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Wang Q, Wu K, Zhang X, Liu Y, Sun Z, Wei S, Zhang B. Primary hepatopancreatobiliary lymphoma: Pathogenesis, diagnosis, and management. Front Oncol 2022; 12:951062. [PMID: 36110965 PMCID: PMC9469986 DOI: 10.3389/fonc.2022.951062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Primary hepatopancreatobiliary lymphoma (PHPBL) is extremely rare, which is defined as a lympho-proliferative disease confined to the hepatobiliary system and pancreas without any involvement of lymph nodes, bone marrow, or other organs. The clinical and imaging manifestations of PHPBL are variable and non-special, which are akin to those of tumors of the hepatobiliary and pancreatic systems. The overall prognosis and management of PHPBL differ from those of other tumors in the hepatobiliary system and pancreas. Proper diagnosis and prompt treatment are essential for improving clinical outcomes. Due to its rarity, the optimal treatment has not been issued. However, combination chemotherapy is considered as a standard treatment for them. This review provides an overview of the pathogenesis, diagnosis, pathology, and management of PHPBL and offers clinicians the diagnosis and management schedule for PHPBL.
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Affiliation(s)
- Qianwen Wang
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Kangze Wu
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuzhao Zhang
- Department of Hematology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Liu
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Zhouyi Sun
- Department of Surgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Shumei Wei
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Bo Zhang, ; Shumei Wei,
| | - Bo Zhang
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Bo Zhang, ; Shumei Wei,
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Pararas N, Foukas P, Pikoulis A, Bagias G, Papakonstantinou D, Pappa V, Nastos K, Pikoulis E. Primary non‑Hodgkin lymphoma of the extra‑hepatic bile duct: A case report. Mol Clin Oncol 2022; 17:115. [PMID: 35747593 PMCID: PMC9204330 DOI: 10.3892/mco.2022.2548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Nikolaos Pararas
- Surgical Department, Dr Sulaiman Al Habib Hospital, Riyadh 12987, Saudi Arabia
| | - Periklis Foukas
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Andreas Pikoulis
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - George Bagias
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Dimitris Papakonstantinou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Vassiliki Pappa
- Hematology Unit, Second Propaedeutic Department of Internal Medicine and Research Institute, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Konstantinos Nastos
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Emmanouil Pikoulis
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
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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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4
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Primary biliary tract malignancies: MRI spectrum and mimics with histopathological correlation. ACTA ACUST UNITED AC 2014; 40:1520-57. [DOI: 10.1007/s00261-014-0300-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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5
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Chemotherapy Versus Surgery in Primary B-Cell Lymphoma Masquerading as Klatskin Tumor—A Diagnostic and Therapeutic Dilemma. Am J Ther 2011; 18:e255-7. [DOI: 10.1097/mjt.0b013e3181d4c957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ross WA, Egwim CI, Wallace MJ, Wang M, Madoff DC, Lee JH. Outcomes in lymphoma patients with obstructive jaundice: a cancer center experience. Dig Dis Sci 2010; 55:3271-7. [PMID: 20632106 DOI: 10.1007/s10620-010-1310-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 06/14/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Little information is available to guide clinicians on the optimal approach to managing obstructive jaundice in lymphoma patients. AIMS The aim of this study was to review our experience in treating lymphoma patients with obstructive jaundice in order to develop guidelines as to the best interventional approach. METHODS We reviewed the medical records of all lymphoma patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) and/or percutaneous biliary drainage (PBD) for obstructive jaundice between June 2002 and October 2008. RESULTS We identified 35 lymphoma patients who underwent ERCP and/or PBD for obstructive jaundice. The mean age was 57.6 years. Most patients (66%) had diffuse large B-cell lymphoma. Stents were placed by ERCP in 25 patients and PBD in nine. Serum bilirubin levels normalized following ERCP or PBD in 29 of 33 (85%) patients with stricture. Stricture resolution occurred in 12 cases. Patients who had obstructive jaundice at the time of their lymphoma diagnosis had significantly longer mean overall survival following intervention than patients in whom obstructive jaundice developed later in the course of their disease (21.3 months vs. 4.5 months, P = 0.0001). CONCLUSIONS ERCP and/or PBD effectively normalized serum bilirubin levels. Plastic stents should be used in patients who have obstructive jaundice at the time of lymphoma diagnosis because these strictures tend to resolve before stent exchanges are necessary. For patients in whom obstructive jaundice develops later in the course of their disease, the limited prognosis often makes a single intervention with insertion of a plastic stent sufficient to provide adequate biliary decompression.
