Context The retroperitoneum is an uncommon location for primary lymphomatous involvement. The retro-peritoneal localization is extremely rare and its diagnosis is often difficult. Because of the uncommon anatomic location, the diagnosis and subsequent management of these patients tend to be difficult for both pathologists and clinicians. Initial presentation of disease in this site (primary retroperitoneal lymphoma) is considered to be rare, especially when its presentation simulates a pancreatic cancer. Case report We report the case of a 63-year-old female affected by an extra-nodal non-Hodgkin lymphoma with an unusual clinical demostration, obstructive jaundice, presenting as a large retroperitoneal mass with an unusual clinical presentation mimicking pancreatic neoplastic disease. Retroperitoneal lymphoma invaded the pancreatic head and this caused obstruction at the biliary level. The patient, except for the presence of jaundice, remained asymptomatic all the time. The patient was treated with R-CHOP chemotherapy after percutaneous drainage of the bile duct. The chemotherapy dose was adjusted by hyperbilirubinemia. She had no significant toxicity and after four cycles of chemotherapy she had a partial treatment response. Conclusion The patient has completed eight chemotherapy cycles and now radiotherapy is being performed. 10-month of follow-up since diagnosis. We do not find similar cases in the literature. A brief review of literature is provided.
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