We report a case of primary pancreatic lymphoma. The patient was a 71-year-old Japanese male who complained of upper abdominal pain. The findings on imaging examinations including CT scan, angiograph, and ERCP suggested pancreatic head adenocarcinoma. CA 19-9 levels were elevated. The patient underwent choledochojejunostomy and gastrojejunostomy. Histologically, swollen mesenteric lymphnodes biopsied intraoperatively showed lymphoplasmacytic lymphoma findings. Leakage occurred repeatedly postoperatively, and the patient died of sepsis. Retrospectively, relatively clearly defined and homogenous low density mass lesion seen on CT scan were more likely findings for lymphoma than for adenocarcinoma. It is important to consider lymphoma in a patient with suspected adenocarcinoma showing atypical imaging findings no matter how minor they are.

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A 73-year-old woman was referred to our hospital because of gait disturbance. She had peripheral polyneuropathy which was mainly of the demyelinating type, splenomegaly, a skin change and M protein (IgA-λ). A bone scinti and a CT scan showed a mass lesion in the thoracic vertebra, and a biopsy revealed plasmacytoma. She was diagnosed as Crow-Fukase syndrome, and treated with local radiation therapy. After the treatment, M protein became undetectable, and gait disturbance was improved.

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