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Kato H, Tsujie M, Wakasa T, Kogata S, Kanaizumi H, Takeyama H, Hara J, Kitani K, Fujiwara Y, Mizuno S, Kawasaki T, Ohta Y, Yukawa M, Inoue M. Primary diffuse large B cell lymphoma of the common bile duct causing obstructive jaundice. Int Cancer Conf J 2015; 5:107-112. [PMID: 31149436 DOI: 10.1007/s13691-015-0238-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/12/2015] [Indexed: 01/10/2023] Open
Abstract
We report a rare case of a diffuse large B-cell lymphoma (DLBCL) arising from the common bile duct (CBD). A 77-year old man presented with general fatigue and obstructive jaundice. Abdominal computed tomography revealed a well-circumscribed enhancing mass in the midportion of the CBD with proximal bile duct dilatation. Endoscopic retrograde cholangiopancreatography (ERCP) also showed a midportion of the CBD stricture. Direct peroral cholangioscopy revealed smooth mass in the midportion of the CBD, and narrow-band imaging (NBI) showed irregular tortuous microvessels. The brushing cytology of the CBD was performed, and it was diagnosed as suspicious for poorly differentiated adenocarcinoma or malignant lymphoma. We performed extrahepatic bile duct resection for accurate diagnosis. Histological and immunohistochemical examination of the resected specimen revealed DLBCL. Although systemic chemotherapy is the mainstay of treatment for DLBCL, he refused scheduled subsequent chemotherapy, and died of multiple liver metastases 6 months after surgery.
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Affiliation(s)
- Hiroaki Kato
- 1Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Masanori Tsujie
- 1Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Tomoko Wakasa
- 2Department of Pathology and Laboratory Medicine, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Shuhei Kogata
- 1Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Hirofumi Kanaizumi
- 1Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Hiroshi Takeyama
- 1Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Johji Hara
- 1Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Kotaro Kitani
- 1Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Yoshinori Fujiwara
- 1Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Shigeto Mizuno
- 3Department of Gastroenterology and Hepatology, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Toshihiko Kawasaki
- 3Department of Gastroenterology and Hepatology, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Yoshio Ohta
- 2Department of Pathology and Laboratory Medicine, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Masao Yukawa
- 1Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Masatoshi Inoue
- 1Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293 Japan
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Zakaria A, Al-Obeidi S, Daradkeh S. Primary non-Hodgkin's lymphoma of the common bile duct: A case report and literature review. Asian J Surg 2013; 40:81-87. [PMID: 24239512 DOI: 10.1016/j.asjsur.2013.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 09/05/2013] [Accepted: 09/23/2013] [Indexed: 01/10/2023] Open
Abstract
Hepatobiliary involvement by malignant lymphoma is usually a secondary manifestation of systemic disease, whereas primary non-Hodgkin's lymphoma of the extrahepatic biliary ducts is an extremely rare entity. We describe the case of a 57-year-old man who presented with an acute onset of obstructive jaundice and severe itching. Abdominal ultrasonography and computed tomography revealed intrahepatic and common hepatic ducts dilatation. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed a mid-common bile duct stricture. The patient was presumed to have cholangiocarcinoma of the common bile duct, and an en bloc resection of the tumor with Roux-en-Y hepaticojejunostomy and porta-hepatis lymph nodes dissection was performed. Histopathology and immunohistochemistry revealed a large B cell non-Hodgkin's lymphoma. The patient received six cycles of combination chemotherapy using cyclophosphamide, vincristine, prednisone, and rituximab (CVP-R) protocol, and after a 5-year follow-up he is still in complete remission. We also reviewed the cases published from 1982 to 2012, highlighting the challenges in reaching a correct preoperative diagnosis and the treatment modalities used in each case.
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Affiliation(s)
- Ali Zakaria
- Department of Surgery, Istishari Hospital, Amman, Jordan
| | | | - Salam Daradkeh
- Department of Surgery, Istishari Hospital, Amman, Jordan.
