A primary biliary diffuse large B-cell lymphoma mimicking Klatskin Tumor in an HIV patient

Bile duct lymphoma disguised as cholangiocarcinoma

We present a case of intrabiliary primary B-cell lymphoma masked as a cholangiocarcinoma in an HIV-positive patient. The two entities have similar symptoms, laboratory findings, and imaging findings but require very different treatments. The case highlights the need to confirm the diagnosis by biopsy.

Primary extrahepatic bile duct lymphoma mimicking Klatskin's tumor, dramatic response to chemotherapy

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We herein explain a rarely seen extrahepatic bile duct tumor.

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Non-Hodgkin’s lymphoma can be confused with Klatskin’s tumor.

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Treatment of Non-Hodgkin’s lymphoma is totally different.

Introduction

Non- Hodgkin’s lymphoma (NHL) mimicking Klatskin’s tumor is rare but possible. It can be confused with tumors for which major surgery is needed. Imaging modalities have similar features in Klatskin’s tumor and non-Hodgkin’s lymphoma.

Presentation of Case

We herein report a patient who was first thought having a Klatskin’s tumor and prepared for major surgery. A month later, obstructive jaundice developed and a second magnetic resonance-magnetic resonance cholangiopancreotography showed a doubling size of the tumor in one month. In terms of tumor behavior, lymphoma was suspected and a tru-cut biopsy was performed by interventional radiology. Pathological examinations revealed non-Hodgkin’s lymphoma large B-cell type. After 4 cycles of chemotherapy by hematology-oncology department, complete cure was achieved.

Discussion

Since the radiologic and clinical features are confusable in Klatskin’s tumor and non-Hodgkin lymphoma. Tumor biologic behavior and other biochemical parameters together may put a suspicion in mind. Upon suspicion biopsy must be done radiologically.

Conclusion

Primary liver lymphoma arising from the bile ducts is extremely rare and radiologic imaging features do not differ from cholangiocarcinoma. A strong suspicion may prevent unnecessary surgery. Since the treatment of non-Hodgkin’s lymphoma is mainly chemotherapy.