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Affiliation(s)
- William A Ross
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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7
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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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9
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Yoon MA, Lee JM, Kim SH, Lee JY, Han JK, Choi BI, Kim SW, Jang JJ. Primary biliary lymphoma mimicking cholangiocarcinoma: a characteristic feature of discrepant CT and direct cholangiography findings. J Korean Med Sci 2009; 24:956-9. [PMID: 19794999 PMCID: PMC2752784 DOI: 10.3346/jkms.2009.24.5.956] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 06/22/2009] [Indexed: 12/04/2022] Open
Abstract
Primary non-Hodgkin's lymphoma arising from the bile duct is extremely rare and the reported imaging features do not differ from those of cholangiocarcinoma of the bile duct. We report a case of a patient with extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue (MALT), who presented with obstructive jaundice and describe the distinctive radiologic features that may suggest the correct preoperative diagnosis of primary lymphoma of the bile duct. Primary MALT lymphoma of the extrahepatic bile duct should be considered in the differential diagnosis when there is a mismatch in imaging findings on computed tomography or magnetic resonance imaging and cholangiography.
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MESH Headings
- Bile Duct Neoplasms/complications
- Bile Duct Neoplasms/diagnosis
- Bile Duct Neoplasms/diagnostic imaging
- Bile Ducts, Extrahepatic
- Cholangiocarcinoma/diagnosis
- Cholangiography
- Diagnosis, Differential
- Humans
- Jaundice, Obstructive/complications
- Jaundice, Obstructive/diagnosis
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Tomography, X-Ray Computed
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Affiliation(s)
- Min A Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ja-June Jang
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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10
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Primary follicular lymphoma of the extrahepatic bile duct mimicking a hilar cholangiocarcinoma: case report and review of the literature. Hum Pathol 2009; 40:1808-12. [PMID: 19716158 DOI: 10.1016/j.humpath.2009.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 05/27/2009] [Accepted: 05/28/2009] [Indexed: 11/23/2022]
Abstract
We report a case of a 53-year-old Asian woman who presented with abdominal pain, bloating, dysphagia, and signs of incomplete biliary obstruction, having elevated liver function tests but without increased bilirubin. Imaging studies revealed a mass measuring 6.0 x 8.0 cm at the porta hepatis extending to the right lobe of the liver and obstructing the common hepatic duct, causing mild to moderate intrahepatic biliary dilation and variable occlusion of the right portal vein. At laparotomy, an infiltrative neoplasm was noted at the hilum that involved the common bile duct, right and left hepatic ducts, and the right lobe of the liver. Extended right hepatectomy and resection of the extrahepatic bile duct and right portal vein was performed. Histologic examination revealed a high grade follicular lymphoma (grade 3A) with a predominantly follicular pattern of growth. Portal lymph nodes and a staging bone marrow biopsy showed no evidence of lymphoma. The patient subsequently received chemotherapy. Postoperative follow-up of more than 4 years has been uneventful, without disease recurrence. To the best of our knowledge, this is the third report of a primary extranodal follicular lymphoma of the extrahepatic biliary system.
