Journal of Digestive Cancer Research

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
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Biliary Obstruction Caused by Non-Hodgkin Lymphoma Involvement: A Case Report

  • Jae Hyun Lim (Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Huapyong Kang (Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Jung Hyun Jo (Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Hee Seung Lee (Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Jeong Youp Park (Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Seungmin Bang (Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Seung Woo Park (Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Si Young Song (Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Moon Jae Chung (Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2018.05.14
  • Accepted : 2018.06.13
  • Published : 2018.06.30
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Abstract

Non-Hodgkin's lymphoma is known to be a rare and unusual cause of biliary obstruction. We report a case of biliary obstruction that a 25-year-old male showed icteric sclera and yellow discoloration of his skin caused by metastasis of non-Hodgkin lymphoma. Initial imaging & endoscopic work-up led us to an impression of either cholangiocarcinoma or IgG4-related disease, yet the pathological results weren't diagnostic. Through our thorough re-examination, we found a 5cm sized round, fixed, non-tender sternal mass, and additional imaging studies were suggestive of lymphoma, which was also consistent with the results of incisional chest wall biopsy. Biliary obstruction by lymphoma was successfully treated by endoscopic plastic stent insertion procedure and chemotherapy. Although it is widely accepted that lymphoma accounts for very few portion of malignant biliary obstruction, due to the fact that lymphoma and cholangiocarcinoma are often indistinguishable, careful diagnostic approach should be done.

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References

  1. Lipsett PA, Pitt HA. Acute cholangitis. Surgical Clinics of North America 1990;70:1297-1312.
  2. Lipsett PA, Pitt HA. Acute cholangitis. Frontiers in Bioscience 2003;8:s1229-s1239.
  3. Sinanan MN. Acute cholangitis. Infectious Disease Clinics of North America 1992;6:571-599.
  4. Odemis B, Parlak E, Basar O, Yuksel O, Sahin B. Biliary tract obstruction secondary to malignant lymphoma: experience at a referral center. Dig Dis Sci 2007;52:2323-2332.
  5. Ravindra KV, Stringer MD, Prasad KR, Kinsey SE, Lodge JP. Non-Hodgkin lymphoma presenting with obstructive jaundice. Br J Surg 2003;90:845-849.
  6. Lokich JJ, Kane RA, Harrison DA, McDermott WV. Biliary tract obstruction secondary to cancer: management guidelines and selected literature review. J Clin Oncol 1987;5:969-981.
  7. Nguyen GK. Primary extranodal non-Hodgkin'S lymphoma of the extrahepatic bile ducts report of a case. Cancer 1982;50:2218-2222.
  8. Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood 2011;117:5019-5032.
  9. Morton LM, Wang SS, Devesa SS, Hartge P, Weisenburger DD, Linet MS. Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood 2006;107:265-276.
  10. Carlos M, Antonio DL, Ivan D, et al. Validation of the NCCNIPI for diffuse large B-cell lymphoma (DLBCL): the addition of β2-microglobulin yields a more accurate GELTAMO-IPI. British Journal of Haematology 2017;176:918-928.
  11. Eliason SC, Grosso LE. Primary biliary malignant lymphoma clinically mimicking cholangiocarcinoma: a case report and review of the literature. Ann Diagn Pathol 2001;5:25-33.
  12. Morra E. The biological Markers of Non-Hodgkin'S Lymphomas: Their Role in Diagnosis, Prognostic Assessment and Therapeutic Strategy. The International Journal of Biological Markers 1999;14:149-153.
  13. 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;55:3271-3277.