L-SAB kit was obtained from Dakopatts; [dagger]Ber-H2 is a monoclonal antibody for CD30 antigen on paraffin-embedded formalin-fixed tissue as well as on frozen section immunohistochemistry.

Among the 15 Japanese cases, the age of the patients ranged from 33 to 74 years (mean 52.2 yr), male:female ratio was 13:2 and the site of the pancreas involved was the head in nine cases, the tail in three, the body with head or tail in two and the whole pancreas in one. Histologic diagnosis revealed that the type with the highest incidence was non-Hodgkin's lymphoma (eight cases), diffuse, large and mixed cell types by the International Working Formulation, followed by single cases of diffuse lymphoma, small cleaved and small lymphocytic cell types, and one case of follicular lymphoma, small cleaved cell type. One case of Hodgkin's disease (mixed cell type) (18) was reported without immunohistochemical examination. Immunohistochemically, four cases were described as being of B-cell phenotype and only one case as T-cell phenotype. Survival in the Japanese patients exceeded 1 yr in only one. The present patient exhibited obstructive jaundice before surgery, but she is still alive over 1.5 yr after surgery and chemotherapy.

Ki-1 ALCL has often been misdiagnosed as anaplastic (ductal) carcinoma, Hodgkin's disease, malignant histiocytosis, sarcoma or amelanotic melanoma (5). Recently, however, immunohistochemical staining for lymphoid markers has allowed definite distinction between these diseases.

Chott et al. (23) described 10 cases of extranodal ALCL among 41 cases of Ki-1 ALCL, but none had primary pancreatic involvement. They mentioned that there were two cytomorphological groups: group A demonstrating pleomorphic large cells, and group B with a monomorphic appearance, very large or relatively small cells, but a T cell phenotype in the majority of cases. They pointed out that the immunohistochemical expression of Ki-1 antigen should be seen in at least 80% of the tumor cells on paraffin sections when ALCL was diagnosed. In their report, the mean age of the 41 patients was 50 yr, with a male:female ratio of 23:18 and an overall median survival of 13 mo. Although both age <40 yr and limited stage of disease (clinical stages I and II) were significantly associated with long survival, lymphoma morphology classified as group A (pleomorphic large cell type) survived longer than group B (rather monomorphic cell type), though the difference was not significant. Our case of a 46-yr-old female patient was histologically considered to be the pleomorphic large cell type [type A in their report (23)] and thus longer survival could be expected (currently 18 months).

In Japan, Nasu et al. (24) have reported five cases of primary ALCL involving the gastrointestinal tract but no pancreatic lymphomas among 69 cases of Ki-1 ALCL. Mann et al. (25) reported two cases of Ki-1 ALCL with abundant neutrophils that were localized to retroperitoneal lymph nodes.

Ki-1 ALCL is included in the updated Kiel classification (4) and is usually classified as a high-grade lymphoma, although it sometimes shows slow growth. According to the recently published REAL classification (5), there are two clinical types in Ki-1 ALCL. One is a primary nodal/extranodal and systemic form in both adults and children, which expresses EMA+ and cutaneous lymphocyte antigen (CLA)- and shows moderately aggressive behavior. The other is a primary cutaneous form occurring in adults only, which expresses EMA- and CLA+ and has the possibility of spontaneous regression. Our present case was a primary nodal/extranodal form of Ki-1 ALCL without skin lesions, but with immunohistochemical negativity for EMA.

Table. 2Reports of patients with malignant lymphoma of the pancreas
First author
(ref. no.)		 Year

 Age (yr), sex
 Involved
sites		 Histology
(type)		 Treatment, survival
Non-Japanese Cases
1. L'Huillier (11)

 1904

 9 days, female Head

 RCS

 Not detected
2. Feathor (12) 1951 29, male Head RCS P-D, 1 yr-survival
3. Ziarek (13) 1975 12, male Head RCS Palliative surgery, 3 mo
4. Ackerman (14) 1976        
4 cases


   27-70
male 3:female 1		 Head, body
or whole

 RCS,
lymphocytic

 Surgery, chemotherapy
& radiation, 2 mo-1 yr
5. Webb (15) 1989        
9 cases
(5 cases)*

   49-76
male 4:female 5		 Head or
tail

 Histiocytic 6 cases
Lymphocytic 1		 Surgery 6 cases,
survival in 6 cases
6. Mansour (16) 1989        
12 cases





   34-83
male 8:female 4



 Head or
tail




 B-cell (10 cases)





 Partial pancreatectomy 1 case,
chemotherapy and radiation 11
cases, 3 yr (1 case), 7yr (1 case)
7. Yusuf (17)