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11
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Primary extranodal non-Hodgkin’s lymphoma of the common bile duct manifesting as obstructive jaundice: Report of a case. Surg Today 2009; 39:448-51. [DOI: 10.1007/s00595-008-3894-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 08/06/2008] [Indexed: 12/13/2022]
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12
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Menias CO, Surabhi VR, Prasad SR, Wang HL, Narra VR, Chintapalli KN. Mimics of cholangiocarcinoma: spectrum of disease. Radiographics 2008; 28:1115-29. [PMID: 18635632 DOI: 10.1148/rg.284075148] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cholangiocarcinoma is the second most common primary malignant hepatobiliary neoplasm, accounting for approximately 15% of liver cancers. Diagnosis of cholangiocarcinoma is challenging and the prognosis is uniformly poor, with recurrence rates of 60%-90% after surgical resection. A wide spectrum of neoplastic and nonneoplastic conditions of the biliary tract may masquerade as cholangiocarcinoma, adding to the complexity of management in patients suspected to have cholangiocarcinoma. Mimics of cholangiocarcinoma constitute a heterogeneous group of entities that includes primary sclerosing cholangitis, recurrent pyogenic cholangitis, acquired immunodeficiency syndrome cholangiopathy, autoimmune pancreatitis, inflammatory pseudotumor, Mirizzi syndrome, xanthogranulomatous cholangitis, sarcoidosis, chemotherapy-induced sclerosis, hepatocellular carcinoma, metastases, melanoma, lymphoma, leukemia, and carcinoid tumors. These entities demonstrate characteristic histomorphology and variable clinicobiologic behaviors. The imaging findings of these disparate entities are protean and may be indistinguishable from those of cholangiocarcinoma. In most cases, a definitive diagnosis can be established only with histopathologic examination of a biopsy specimen.
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Affiliation(s)
- Christine O Menias
- Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, MO, USA
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13
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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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14
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Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings. AJR Am J Roentgenol 2008; 191:198-206. [PMID: 18562746 DOI: 10.2214/ajr.07.3146] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The purpose of this article is to illustrate the spectrum of appearances of extranodal lymphoma in the abdomen using cross-sectional imaging techniques. CONCLUSION Extranodal lymphoma in the abdomen can mimic other neoplastic or inflammatory conditions. Although a definitive diagnosis is possible only with biopsy, it is important to consider extranodal lymphoma in the presence of certain imaging appearances in the appropriate clinical setting for the correct diagnosis, accurate staging, and optimal management.
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15
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Sugawara G, Nagino M, Oda K, Nishio H, Ebata T, Nimura Y. Follicular lymphoma of the extrahepatic bile duct mimicking cholangiocarcinoma. ACTA ACUST UNITED AC 2008; 15:196-9. [PMID: 18392714 DOI: 10.1007/s00534-007-1248-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 07/13/2006] [Indexed: 11/28/2022]
Abstract
We report a case of a 33-year old man who presented with symptoms and signs of an acute biliary tract obstruction with jaundice and abdominal pain. Diagnostic imaging studies revealed a biliary stricture of the hepatic confluence, and a mass at the hepatic hilum which obstructed the extrahepatic bile duct from the outside. At laparotomy, there was 3-cm-size nodule at the hilum which presented with a rubbery consistency. We performed extrahepatic bile duct resection and right and left hepaticojejunostomy. Histological examination of the resected specimen revealed follicular lymphoma, which consisted of medium cleaved follicle-like cells, grade 1 of 3 according to the revised European-American classification of lymphoid neoplasms proposed by International Lymphoma Study Group. Postoperative follow-up of more than 1 year has been completely uneventful, without any symptoms or signs of disease recurrence. This is the second case report of follicular lymphoma of the extrahepatic bile duct.
