Shapeshifting lymphoma – Diagnosis through endoscopic ultrasound-guided fine needle aspiration combined with flow cytometry

An 18-year-old man presented with epigastric pain and progressive jaundice. His past medical history was remarkable for the diagnosis of nodular sclerosing Hodgkin’s lymphoma (HL) (stage IIa -cervical and mediastinum) 10 months before, for which he underwent chemoradiation therapy. Of note, he was in remission for the last 2 months before the current symptoms. CT imaging revealed a heterogeneous 30mm pancreatic head mass, causing dilation of both the common bile duct and pancreatic duct (Fig. 1). These findings were replicated on EUS, with no other significant findings, namely mediastinal or abdominal adenopathies. FNA was performed using a 22-gauge ProCore needle. The samples were sent to pathological examination and flow cytometry (FC). The results of the analysis were surprising as they unveiled a high-grade