Case Report
Primary Mediastinal B Cell Lymphoma Presenting As Acute Abdomen
Fathima R1, Pratap T1, Jacob D1 and Jalal MJA2*
1Department of Radiology, VPS Lakeshore Hospital, Kochi, Kerala, India.
2Department of Internal Medicine and Rheumatology, Olive Healthcare, Thrissur, Kerala, India.
2Department of Internal Medicine and Rheumatology, Olive Healthcare, Thrissur, Kerala, India.
*Corresponding author:Muhammed Jasim Abdul Jalal, Department of Internal Medicine and Rheumatology Olive Healthcare, Thrissur, Kerala, India.E-mail Id:jasimabduljalal@yahoo.com
Copyright: © 2026 Fathima R, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article Information:Submission: 26/03/2026; Accepted: 05/05/2026; Published: 09/05/2026
Abstract
Primary mediastinal B-cell lymphoma (PMBCL) is a distinct subtype of non-Hodgkin lymphoma that typically presents as an anterior mediastinal mass, with limited extrathoracic involvement at diagnosis. Pancreatic involvement is rare and may mimic primary pancreatic pathology.
We describe a rare case of primary mediastinal B‑cell lymphoma (PMBCL) with synchronous mediastinal and pancreatic mass in a 22‑year‑old male who presented with features of acute pancreatitis. Imaging revealed a heterogeneous mass in the pancreatic head with double-duct obstruction, raising suspicion of pancreatic malignancy. A concurrent anterior mediastinal mass was incidentally detected on chest imaging. Endoscopic ultrasound-guided fine-needle aspiration of the pancreatic lesion and biopsy of the mediastinal mass demonstrated a malignant lymphoid neoplasm. Immunohistochemistry showed positivity for CD20, CD30, BCL6, and MUM1, with a high Ki-67 proliferation index, confirming PMBCL. Staging PET-CT demonstrated FDG-avid lesions limited to the mediastinum and pancreas. The patient was initiated on R-CHOP chemotherapy. This case highlights a rare presentation of PMBCL with synchronous pancreatic involvement presenting as acute pancreatitis. Recognition of such atypical presentations is essential to avoid misdiagnosis and unnecessary surgical interventions, emphasizing the importance of histopathology and immunohistochemistry in establishing the diagnosis.
We describe a rare case of primary mediastinal B‑cell lymphoma (PMBCL) with synchronous mediastinal and pancreatic mass in a 22‑year‑old male who presented with features of acute pancreatitis. Imaging revealed a heterogeneous mass in the pancreatic head with double-duct obstruction, raising suspicion of pancreatic malignancy. A concurrent anterior mediastinal mass was incidentally detected on chest imaging. Endoscopic ultrasound-guided fine-needle aspiration of the pancreatic lesion and biopsy of the mediastinal mass demonstrated a malignant lymphoid neoplasm. Immunohistochemistry showed positivity for CD20, CD30, BCL6, and MUM1, with a high Ki-67 proliferation index, confirming PMBCL. Staging PET-CT demonstrated FDG-avid lesions limited to the mediastinum and pancreas. The patient was initiated on R-CHOP chemotherapy. This case highlights a rare presentation of PMBCL with synchronous pancreatic involvement presenting as acute pancreatitis. Recognition of such atypical presentations is essential to avoid misdiagnosis and unnecessary surgical interventions, emphasizing the importance of histopathology and immunohistochemistry in establishing the diagnosis.