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Affiliation(s)
- Gen Sugawara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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16
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Krishna RP, Lal R, Sikora SS, Yachha SK, Pal L. Unusual causes of extrahepatic biliary obstruction in children: a case series with review of literature. Pediatr Surg Int 2008; 24:183-90. [PMID: 18071716 DOI: 10.1007/s00383-007-2087-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2007] [Indexed: 11/25/2022]
Abstract
This paper highlights the etiology, diagnosis, management and outcome in nine unusual cases of extrahepatic biliary obstruction in children. Extrahepatic biliary atresia and choledochal cyst constituted 127 out of 136 (93%) cases of all pediatric surgical biliary disorders managed between March 2000 and February 2007 at the reporting centre. However, nine children (aged 1.5-15 years) presented with uncommon causes like (1) idiopathic benign non-traumatic inflammatory stricture (n = 3), (2) idiopathic fibrosing chronic pancreatitis (n = 2), (3) post-cholecystectomy type 4 benign biliary stricture (n = 1), (4) post-acute pancreatitis pseudo-cyst of pancreas (n = 1), (5) non-Hodgkin's lymphoma (NHL) with extramural common bile duct compression and gall bladder perforation (n = 1), and (6) Langerhan cell histiocytosis (LCH, n = 1). The clinical features and the diagnostic work up of each group are discussed. A preoperative endoscopic/percutaneous biliary drainage was required in four children because of cholangitis at presentation. A biliary-enteric anastomosis was performed for all seven children in groups (1)-(4). The patients with NHL and LCH were referred for chemotherapy after establishing tissue diagnosis at laparotomy. With a follow-up period of 3 months to 7 years, seven children (with the exception of patients with NHL and LCH) are currently anicteric. This paper draws attention to some infrequently discussed causes of extrahepatic biliary obstruction in children. The management entails a carefully planned combination of endoscopic interventions, interventional radiology and surgery. The outcome in benign cases is usually satisfactory.
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Affiliation(s)
- R Phani Krishna
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226 014, India
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17
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Kondo N, Furuya H, Yamamoto S, Nakano A, Sakashita Y. Diffuse Large B-cell Lymphoma in the Ampulla of Vater Causing Obstructive Jaundice: Report of a Case. Surg Today 2007; 38:76-80. [DOI: 10.1007/s00595-007-3571-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Accepted: 04/06/2007] [Indexed: 10/22/2022]
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18
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Odemiş B, Parlak E, Başar O, Yüksel O, Sahin B. Biliary tract obstruction secondary to malignant lymphoma: experience at a referral center. Dig Dis Sci 2007; 52:2323-32. [PMID: 17406815 DOI: 10.1007/s10620-007-9786-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 01/18/2007] [Indexed: 12/15/2022]
Abstract
Lymphoma is a rare cause of biliary obstruction and, on cholangiography, may mimic other causes of obstructive jaundice. The optimum treatment for these patients is unclear. The aim of this study is to evaluate the incidence, clinical and imaging findings, management, and outcome of biliary obstruction caused by lymphoma. Our database was searched retrospectively for patients with biliary obstruction due to lymphoma between 1999 and 2005. Biliary obstruction secondary to lymphoma was found in 7 (0.6%) of 1123 patients with malignant biliary obstruction. One patient had benign biliary obstruction related to lymphoma. Of the eight patients (five male, three female; mean age, 34.50 +/- 17.93 years), four had Hodgkin's disease and four had non-Hodgkin's lymphoma. Biliary obstruction occurred as part of the initial or early presentation of lymphoma in two patients. The most common cause of obstruction was compression of the biliary tract by enlarged lymph nodes (six patients). Cholangiographic appearances were diverse: narrowing of the common bile duct (six patients), splayed and narrowed common bile duct (one patient), and multiple strictures and dilatations of the intrahepatic bile ducts (one patient). Biliary drainage was performed in all patients including endoscopic stent placement in six patients, nasobiliary drainage in one, and choledochoduodenostomy in one. Hyperbilirubinemia resolved in all but one of the patients with a stent; however, none could be maintained in a stent-free condition. Five patients died within 1 year after onset of jaundice. One of the surviving patients developed a late benign stricture at the site of the earlier lymphoma. We conclude that lymphoma should be considered in the differential diagnosis of obstructive jaundice, particularly in younger patients. We suggest that biliary drainage by the endoscopic or percutaneous route is necessary for the treatment of these patients. Late benign strictures may develop. Biliary obstruction is a sign of poor prognosis in lymphoma.
