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Biliary Tract Obstruction Secondary to Malignant Lymphoma: Experience at a Referral Center

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Abstract

Lymphoma is a rare cause of biliary obstruction and, on cholangiography, may mimic other causes of obstructive jaundice. The optimum treatment for these patients is unclear. The aim of this study is to evaluate the incidence, clinical and imaging findings, management, and outcome of biliary obstruction caused by lymphoma. Our database was searched retrospectively for patients with biliary obstruction due to lymphoma between 1999 and 2005. Biliary obstruction secondary to lymphoma was found in 7 (0.6%) of 1123 patients with malignant biliary obstruction. One patient had benign biliary obstruction related to lymphoma. Of the eight patients (five male, three female; mean age, 34.50 ± 17.93 years), four had Hodgkin’s disease and four had non-Hodgkin’s lymphoma. Biliary obstruction occurred as part of the initial or early presentation of lymphoma in two patients. The most common cause of obstruction was compression of the biliary tract by enlarged lymph nodes (six patients). Cholangiographic appearances were diverse: narrowing of the common bile duct (six patients), splayed and narrowed common bile duct (one patient), and multiple strictures and dilatations of the intrahepatic bile ducts (one patient). Biliary drainage was performed in all patients including endoscopic stent placement in six patients, nasobiliary drainage in one, and choledochoduodenostomy in one. Hyperbilirubinemia resolved in all but one of the patients with a stent; however, none could be maintained in a stent-free condition. Five patients died within 1 year after onset of jaundice. One of the surviving patients developed a late benign stricture at the site of the earlier lymphoma. We conclude that lymphoma should be considered in the differential diagnosis of obstructive jaundice, particularly in younger patients. We suggest that biliary drainage by the endoscopic or percutaneous route is necessary for the treatment of these patients. Late benign strictures may develop. Biliary obstruction is a sign of poor prognosis in lymphoma.

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References

  1. Boddie AW, Eisenberg BL, Mullins JD, Schlichtemeier AL (1980) The diagnosis and treatment of obstructive jaundice secondary to malignant lymphoma: a problem in multidiciplinary management. J Surg Oncol 14(2):111–123

    Article  PubMed  Google Scholar 

  2. Di Sena V, Thuler FP, Macedo EP, Paulo GA, Della Libera E, Ferrari AP (2005) Obstructive jaundice secondary to bile duct involvement with Hodgkin’s disease: a case report. Sao Paulo Med J 123(1):30–32

    Article  PubMed  Google Scholar 

  3. Severini A, Bellomi M, Cozzi G, Pizzetti P, Spinelli P (1981) Lymphomatous invovement of intrahepatic and extrahepatic biliary ducts. PTC and ERCP findings. Acta Radiol Diagn (Stockh) 22(2):159–163

    CAS  Google Scholar 

  4. Fidias P, Carey RW, Grossbard ML (1995) Non-Hodgkin’s lymphoma presenting with biliary tract obstruction. A discussion of seven patients and a review of the literature. Cancer 75(7):1669–1677

    Article  PubMed  CAS  Google Scholar 

  5. Birrer MJ, Young RC (1987) Differential diagnosis of jaundice in lymphoma patients. Semin Liver Dis 7:269–277

    PubMed  CAS  Google Scholar 

  6. Ravindra KV, Stringer MD, Prasad KR, Kinsey SE, Lodge JPA (2003) Non-Hodgkin lymphoma presenting with obstructive jaundice. Br J Surg 90(7):845–849

    Article  PubMed  CAS  Google Scholar 

  7. Joo YE, Park CH, Lee WS, et al (2004) Primary non-Hodgkin’s lymphoma of the common bile duct presenting as obstructive jaundice. J Gastroenterol 39(7):692–696

    Article  PubMed  Google Scholar 

  8. Martin KR, Moore TJ, Wright RA (1992) Obstructive jaundice secondary to primary biliary involvement with Hodgkin’s disease. Am J Gastroenterol 87(9):1194–1195

    PubMed  CAS  Google Scholar 

  9. Irıe H, Honda H, Kaneko K, et al (1996) Primary malignant lymphoma in the porta hepatis: a case report. Abdom Imaging 21(5):448–450

