S3660 A Patient With Pancreatic Cancer Following Radiation Therapy for Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma Diagnosed Incidentally by Upper Endoscopy

Introduction: Pancreatic cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma are unrelated malignancies. However, there are reports of pancreatic cancer developing following radiation therapy (RT) for MALT lymphoma, as the pancreas is within the radiation field. We present a case of pancreatic cancer, incidentally diagnosed by upper endoscopy (EGD), occurring years after radiation therapy for MALT lymphoma. Case Description/Methods: A 72-year-old asymptomatic man presented for a surveillance EGD for a history of both intestinal metaplasia in the stomach and non-H. pylori-associated gastric MALT lymphoma treated with RT 17 years prior. The EGD was significant for an ulcerated, hemorrhagic mass in the proximal gastric body. Given the patient’s history, this was presumed to be recurrent MALT lymphoma. However, biopsies revealed invasive poorly differentiated adenocarcinoma with micropapillary features consistent with pancreaticobiliary origin. The patient underwent computed tomography scan of the abdomen which revealed a 4.3 × 3.7 cm heterogeneous mass within the pancreatic body/tail extending along the lesser curvature of the stomach. Numerous soft tissue nodular densities were noted along the anterior omentum/mesentery compatible with carcinomatosis. Ca 19-9 was markedly elevated at 3708. The patient was referred to oncology and treated with systemic chemotherapy. Discussion: The patient described above has 2 interesting facets to his presentation. Firstly, he developed pancreatic cancer 17 years after receiving RT for MALT lymphoma. This is a rare complication of this treatment. Secondly, the cancer was diagnosed as a gastric mass noted incidentally on esophagogastroduodenoscopy. There are rare case reports of the diagnosis being made in this fashion. Our experience reinforces the importance of a thorough patient history and awareness of the risks of previous RT. Additionally, pancreatic cancer should be included in the differential diagnosis of endoscopically noted gastric masses.