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Gall bladder and extrahepatic bile duct lymphomas: clinicopathological observations and biological implications. Am J Surg Pathol 2010; 34:1277-86. [PMID: 20679881 DOI: 10.1097/pas.0b013e3181e9bb8b] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Lymphomas of the gall bladder and extrahepatic bile ducts are exceedingly rare. We present the clinicopathological features of 19 cases from our files; 14 patients had primary lymphoma (13 involving gall bladder and 1 involving common hepatic duct), while 5 had systemic lymphoma on further work-up. Most patients presented with symptoms mimicking cholecystitis. The most common primary lymphoma types were diffuse large B-cell lymphoma, extranodal marginal zone lymphoma, B-lymphoblastic lymphoma, and follicular lymphoma. Two cases had features of lymphomatous polyposis, one a case of follicular lymphoma and the second a case of mantle cell lymphoma, with disease limited to the mantle zones, so-called in situ mantle cell lymphoma. Other rare lymphoma subtypes not described earlier in this site included the extracavitary variant of primary effusion lymphoma and plasmablastic lymphoma. Patients with diffuse large B-cell lymphoma and extranodal marginal zone lymphoma were older (mean age 75.8 y) than those with other subtypes (mean age 47 y) and more likely to have gallstones (60% vs. 12.5%). A comprehensive literature review revealed 36 primary gall bladder and 16 primary extrahepatic bile duct lymphomas. When compared with primary gall bladder lymphomas, those involving the extrahepatic bile ducts present at a younger age (47 y vs. 63 y) usually with obstructive jaundice, and are less often associated with gallstones (17% vs. 50%) or regional lymph node involvement (6% vs. 31%). In conclusion, primary lymphomas of the gall bladder and extrahepatic bile ducts show a broad spectrum of disease types, but in many respects mirror the spectrum of primary lymphomas of the gastrointestinal tract.
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Hwang DW, Lim CS, Jang JY, Lee SE, Yoon SO, Jeon YK, Uk Lee K, Kim SW. Primary hematolymphoid malignancies involving the extrahepatic bile duct or gallbladder. Leuk Lymphoma 2010; 51:1278-87. [PMID: 20572800 DOI: 10.3109/10428194.2010.483300] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Primary hematolymphoid malignancies of the extrahepatic biliary tract are rare tumors. We report five cases of primary hematolymphoid malignancies involving the extrahepatic biliary tract. One is a granulocytic sarcoma of the extrahepatic bile duct, another is an extramedullary plasmacytoma of the gallbladder, and the others are two non-Hodgkin lymphomas of the extrahepatic bile duct and one of the gallbladder. The clinical presentations, radiographic studies, and gross findings at surgery have not been a significant help in differential diagnosis. Although a preoperative diagnosis of primary hematolymphoid malignancy is very difficult to reach because of the rarity of this disease, it should be considered, because, if an accurate diagnosis is made before surgical intervention, chemotherapy is the most appropriate treatment. In limited cases mimicking cholangiocarcinoma and gallbladder cancer, surgical resection followed by chemotherapy has a valid role as reasonable treatment for patients.
