Hashimoto Masao, Umekita Nobutaka, Noda Kazumasa
Department of Surgery, Tokyo Metropolitan Bokutoh General Hospital, 4-23-15 Kohtohbashi, Sumida-ku, Tokyo 130-8575, Japan.
World J Gastroenterol. 2008 Jul 7;14(25):4093-5. doi: 10.3748/wjg.14.4093.
Non-Hodgkin lymphoma is a rare cause of biliary obstruction. To the best of our knowledge, non-Hodgkin lymphoma in the peripancreatic region causing obstructive jaundice with simultaneous portal vein (PV) invasion has not yet been reported. We present a 50-year-old patient with obstructive jaundice whose extrahepatic portal vein was obstructed by the invasion of a peripancreatic non-Hodgkin lymphoma. The patient denied any other symptoms such as recurrent fever, night sweat and loss of body weight. Computed tomography (CT) revealed a 10 cm mass in the retroperitoneal space behind the head of the pancreas causing obstruction of the distal bile duct and the PV. A pylorus-preserving pancreaticoduodenectomy combined with a PV resection was performed. The PV was reconstructed using an autologous right internal jugular vein graft. The resected specimen showed endoluminal invasion of both the bile duct and the PV. Histological examination showed the mass consisting of diffuse sheets of large malignant lymphoid cells. These cells were positive for CD20 and CD79a, partially positive for CD10, and negative for CD3, CD4, CD5, CD8 and CD30. The pathologic diagnosis was diffuse large B-cell type non-Hodgkin lymphoma and the patient was transferred to the Department of Hematology and Oncology for chemotherapy. He received four cycles of combined chemotherapy including cyclophosphamide, doxorubicin, vincristine and prednisone plus rituximab, and three cycles of intrathecal chemoprophylaxis including methotorexate, cytosine arbinoside and prednisone. The patient is alive with no evidence of the disease for 7 mo after operation and will receive additional courses of chemotherapy.
非霍奇金淋巴瘤是导致胆管梗阻的罕见病因。据我们所知，胰周区域的非霍奇金淋巴瘤导致梗阻性黄疸并同时侵犯门静脉（PV）的情况尚未见报道。我们报告一例50岁患有梗阻性黄疸的患者，其肝外门静脉被胰周非霍奇金淋巴瘤侵犯而梗阻。患者否认有任何其他症状，如反复发热、盗汗和体重减轻。计算机断层扫描（CT）显示胰腺头部后方的腹膜后间隙有一个10厘米的肿块，导致远端胆管和门静脉梗阻。实施了保留幽门的胰十二指肠切除术并联合门静脉切除术。使用自体右颈内静脉移植物重建门静脉。切除的标本显示胆管和门静脉均有腔内侵犯。组织学检查显示肿块由弥漫性大片状大恶性淋巴细胞组成。这些细胞CD20和CD79a呈阳性，CD10部分呈阳性，CD3、CD4、CD5、CD8和CD30呈阴性。病理诊断为弥漫性大B细胞型非霍奇金淋巴瘤，患者被转至血液学和肿瘤学部门进行化疗。他接受了四个周期的联合化疗，包括环磷酰胺、阿霉素、长春新碱和泼尼松加利妥昔单抗，以及三个周期的鞘内化学预防，包括甲氨蝶呤、阿糖胞苷和泼尼松。患者术后存活7个月，无疾病证据，将接受额外疗程的化疗。
