Cascio Baccanelli Clara María, Sian Andrea Melissa, Uad Pedro Vicente, Goransky Patiño Jeremias
Instituto Universitario Hospital Italiano de Buenos Aires.
Hospital Italiano de Buenos Aires.
Rev Fac Cien Med Univ Nac Cordoba. 2023 Dec 26;80(4):510-522. doi: 10.31053/1853.0605.v80.n4.42808.
The obstruction of the bile duct secondary to non-Hodgkin lymphoma is extremely rare. That's why we present the case of a 63-year-old female patient who sought medical attention due to jaundice, dark urine, acholia, and weakness. Laboratory results showed a cholestatic pattern, and an ultrasound revealed dilation of the intra and extrahepatic bile ducts, for which a cholangio resonance was ordered. It showed an expansive formation with ill-defined borders compromising the common hepatic duct associated with its stenosis. The initial suspicion was a Klatskin tumor, for which a biopsy was performed, which reported infiltration of a double expressor large B-cell lymphoma as a primary neoplasm of the bile duct. The patient underwent chemotherapy treatment with R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and went into remission. Due to continuous episodes of cholangitis, a Roux-en-Y hepatic jejunal anastomosis with biliary tract reconstruction was performed. Currently, she remains in remission, seven years after the diagnosis. This case highlights the rarity of large B-cell non-Hodgkin lymphoma in the bile duct and emphasizes the importance of biopsy for effective treatment, combining chemotherapy for the underlying disease and surgery for obstructive complications.
非霍奇金淋巴瘤继发胆管梗阻极为罕见。这就是为什么我们要介绍一位63岁女性患者的病例,她因黄疸、深色尿液、无胆汁和虚弱前来就医。实验室检查结果显示为胆汁淤积型,超声检查发现肝内和肝外胆管扩张,为此安排了胆管磁共振成像检查。检查显示有一个边界不清的占位性病变,累及肝总管并伴有狭窄。最初怀疑是肝门部胆管癌,于是进行了活检,结果报告为双表达大B细胞淋巴瘤浸润,这是胆管的原发性肿瘤。患者接受了R-CHOP方案(利妥昔单抗、环磷酰胺、阿霉素、长春新碱、泼尼松)化疗并进入缓解期。由于胆管炎持续发作,进行了Roux-en-Y肝空肠吻合术并重建胆道。目前,诊断后七年她仍处于缓解期。该病例凸显了胆管大B细胞非霍奇金淋巴瘤的罕见性,并强调了活检对于有效治疗的重要性,治疗需结合针对基础疾病的化疗和针对梗阻性并发症的手术。