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Affiliation(s)
- Dae Wook Hwang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Shito M, Kakefuda T, Omori T, Ishii S, Sugiura H. Primary non-Hodgkin's lymphoma of the main hepatic duct junction. ACTA ACUST UNITED AC 2008; 15:440-3. [PMID: 18670848 DOI: 10.1007/s00534-007-1229-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 03/17/2007] [Indexed: 11/26/2022]
Abstract
A rare case of primary non-Hodgkin's lymphoma of the main hepatic duct junction is reported. A 71-year-old man was admitted for treatment of obstructive jaundice. Radiological examination revealed stenosis of the main hepatic duct junction. Biliary drainage was not necessary because total bilirubin decreased spontaneously. A left hepatic and caudate lobectomy, combined with resection of bile ducts and lymph node dissection, was performed with the preoperative diagnosis of cholangiocarcinoma of the main hepatic duct junction. Macroscopic examination of the resected specimen revealed tumorous growth in the main hepatic duct junction. Histological and immunochemistry findings disclosed a mucosa-associated lymphoid tissue (MALT) lymphoma. The patient received three courses of combination chemotherapy [cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP)], and there was no evidence of recurrence 45 months after the surgery. Although primary non-Hodgkin's lymphoma of the main hepatic duct junction is extremely rare and difficult to diagnose preoperatively, aggressive surgery followed by chemotherapy, as here, is a possible curative option.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bile Duct Neoplasms/diagnosis
- Bile Duct Neoplasms/drug therapy
- Bile Duct Neoplasms/pathology
- Bile Duct Neoplasms/surgery
- Cholangiopancreatography, Magnetic Resonance
- Combined Modality Therapy
- Hepatic Duct, Common
- Humans
- Immunohistochemistry
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/surgery
- Male
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Affiliation(s)
- Masaya Shito
- Department of Surgery, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa 210-0013, Japan
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Das K, Fisher A, Wilson DJ, dela Torre AN, Seguel J, Koneru B. Primary non-Hodgkin's lymphoma of the bile ducts mimicking cholangiocarcinoma. Surgery 2003; 134:496-500. [PMID: 14555939 DOI: 10.1067/s0039-6060(03)00149-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Primary non-Hodgkin's lymphoma (NHL) of the liver and bile duct mimicking cholangiocarcinoma is rare. METHODS The clinical and radiologic features and the treatment of 2 patients with primary NHL of the bile ducts are presented and analyzed together with cases collected from a review of the English literature between 1966 and 2003. RESULTS Fifteen patients with primary NHL, including our 2 patients, presented with clinical features mimicking cholangiocarcinoma. All had jaundice; 9 had systemic symptoms; 7 had abdominal pain; and 5 had mass lesions. All had biliary strictures as shown on cholangiography. Two patients were infected with human immunodeficiency virus-1. In only 1 patient was the diagnosis established without surgery. Immunophenotyping in 10 patients showed 9 B-cell tumors and 1 T-cell tumor. Twelve patients underwent resection. Seven received chemotherapy immediately after the diagnosis was made. Only 3 patients have survived more than 3 years, with the longest survival being 68 months. CONCLUSIONS Non-Hodgkin's lymphoma of the liver and bile duct must be considered in the differential diagnosis of patients with obstructive jaundice. If the correct diagnosis is made before surgery, current protocols of chemotherapy may be the primary modality of therapy. Surgical resection should be reserved to address complications of biliary obstruction or the failure of chemotherapy to eradicate localized disease.
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Affiliation(s)
- Kasturi Das
- Departments of Surgery and Pathology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Weinstock LB, Swanson PE, Bennett KJ, Van Amburg A, Wald SM, Shah NB. Jaundice caused by a clinically undetectable T-cell lymphoma infiltrating the sphincter of Oddi. Am J Gastroenterol 2001; 96:3186-9. [PMID: 11721770 DOI: 10.1111/j.1572-0241.2001.05280.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Malignant lymphoma rarely presents with jaundice. We describe a patient who had a unique etiology for painless jaundice, dilated ducts, and a normal ampulla of Vater. A Whipple's procedure was performed for the suspicion of pancreatic cancer, and initial pathological review detected only mild focal chronic pancreatitis. Seven months later, the patient developed ascites, retroperitoneal mass, and splenomegaly caused by a T-cell lymphoma. Reevaluation of the Whipple's specimen revealed previously unrecognized microscopic infiltration and fibrosis of the sphincter of Oddi by atypical T-lymphocytes. Obstructive jaundice caused by a clinically undetectable primary duodenal T-cell lymphoma has not been previously reported and is contrasted with other causes of jaundice associated with malignant lymphoma and ampullary lesions.
