Table 1 Patient characteristics, treatment and outcomes
Case 1 | Case 2 | Case 3 | Case 4 | |
|---|---|---|---|---|
Age | 64 | 70 | 56 | 61 |
Sex | Male | Male | Male | Male |
Presenting Symptoms | Abdominal pain, nausea, weight loss then jaundice | Vomiting, weight loss | Dyspepsia, weight loss | Abdominal pain, weight loss then jaundice |
Delay until diagnosis | 5 weeks | 3 months | 18 months | 4 months |
Method of diagnosis | Endoscopic ultrasound FNA | Laparotomy | Laparotomy | Laparotomy |
CT appearance | 6 cm pancreatic mass with biliary obstruction and portal vein involvement | Large peri-pancreatic mass | 5 cm pancreatic mass | Pancreatic mass and peripancreatic lymph nodes |
Ca-19.9 level* | 500 kU/L | 50 kU/L | Not available | 39 kU/L |
Pre-treatment LDH | Normal | Elevated | Normal | Elevated |
Histology** | DLBCL | DLBCL | Grade II follicular non-Hodgkins lymphoma | DLBCL |
Stage*** | IIE | IIE | IIE | IIE |
Prognostic index | Low-intermediate risk (IPI 2/5) | Low-intermediate risk (IPI 2/5) | Low risk (FLIPI 1/5) | Low-intermediate risk (IPI 2/5) |
Treatment | R-CHOP * 4 then involved-field RT | CHOP * 3 then involved-field RT | Involved-field RT then CVP then rituximab | 3 * CHOP then involved-field RT |
Outcome | NED at 23 months | Local recurrence at 32 months post-diagnosis, with poor tolerance of 2nd line chemotherapy and rapid treatment-related death | NED at 25 months | Out of field recurrence at 21 months post diagnosis. Salvage chemotherapy and autologous SCT. NED at 64 months from diagnosis |