 1991

 32, male

 Body & tail B-cell,
immunoblastic		 Chemotherapy
Japanese Cases
1. Hirata (18) 1978 72, female Head RCS None, 2 mo
2. Yamagiwa 1981 50, female Tail Diffuse, histiocytic Resection of tail
3. Kawabata (19)


 1982


 47, male


 Head


 Hodgkin's disease,
mixed cell		 None, 2 mo
4. Takenaka

1984

 58, male

Head

Diffuse, histiocytic
Total pancreatectomy,
3 mo
5. Terahata 1986 33, male Head Diffuse, small cell P-D
6. Ogawa 1986 50, male Head Diffuse, large cell Total pancreatectomy
7. Kaneko* 1986 36, male Head Diffuse, mixed cell None, 3 mo
8. Shirahase* 1987 41, male Head Diffuse, large cell P-D,VEPA
9. Hasebe 1988 46, male Head & body Diffuse, mixed cell CHOP etc., 6 mo
10. Sasaki*

 1989

 37, male

 Head

 Diffuse, mixed,
B-cell		 None, 2 mo
11. Hirabayashi

 1990

 74, male

 Body & tail
 Diffuse, large,
B-cell		 Partial resection,
2 mo
12. Shikano 1991 57, male Tail Diffuse Resection of tail
13. Satake (20)

 1991

 52, male

 Whole

 Diffuse, large, T-cell CHOP, 2 mo
14. Matsumoto (21) 1993

 67, male

 Tail

 Diffuse, large, B-cell Partial resection
1 yr 5 mo
15. Yamaguchi (22)[dagger] 1993

63, male

Head

Follicular,
small, B-cell		 P-D, VEPA,
6 mo
16. Current case

 1997

 46, female

Head

 Ki-1 ALCL

 P-D, MACOP,
1 yr 6 mo
RCS, reticulum cell sarcoma; P-D, pancreatoduodenectomy; VEPA or CHOP, combination chemotherapy of vincristine, cyclophosphamide, prednisolone and adriamycin; *jaundice; [dagger]in Japanese cases, no.15 (Yamaguchi, 22) listed no. 2 and nos 4-12.

To our knowledge, the present case is the first reported case of Ki-1 ALCL arising in the pancreas. This case suggests that surgery not only allows confirmation of diagnosis but also might improve survival when combination chemotherapy is also performed.

Acknowledgments

We thank Dr. Koichi Ohshima, First Department of Pathology, School of Medicine, Fukuoka University, for confirmation of the pathological diagnosis and for his excellent advice.

References

1. Baylor SM, Berg JW. Cross classification and survival characteristics of 5000 cases of cancer of the pancreas. J Surg Oncol 1973;5:335-58. MEDLINE Abstract

2. Freeman C, Berg JW, Cutler SJ. Occurrence and prognosis of extranodal lymphomas. Cancer 1972;29:252-60. MEDLINE Abstract

3. Stein H, Mason D, Gerdes J, O'Connor N, Wainscoat J, Pallesen G et al. The expression of the Hodgkin's disease associated antigen Ki-1 in reactive and neoplastic lymphoid tissue: evidence that Reed-Sternberg cells and histiocytic malignancies are derived from activated lymphoid cells. Blood 1985;66: 848-58. MEDLINE Abstract

4. Stansfield A, Diebold J, Noel H. Updated Kiel classification for lymphomas. Lancet 1988;1:292-3.

5. Harris NL, Jaffe ES, Stein H, Banks PM, Chan JKC, Cleary ML et al. A revised European-American classification of lymphoid neoplasms. A proposal from the international lymphoma study group. Blood 199484:1361-92. MEDLINE Abstract

6. Elias JM, Margiotta M, Gaborc D. Sensitivity and detection efficiency of the peroxidase antiperoxidase (PAP), avidin-biotin peroxidase complex (ABC), and peroxidase-labeled avidin-biotin (LAB) methods. Am J Clin Pathol 1989;92:62-7. MEDLINE Abstract

7. Isaacson PG, Spencer J. Malignant lymphoma of mucosa-associated lymphoid tissue. Histopathology 1987;11:445-6. MEDLINE Abstract

8. Goffinet DR, Warnke R, Dunnick NR, Castellino R, Glatstein E, NelsenTS et al. Clinical and surgical (laparotomy) evaluation of patients with non-Hodgkin's lymphomas. Cancer Treat Rep 1977;61:981-92. MEDLINE Abstract

9. Rosenberg SA, Diamond HD, Jaslowitz B, Craver LF. Lymphosarcoma: a review of 1269 cases. Medicine 1961;61:31-84.

10. Miyake K, Yoshino T, Sarker AB, Teramoto N, Akagi T. CD30 antigen in non-Hodgkin's lymphoma. Pathol Int 1994;44:428-434. MEDLINE Abstract