    Article  PubMed  Google Scholar 

  10. Pawade J, Lee CS, Ellis DW, Vellas ID, Rode J (1994) Primary lymphoma of the ampulla of Vater. Cancer 73:2083–2086

    Article  PubMed  CAS  Google Scholar 

  11. Young IF, Roberts-Thomson IC, Sullivan JR (1981) Histiocytic lymphoma presenting with extrahepatic biliary obstruction: a report of three cases. Aust NZ J Surg 51:181–183

    CAS  Google Scholar 

  12. Radhakrishnan S, Nakib BA, Liddawi HA, Ruwaih AA (1986) Primary gastrointestinal lymphoma complicated by common bile duct obstruction: report of two cases. Am J Gastroenterol 81:691–694

    PubMed  CAS  Google Scholar 

  13. Cherqui D, Palazzo L, Piedbois P, et al (1994) Common bile duct stricture as a late complication of upper abdominal radiotherapy. J Hepatol 20(6):693–697

    Article  PubMed  CAS  Google Scholar 

  14. Feller E, Schiffman FJ (1990) Extrahepatic biliary obstruction by lymphoma. Arch Surg 125:1507–1509

    PubMed  CAS  Google Scholar 

  15. Ryoo JW, Manaligod JR, Walker MJ (1986) Primary lymphoma of the liver. J Clin Gastroenterol 8:308–311

    Article  PubMed  CAS  Google Scholar 

  16. Ugur H, Tacyildiz N, Yavuz G, et al (2006) Obstructive jaundice: an unusual initial manifestation of intra-abdominal non-Hodgkin lymphoma in a child. Pediatr Hematol Oncol 23(1):87–90

    Article  PubMed  Google Scholar 

  17. Lieberman DA (1986) Intrahepatic cholestasis due to Hodgkin’s disease. J Clin Gastroenterol 8:304–307

    Article  PubMed  CAS  Google Scholar 

  18. Rossini MS, Lorand-Metze I, Oliveira GB, Souza CA (2000) Vanishing bile duct syndrome in Hodgkin’s disease: case report. Sao Paulo Med J 118(5):154–157

    Article  PubMed  CAS  Google Scholar 

  19. Desmet VJ (1992) Vanishing bile duct disorders. Prog Liver Dis 10:89–121

    PubMed  CAS  Google Scholar 

  20. Friedman CJ, Lambert MJ (1981) Obstructive jaundice as initial presention of non-Hodgkin’s lymphoma; value of internal percutaneous transhepatic biliary drainage. South Med J 74(8):1005–1007

    PubMed  CAS  Google Scholar 

  21. Dudgeon DJ, Brower M (1993) Primary chemotherapy for obstructive jaundice caused by intermediate-grade non-Hodgkin’s lymphoma. Cancer 71:2813–2816

    Article  PubMed  CAS  Google Scholar 

  22. Lokich JJ, Kane RA, Harrison DA, McDermott WV (1987) Biliary tract obstruction secondary to cancer: management guidelines and selected literature review. J Clin Oncol 5:969–981

    PubMed  CAS  Google Scholar 

  23. Nguyen GK (1982) Primary extranodal non-Hodgkin’s lymphoma of the extrahepatic bile ducts. Report of a case. Cancer 50:2218–2222

    Article  PubMed  CAS  Google Scholar 

  24. Kaplan LD, Kahn J, Jacobson M, Bottles K, Cello J (1989) Primary bile duct lymphoma in the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 110:161–162

    PubMed  CAS  Google Scholar 

  25. Tartar VM, Balfe DM (1990) Lymphoma in the wall of the bile ducts: radiologic imaging. Gastrointest Radiol 15:53–57

    Article  PubMed  CAS  Google Scholar 

  26. Boccardo J, Khandelwal A, Ye D, Duke BE (2006) Common bile duct MALT lymphoma:case report and review of the literature. Am Surg 72(1):85–88

    PubMed  Google Scholar 

  27. Al-Fadda M, Fashir BM (1998) Primary large cell lymphoma presenting as hilar mass and obstructive jaundice. Am J Gastroenterol 93(2):274–275

    Article  Google Scholar 

  28. Chu KM, Lai EC, Fan ST (1995) Primary lymphoma presenting as intra-abdominal mass and obstructive jaundice. Am J Gastroenterol 90(3):482–484

    PubMed  CAS  Google Scholar 

  29. Buess M, Steuerwald M, Wegmann W, Rothen M (2004) Obstructive jaundice caused by enteropathy-associated T-cell lymphoma in a patient with celiac sprue. J Gastroenterol 39(11):1110–1113

