Primary extranodal non-Hodgkin’s lymphoma of the common bile duct manifesting as obstructive jaundice: Report of a case

Abstract

Primary non-Hodgkin's lymphoma (NHL) of the common bile duct (CBD) manifesting as obstructive jaundice is extremely rare: to our knowledge, only 22 cases of primary NHL arising from the CBD have been reported. The patient in this case report was a 63-year-old man who presented with obstructive jaundice. Abdominal sonography, positron emission tomography, and computed tomography showed a mass with abnormal 18-fluorodeoxyglucose uptake in pancreatic head. Magnetic resonance cholangiopancreatography demonstrated a strictured segment of the CBD with proximal bile duct dilatation. We performed pancreaticoduodenectomy for a presumptive diagnosis of pancreatic head carcinoma or cholangiocarcinoma of the CBD. However, the histological diagnosis was a primary, diffuse, large B-cell lymphoma of the CBD. He received three courses of combination chemotherapy, including rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The patient remains well, without evidence of tumor recurrence, 8 months after surgery. In summary, primary NHL of the CBD, despite its rarity, should be considered in the differential diagnosis of obstructive jaundice. An accurate histopathologic diagnosis and complete surgical resection, followed by combination chemotherapy plus rituximab may be effective.

Histiocytic Sarcoma of the Bile Duct

“…Other differential diagnoses included cholangiocarcinoma and extranodal non-Hodgkin's lymphoma of the bile duct. These tumors usually appear on CT or MRI as well-defined mass lesions, as in our case, or the presence of diffuse wall thickening of the bile duct (17). Therefore, it is difficult to distinguish HS from nonHodgkin's lymphoma and cholangiocarcinoma employing solely radiographic imaging.…”

Primary Malt Lymphoma of the Common Bile Duct

“…Since Nguyen reported the first case of primary CBD lymphoma in 1982, only 23 cases of primary CBD lymphoma have been reported in the medical literature (10, 11). Although various lymphoma subtypes have been reported in the literature, the most common subtype is large-cell lymphoma and the most common immunophenotype is B-cell lineage (12, 13).…”

“…Nonetheless, the dramatic difference in the prognosis and treatment of cholangiocarcinoma and primary lymphoma emphasizes the importance of the differential diagnosis in extrahepatic bile duct tumors with obstructive jaundice. To date, there are no known characteristic radiologic findings specific for the diagnosis of primary lymphoma of the CBD, including MALT lymphoma (3-7, 10, 12, 17, 18). CT scans in previously published reports demonstrated diffuse wall thickening of the CBD with or without the presence of an intraductal mass lesion causing proximal bile duct dilatation.…”

Primary spinal epidural non-Hodgkin’s lymphoma presented with spinal cord compression syndrome

“…They occur in 0.9%-6.5% of cases of non-Hodgkin's B-cell lymphoma [7][8][9][10]. They are rare and lethal neoplasms that represent a challenge in terms of their diagnosis, treatment, and prognosis.…”