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• W2922394499 abstract "84-year-old African-American woman presets with jaundice, anorexia, and weight loss for six months. Three weeks prior to presentation, she developed worsening abdominal pain, dark urine, and pale stools. She had hepatomegaly with a palpable mass in the RUQ as well as moderate RUQ, epigastric, and periumbilical tenderness. Her labs were significant for an elevated CA 19-9 of 1527 U/mL, total bilirubin 10.1 mg/dl, direct bilirubin 8.2 mg/dl, ALP 410, AST 200, and ALT 181. CT abdomen/pelvis revealed RUQ lymphadenopathy with intrahepatic dilatation and masslike replacement of the CBD & CHD, compatible with cholangiocarcinoma with metastatic lymphadenopathy. ERCP showed near occlusive narrowing of the CHD which was successfully resolved with placement of two plastic stents into the right and left intrahepatic systems resulting in resolution of jaundice. EUS revealed a hypoechoic 30mm x 2.5mm peripancreatic mass with peripancreatic, periportal and celiac axis adenopathy. Fine-needle biopsies of peripancreatic mass and lymph nodes revealed presence of a monoclonal B-cell population, suspicious but non-diagnostic for a primary biliary lymphoma. CT-guided percutaneous biopsy of aortocaval lymph nodes confirmed diagnosis of diffuse large B-cell lymphoma. She was discharged with plans to initiate R-CHOP and repeat ERCP in 6 weeks for stent management. While malignant biliary obstruction more often is a result of compressive adenopathy, ductal occlusion resulting from intraductal spread of a primary Non-Hodgkin's lymphoma may rarely occur. These primary biliary lymphomas (PBL) account for 1-2% of all cases of malignant biliary obstruction and can be challenging to differentiate from more common biliary processes such as cholangiocarcinoma, PSC, IgG4 associated cholangiopathy, or non-IgG4 autoimmune cholangiopathy. Radiographic features that support the diagnosis of PBL include cholangiography showing a smooth, mild luminal narrowing of the extrahepatic ducts without mucosal irregularities, despite diffuse thickening of the ductal wall on CT/MRI. Conclusive diagnosis and treatment decisions for PBL frequently require surgical excisional biopsies or CT/US transcutaneous biopsies in order to obtain detailed histopathological architecture. As a result, PBL is often not considered in the differential but recognizing these characteristic features can have an enormous impact as it could result in a significantly different diagnosis, treatment, and prognosis.1415_A.tif Figure 1: CT Abdomen & Pelvis with oral and IV contrast showing masslike replacement common hepatic/bile duct compatible with cholangiocarcinoma with surrounding metastatic spread/lymphadenopathy resulting in marked intrahepatic biliary dilatation and marked narrowing of the main portal vein1415_B.tif Figure 2: EUS demonstrating a hypoechoic peripancreatic mass extendign to the porta hepatis and extending to the bile duct, measuring 30mm x 2.5mm1415_C.tif Figure 3: ERCP cholangiogram showing smooth near occlusive narrowing of the CHD with upstream dilatation of the RHD, LHD and intrahepatic ducts to a maximum diameter of 1.5cm in the LHD." @default.
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• W2922394499 date "2018-10-01" @default.
• W2922394499 modified "2023-09-27" @default.
• W2922394499 title "Non-Hodgkinʼs Lymphoma Masquerading as Cholangiocarcinoma: A Differential Diagnosis for Malignant Obstructive Jaundice" @default.
• W2922394499 doi "https://doi.org/10.14309/00000434-201810001-01415" @default.
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