Primary non-Hodgkin’s lymphoma of the common bile duct presenting as obstructive jaundice

Abstract

Primary non-Hodgkin's lymphoma of the extrahepatic bile duct presenting as obstructive jaundice is an extremely rare disease. At this writing, a review of the medical literature disclosed 17 reported cases of primary non-Hodgkin's lymphoma arising from the extrahepatic bile duct. We, herein, report an additional case of obstructive jaundice caused by primary non-Hodgkin's lymphoma of the common bile duct, in a 21-year-old woman. Our patient showed clinical evidence of obstructive jaundice, and endoscopic retrograde cholangiopancreatography and abdominal magnetic resonance imaging demonstrated a long strictured segment of the common bile duct with proximal bile duct dilatation. These clinical and radiological findings resembled those of cholangiocarcinoma. Resection of the common bile duct tumor, cholecystectomy, lymph node dissection, and Roux-en-Y hepaticojejunostomy were carried out. Histology and immunohistochemistry of the resected specimen confirmed a diffuse large B-cell-type malignant lymphoma involving the common bile duct. She received four courses of combination chemotherapy, including cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), and 3060 cGy external irradiation. She has been well, without evidence of tumor recurrence, 17 months after the surgery. In summary, first, primary non-Hodgkin's lymphoma of the extrahepatic bile duct, despite its rarity, should be considered in the differential diagnosis of causes of obstructive jaundice. Second, an accurate histopathologic diagnosis and surgical resection, if feasible, combined with chemotherapy with or without radiotherapy may be the approach to offer a chance for cure.

Burkitts lymphoma: Causing obstructive jaundice in an adult

“…The presentation of obstructive jaundice due to BL is very rare (Kessel et al, 2005;Nistala et al, 2009). Obstructive jaundice is a presenting sign in only 1% of patients with NHL (Joo et al, 2004). On the other hand, biliary obstruction secondary to primary carcinomas of the pancreas are more frequently encountered in the clinical setting.…”

“…BL is a subtype of B-cell non-Hodgkin's lymphoma. Unlike other forms of NHL, BL is present as an extranodal disease (Joo et al, 2004). It accounts for over half of all childhood cancers in endemic areas (Equatorial Africa and Papua New Guinea), and 40 to 50% of childhood NHLs in nonendemic areas (America and Western Europe) (Murphy Med.…”

“…However, obstructive jaundice due to Non-Hodgkin's lymphoma (NHL) is quite rare (Fidias et al, 1995;Kessel et al, 2005). In only 1% of the patients with NHL, obstructive jaundice is the presenting sign of the disease (Joo et al, 2004). The mechanism of obstructive jaundice due to NHL is through enlarged lymph nodes compressing the biliary tree.…”

“…Burkitt's lymphoma (BL) is a solid sub-type of B-cell lymphoma and occurs commonly in children (Joo et al, 2004). This tumour is very rarely seen involving the pancreas (Nistala et al, 2009).…”

Single-operator cholangioscopy for the diagnosis of bile duct lymphoma: a case report and brief review of the literature

“…Lymphoma involving the bile duct is rare and is commonly a manifestation of advanced disease [1]. Biliary obstruction caused by lymphoma occurs in only 1 % -2 % of all malignant strictures [2]. Obstructive jaundice, weight loss, abdominal pain, and fever are the most common symptoms upon presentation [3].…”