Deciphering Deception: Pancreatic Mass Presenting as Post-Transplant Lymphoproliferative Disorder

ABSTRACT Post-transplant lymphoproliferative disorder (PTLD) represents a spectrum of lymphoid proliferations occurring in immunocompromised transplant recipients, often associated with Epstein-Barr virus (EBV). PTLD frequently manifests at extranodal sites, posing diagnostic challenges due to its variable clinical presentation and potential mimicry of other malignancies. Here, we report a rare case of PTLD presenting as a pancreatic mass in a 68-year-old renal transplant recipient, who exhibited progressive gastrointestinal symptoms including nausea, vomiting, and jaundice. Initial imaging revealed a pancreatic head mass and extensive lymphadenopathy. Although an initial lymph node biopsy was inconclusive, endoscopic ultrasound-guided biopsy of the pancreatic mass confirmed diffuse large B-cell lymphoma, specifically activated B-cell type, indicating monomorphic PTLD. The patient's management included immunosuppression reduction and initiation of mini-R-CHOP chemotherapy. This case highlights the atypical PTLD presentation involving atypical sites such as the pancreas, emphasizing the need for persistent clinical suspicion and comprehensive diagnostic evaluation in post-transplant patients. Early recognition and a multidisciplinary approach to treatment are vital to optimizing outcomes in patients with PTLD presenting with atypical gastrointestinal manifestations.