Angioblastic T‐cell lymphoma of the gall bladder

Abstract

A 53-year-old man with chronic hepatitis C infection presented to the infectious diseases clinic with a 7-week history of a widespread maculopapular rash, night sweats, loss of weight, a fever and intermittent right upper quadrant pain. Examination revealed tender inguinal and cervical lymphadenopathy and a discrete left lower quadrant mass on abdominal examination. There was abdominal tenderness in the right upper quadrant clinically. He was admitted for further assessment and evaluation. Laboratory investigations demonstrated a normocytic, normochromic anaemia, haemoglobin 112 g/L (130-180) and a normal white cell count 4.7 ¥ 10∧9/L (4.0-11.0). The lymphocyte count was low at 0.68 ¥ 10∧9/L (1.0-4.0). The blood film showed occasional reactive lymphocytes but was otherwise normal.Initial computed tomography (CT) scan of the chest/abdomen/ pelvis revealed diffused lymphadenopathy (superior and inferior to the diaphragm), with a haemorrhagic subcapsular liver collection, a thick-walled gall bladder (Fig. 1) measuring 6 mm, and stomach wall thickening. Ultrasound of the gall bladder showed echogenicity with posterior shadowing (Fig. 2). No radiopaque stones were seen on either the ultrasound or CT of the abdomen, and the patient's sonographic Murphy's sign was negative .Open biopsy of inguinal lymph nodes showed reactive changes only. Gastroscopy revealed an oedematous pylorus with secondary gastric outlet obstruction, with biopsy again showing reactive changes only.