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Affiliation(s)
- Bülent Odemiş
- Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Sihhiye, Ankara 06100, Turkey.
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Jho DH, Jho DJ, Chejfec G, Ahn M, Ong ES, Espat NJ. Primary Biliary B-Cell Lymphoma of the Cystic Duct Causing Obstructive Jaundice. Am Surg 2007. [DOI: 10.1177/000313480707300517] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A distinctive case of primary biliary lymphoma occurring in the cystic duct causing extrinsic compression of the porta hepatis in a 48-year-old woman is presented. Imaging studies revealed stricture of the common hepatic duct with a 2.5-cm nonhomogeneous mass at the porta hepatis, mimicking a Klatskin tumor. Exploratory laparotomy revealed a mass in the gallbladder neck with extension into the cystic duct akin to Mirizzi's syndrome. A soft, tan-yellow 1.0-cm mass was removed from the cystic duct, and infiltrating atypical lymphocytic nodules were identified with a final diagnosis of an anaplastic variant of diffuse large B-cell lymphoma.
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Affiliation(s)
- David H. Jho
- Departments of Surgery, University of Illinois, Chicago, Illinois
| | - Diana J. Jho
- Departments of Surgery, University of Illinois, Chicago, Illinois
| | - Gregorio Chejfec
- Departments of Pathology, University of Illinois, Chicago, Illinois
| | - Maria Ahn
- Departments of Pathology, University of Illinois, Chicago, Illinois
| | - Evan S. Ong
- Departments of Surgery, University of Illinois, Chicago, Illinois
| | - N. Joseph Espat
- Departments of Surgery, University of Illinois, Chicago, Illinois
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Salmon JS, Thompson MA, Arildsen RC, Greer JP. Non-Hodgkin's lymphoma involving the liver: clinical and therapeutic considerations. ACTA ACUST UNITED AC 2006; 6:273-80. [PMID: 16507204 DOI: 10.3816/clm.2006.n.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary hepatic non-Hodgkin's lymphoma (NHL) is a rare disease that presents unique diagnostic and therapeutic challenges. Secondary liver involvement by lymphoma is common and can complicate treatment decisions. A review of the published case reports and the few larger series suggests that primary hepatic NHL represents a heterogeneous mixture of disparate diseases rather than a single entity. Presentations vary from the incidental discovery of hepatic abnormalities in an otherwise asymptomatic patient to that of fulminant hepatic failure with rapid progression of encephalopathy to coma and death. The clinical, laboratory, and radiographic characteristics are nonspecific, which means the diagnosis is often not suspected until histopathologic examination of liver tissue. There appears to be a strong association between primary hepatic NHL and the hepatitis C virus. Hepatosplenic T-cell lymphoma has attained its own status as a unique disease, whereas case reports suggest that the spectrum of hepatic lymphoma includes many histologies. Involvement of the liver by lymphoma can compound the difficulty of pursuing aggressive chemotherapy in patients who have a life-threatening illness and impaired metabolism of the most effective drugs. Therapy should be tailored to the individual clinical situation, with consideration of the underlying histology and degree of hepatic insufficiency.
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Affiliation(s)
- J Stuart Salmon
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Schapiro RH, Maher MM, Misdraji J. Case records of the Massachusetts General Hospital. Case 3-2006. A 63-year-old woman with jaundice and a pancreatic mass. N Engl J Med 2006; 354:398-406. [PMID: 16436772 DOI: 10.1056/nejmcpc059037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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