11. L'Hillier A. Über einen Fall von kongenitalem Lymphosarkom des Pankreas. Virchows Arch Pathol Anat 1904;178:507-9.

12. Feather HE, Kuhn CL. Total pancreatectomy for sarcoma of the pancreas. Ann Surg 1951;134:904-12.

13. Ziarek S, Deddouche M, Nekkache M. Reticulosarcome du pancreas. Med Chir Dig 19754:195-6. MEDLINE Abstract

14. Ackerman NB, Aust JC, Bredenberg CE, Hanson VA, Rogers LS. Problems in differentiating between pancreatic lymphoma and anaplastic carcinoma and their management. Ann Surg 1976;184:705-8. MEDLINE Abstract

15. Webb TH, Lillemoe KD, Pitt HA, Jones RJ, Cameron JL. Pancreatic lymphoma: is surgery mandatory for diagnosis or treatment? Ann Surg 1989;209:25-30. MEDLINE Abstract

16. Mansour GMI, Cucchiaro G, Niotis MT, Fetter BF, Moore J, Rice RR et al. Surgical management of pancreatic lymphoma. Arch Surg 1989;124: 1287-9.

17. Yusuf SW,Harrison JD, Mahire AR, Balfour TW, Williams CB. Primary B-cell immunoblastic lymphoma of pancreas. Eur J Surg Oncol 1991;17:555-7.MEDLINE Abstract

18. Hirata Y, Toyoda H. A case of reticulosarcoma observed in the head of the pancreas. Gan No Rinsho 197824:844-7. (in Japanese)

19. Kawabata K, Motoi M, Tsutsumi A, Doi K, Matsuo S. A case of Hodgkin's disease which shows mass formation at the pancreatic head associated with severe jaundice. Saibo Kaku Byorigaku Zasshi 1982;19: 71-4. (in Japanese)

20. Satake K, Aimoto Y, Fijimoto Y, Nishiwaki H, Nishino H, Umeyama K et al. Malignant T-cell lymphoma of the pancreas. Pancreas 1991;6:120-4. MEDLINE Abstract

21. Matsumoto J, Takahashi M, Takeda K, Furukawa T, Tezuka F. A resected case of primary malignant lymphoma of pancreas. Suizobyo Gakkai Zasshi 1993;8:32-8. (in Japanese)

22. Yamaguchi K, Suga M, Ikeda H, Yamashiro K, Takashima K, Hirata K et al. A case of primary malignant lymphoma of the pancreas. Gan No Rinsho 1994;40:861-7. (in Japanese)

23. Chott A, Kaserer K, Augustin I, Vesely M, Heinz R, Oehlinger W et al. Ki-1-positive large cell lymphoma-A clinicopathologic study of 41 cases. Am J Surg Pathol 1990;14:439-48. MEDLINE Abstract

24. Nasu K, Nakamine H. Anaplastic large cell lymphoma (Ki-1). Byori To Rinsho 1994;12:157-61. (in Japanese)

25. Mann KP, Hall B, Kamino H, Borowitz MJ, Ratech H. Neutrophil-rich, Ki-1-positive anaplastic large cell malignant lymphoma. Am J Surg Pathol 1995;19:407-16. MEDLINE Abstract

Received February 28, 1996; accepted July 31, 1996
For reprints and all correspondence: Hiroshi Maruyama, Department of Pathology, Hoshigaoka Koseinenkin Hospital, 8-1, Hoshigaoka 4-chome, Hirakata, Osaka 573, Japan
Abbreviations: Ki-1 ALCL, Ki-1-positive anaplastic large cell lymphoma; REAL classification, Revised European-American Classification of Lymphoid Neoplasms; CBD, common bile duct; KAU, King-Armstrong units; GR, Goldbarg-Rutenberg units; MPD, main pancreatic duct; CT, computed tomography; ERP, Endoscopic retrograde pancreatography; (MACOP-P: combination chemotherapy); MTX, methotrexate; ADR, adriamycin; CPM, cyclophosphamide; L-SAB, labeled streptavidin biotin; EMA, epithelial membrane antigen; CLA, cutaneous lymphocyte antigen.

This page is run by Oxford University Press, Great Clarendon Street, Oxford OX2 6DP, as part of the OUP Journals
Comments and feedback: www-admin{at}oup.co.uk
Last modification: 19 May 1998
Copyright© Japanese Journal of Clinical Oncology, 1997.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (6)
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Maruyama, H
Right arrow Articles by Konishi, Y
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Maruyama, H
Right arrow Articles by Konishi, Y
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?