Outcomes in Lymphoma Patients with Obstructive Jaundice: A Cancer Center Experience

Ross, William A.; Egwim, Chukwuma; Wallace, Michael J.; Wang, Michael; Madoff, David C.; Lee, Jeffrey H.

doi:10.1007/s10620-010-1310-6

Cited by 13 publications

(17 citation statements)

References 31 publications

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“…The resolution of malignant strictures with chemotherapy is common, particularly with chemosensitive tumors like some lymphomas. 18 The fact that normal ERCP findings were more prevalent in the early part of the period studied can be attributed to improvements in noninvasive imaging of the biliary tree over the past decade. In addition, EUS is being used more frequently to evaluate potential common duct pathology so that ERCP has been increasingly reserved over time for individuals who are in need of endoscopic therapeutic intervention.…”

Section: Discussionmentioning

confidence: 99%

Role of ERCP in patients after hematopoietic stem cell transplantation

Kim¹,

Alousi²,

Lee³

et al. 2011

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 99%

Role of ERCP in patients after hematopoietic stem cell transplantation

Kim¹,

Alousi²,

Lee³

et al. 2011

Gastrointestinal Endoscopy

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“…A retrospective study of 35 patients with lymphoma and obstructive jaundice was published in 2010. Large B cell lymphomas were found in the majority of cases 22 . Hypothetically, any tumor that can cause mechanical obstruction of the distal bile duct or the ampulla of Vater can induce acute pancreatitis.…”

mentioning

confidence: 98%

Acute pancreatitis as the first manifestation of duodenal MALT lymphoma

Šimková¹,

Urbánek²,

Procházka³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Possibly any tumor that can cause mechanical obstruction of the distal bile duct can induce acute pancreatitis. However, acute pancreatitis as the first clinical manifestation of duodenal lymphoma is extremely rare. Objective. To report the case of a patient with acute pancreatitis as an extremely rare first manifestation of duodenal MALT lymphoma and possible association with erythema nodosum. Methods. Case report of a 66-year-old woman who was diagnosed with acute pancreatitis caused by infiltration with duodenal lymphoma. Results. Acute pancreatitis was confirmed by CT imaging. Detailed investigation revealed a duodenal mass causing pancreatic injury. Histological analysis established the diagnosis of MALT lymphoma. The patient's medical history also included erythema nodosum. Complete remission of the malignancy was achieved with chemotherapy. Conclusion. This is the first published case report of acute pancreatitis caused by the growth of duodenal MALT lymphoma. An association with erythema nodosum is possible.

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“…

We read with great interest the recent article by Ross et al [1] reporting one cancer center's experience with the treatment of obstructive jaundice in patients with lymphoma. This article describes outcomes for 35 patients who underwent biliary decompression endoscopically or percutaneously; biliary stents were placed in 43 of the 50 ERCP's completed, and all but four of these stents were plastic.

As quoted by Ross et al

[1], the need for a permanent metal stent in cases of biliary obstruction secondary to lymphoma is less prevalent given the increased chemoresponsiveness of many lymphomas when compared to other more refractory types of malignant biliary obstruction.

…”

mentioning

confidence: 99%

“…We read with great interest the recent article by Ross et al [1] reporting one cancer center's experience with the treatment of obstructive jaundice in patients with lymphoma. This article describes outcomes for 35 patients who underwent biliary decompression endoscopically or percutaneously; biliary stents were placed in 43 of the 50 ERCP's completed, and all but four of these stents were plastic.…”

mentioning

confidence: 99%

“…As quoted by Ross et al [1], the need for a permanent metal stent in cases of biliary obstruction secondary to lymphoma is less prevalent given the increased chemoresponsiveness of many lymphomas when compared to other more refractory types of malignant biliary obstruction. The authors conclude that metal stents should be reserved for patients with lymphomas refractory to treatment who are expected to live more than 6 months.…”

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confidence: 99%

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Metal Stents and Biliary Obstruction Secondary to Lymphoma: A Tale of Caution

Bakken

Baron

2010

Dig Dis Sci

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We read with great interest the recent article by Ross et al. [1] reporting one cancer center's experience with the treatment of obstructive jaundice in patients with lymphoma. This article describes outcomes for 35 patients who underwent biliary decompression endoscopically or percutaneously; biliary stents were placed in 43 of the 50 ERCP's completed, and all but four of these stents were plastic.As quoted by Ross et al.[1], the need for a permanent metal stent in cases of biliary obstruction secondary to lymphoma is less prevalent given the increased chemoresponsiveness of many lymphomas when compared to other more refractory types of malignant biliary obstruction. The authors conclude that metal stents should be reserved for patients with lymphomas refractory to treatment who are expected to live more than 6 months.Based on experiences at our institution, we fully agree with the placement of plastic biliary stents for obstructive lymphomas, but would also urge more caution when considering uncovered metal stent placement in these cases, given the potential complications which can ensue due to the difficult (if not impossible) removal of such stents. We have two cases that illustrate this point.The first is of a 75-year-old male who was found to have a hilar mass that was thought to be a cholangiocarcinoma or a pancreatic adenocarcinoma based on abdominal CT scan. Given the presumed poor prognosis, bilateral uncovered metal stents were placed across the bifurcation to provide bilateral intrahepatic drainage. Biopsy specimens obtained during ERCP showed diffuse large B cell lymphoma. Attempts to remove the metal stents 2 weeks after placement were unsuccessful due to tissue imbedding. Over the course of the next 18 months, the patient underwent six additional ERCP's to treat biliary obstruction secondary to stent occlusion from tissue hyperplasia. He ultimately underwent intrabiliary photodynamic therapy in an attempt to deliberately necrose the tissue surrounding the stents and to allow removal, but the stents could not be removed. The patient's lymphoma responded very well to chemotherapy, with no signs of recurrence, and he is still living 32 months after his diagnosis.Our second case is of a 73-year-old female who underwent placement of an uncovered metal stent for a high-grade obstruction in the distal common bile duct thought to be secondary to pancreatic adenocarcinoma with metastases based on radiographic appearance. Ultimately, the tumor also proved to be a B cell lymphoma, and 5 months after placement, the stent was irretrievable secondary to tissue ingrowth. A covered metal stent was placed inside the original stent due to occlusion.Uncovered metal biliary stents are nearly always nonremovable and based on our experiences, we would first and foremost recommend plastic stent placement for any confirmed hepatobiliary lymphoma resulting in biliary obstruction. For cases without confirmed tissue diagnosis, initial plastic stent placement or covered metal stent placement is an approach which may signific...

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Outcomes in Lymphoma Patients with Obstructive Jaundice: A Cancer Center Experience

Cited by 13 publications

References 31 publications

Role of ERCP in patients after hematopoietic stem cell transplantation

Role of ERCP in patients after hematopoietic stem cell transplantation

Acute pancreatitis as the first manifestation of duodenal MALT lymphoma

Metal Stents and Biliary Obstruction Secondary to Lymphoma: A Tale of Caution

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