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Affiliation(s)
- L B Weinstock
- Department of Medicine, Barnes-Jewish Hospital, Washington University Medical Center, St. Louis, Missouri, USA
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Gravel J, Lallier M, Garel L, Brochu P, Champagne J, Alvarez F. Primary non-Hodgkin lymphoma of the extrahepatic biliary tract and gallbladder in a child. J Pediatr Gastroenterol Nutr 2001; 32:598-601. [PMID: 11429524 DOI: 10.1097/00005176-200105000-00021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- J Gravel
- Department of Pediatrics, Sainte Justine Hospital, 3175 chemin de la Côte, Ste. Catherine, Montreal, Quebec H3T 1C5, Canada
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Abstract
Lymphoma can often present in unusual situations. This article provides a comprehensive review of the literature in which both non-Hodgkin's lymphoma and Hodgkin's disease are discussed.
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Affiliation(s)
- G A Young
- Kanematsu Laboratories, Royal Prince Alfred Hospital, Department of Medicine, Camperdown, NSW 2050, Australia.
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Navarro F, Pyda P, Pageaux GP, Perrigault PF, Ramos J, Taourel P, Fabre JM, Domergue J. Lymphoproliferative disease after liver transplantation: primary biliary localization. Transplant Proc 1998; 30:1486-8. [PMID: 9636604 DOI: 10.1016/s0041-1345(98)00327-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- F Navarro
- Département de Transplantation Hépatique, Hôpital St. Eloi, Montpellier, France
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Misdraji J, Fernandez del Castillo C, Ferry JA. Follicle center lymphoma of the ampulla of Vater presenting with jaundice: report of a case. Am J Surg Pathol 1997; 21:484-8. [PMID: 9130997 DOI: 10.1097/00000478-199704000-00016] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report the case of a 56-year-old woman who presented with biliary obstruction due to a neoplasm involving the duodenum in the area of the ampulla of Vater and the head of the pancreas. Clinically and radiographically, she was thought to have pancreatic carcinoma. Histologic examination of the specimen from a Whipple procedure revealed malignant lymphoma, follicle center type, follicular, grade 1 of 3 (follicular, predominantly small cleaved cell type), arising in the duodenum and invading the pancreas. Five peripancreatic lymph nodes were partially involved by lymphoma. Follicle center lymphoma presenting as a mass involving the ampulla of Vater with jaundice has not been described previously. Our case indicates that this type of lymphoma can occur in this location and can present with features that mimic pancreatic carcinoma.
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Affiliation(s)
- J Misdraji
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Boston 02114, USA
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Abstract
T-cell-rich B-cell lymphoma is a particular variant of large B-cell lymphomas with the morphological hallmark of a small number of large neoplastic B-cells scattered in between a dense background of reactive T-lymphocytes, while histiocytes may be admixed in variable numbers. In the typical case, the neoplastic population resembles large germinal center cells including cells similar to the L+H-variants of Reed-Sternberg cells. The immunophenotype of these tumour cells is L26 + Leu-M1-BerH2-. Apart from these unifying features, the individual cases constitute a broad spectrum of various growth patterns, so that a multiplicity of different relations to other types of malignant lymphomas are discussed in the literature. This occurs to such an extent that it may be doubted, that one deals with a distinct and separate lymphoma entity. Moreover, a close relationship exists between T-cell-rich B-cell lymphoma and lymphocyte predominant Hodgkin's disease, because there are striking similarities between the two, and, in addition, coexistence of T-cell-rich B-cell lymphoma with Hodgkin's paragranuloma has been reported. It, therefore, seems conceivable that T-cell-rich B-cell lymphoma represents a developmental stage of lymphocyte predominant Hodgkin's disease. Be that as it may: There is no doubt that, presently, the nosological position of T-cell-rich B-cell lymphoma is unsettled and still remains to be clarified.
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Affiliation(s)
- U Schmidt
- Department of Pathology, University of Essen, Germany
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