    Article  PubMed  Google Scholar 

  30. Moreira VF, Lopez-San Roman A, Ledo L, Merorio E, Erdozain JC (1990) Retroperitoneal lymphoma causing pancreatic ductal obstruction on endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 36(1):80–81

    PubMed  CAS  Google Scholar 

  31. Pariente D, Cornud F, Grenier P, Degos F, Nahum H (1981) Involvement of the common bile duct in Hodgkin’s disease: report of three cases [author’s translation]. Sem Hop 57(47-48):2027–2030

    PubMed  CAS  Google Scholar 

  32. Knibbeler-van Rossum CT, Peters FJ, Erdkamp FL, Bos LP (2002) Unusual presentation of Hodgkin’s lymphoma. Ann Oncol 13(4):637–638

    Article  PubMed  CAS  Google Scholar 

  33. Schoeppner HL, Wong DK, Bresalier RS (1995) Primary small bowel lymphoma manifested as obstructive jaundice in a patient with AIDS. South Med J 88(5):583–585

    PubMed  CAS  Google Scholar 

  34. Misdraji J, Fernandez del Castillo C, Ferry JA (1997) Follicle center lymphoma of the ampulla of Vater presenting with jaundice: report of a case. Am J Surg Pathol 21(4):484–488

    Article  PubMed  CAS  Google Scholar 

  35. Halline A, Lerios M, Melissas J, Segal I, Grieve TP (1987) Primary lymphoma of the small bowel with obstructive jaundice and pancreatitis. A case report. S Afr Med J 72(1):61–62

    PubMed  CAS  Google Scholar 

  36. Neef B, Kunzig B, Sinn I, Kieninger G, von Gaisberg U (1997) Primary pancreatic lymphoma. A rare cause of pain-free icterus. Dtsch Med Wochenschr 122(1-2):12–17

    PubMed  CAS  Google Scholar 

  37. Hamaya Y, Kageyama F, Takehira Y, et al (2005) A case of obstructive jaundice as the initial manifestation of non-Hodgkin’s lymphoma. JMAJ 48(11):557–563

    Google Scholar 

  38. Cavalli G, Casali AM, Lambertini F, Busachi C (1979) Changes in the small biliary passages in the hepatic localization of Hodgkin’s disease. Virchows Arch 384:295–306

    Article  CAS  Google Scholar 

  39. Trewby PN, Portmann B, Brinkley DM, Williams R (1979) Liver disease as presenting manifestation of Hodgkin’s disease. Q J Med 48(189):137–150

    PubMed  CAS  Google Scholar 

  40. Terada T, Nakanuma Y (1995) Intrahepatic cholangiographic appearance simulating primary sclerosing cholangitis in several hepatobiliary diseases: a postmortem cholangiographic and histopathological study in 154 livers at autopsy. Hepatology 22(1):75–81

    PubMed  CAS  Google Scholar 

  41. Gupta A, Roebuck DJ, Michalski AJ (2002) Biliary involvement in Hodgkin’s disease. Pediatr Radiol 32:202–204

    Article  PubMed  Google Scholar 

  42. Man KM, Drejet A, Keeffe EB, et al (1993) Primary sclerosing cholangitis and Hodgkin’s disease. Hepatology 18(5):1127–1131

    Article  PubMed  CAS  Google Scholar 

  43. DiStasi M, Cavanna L, Fornari F, et al (1990) Obstructive jaundice secondary to non-Hodgkin’s lymphoma: usefulness of ultrasound-guided fine-needle aspiration biopsy (UG-FNAB). Eur J Haematol 44:265–266

    CAS  Google Scholar 

  44. Shtamler B, Bickel A, Manor E, et al (1988) Primary lymphoma of the head of the pancreas. J Surg Oncol 38:48–51

    Article  PubMed  CAS  Google Scholar 

  45. Webb TH, Lillemoe KD, Pitt HA, Jones RJ, Cameron JL (1989) Pancreatic lymphoma: Is surgery mandatory for diagnosis or treatment? Ann Surg 209:25–30

    Article  PubMed  CAS  Google Scholar 

  46. Joly I, David A, Payan MJ, Sahel J, Sarles H (1992) A case of primary non-Hodgkin lymphoma of the pancreas. Pancreas 7:118–120

    Article  PubMed  CAS  Google Scholar 

  47. Barek L, Orron D (1986) Non-Hodgkin’s lymphoma presenting as periampullary mass with obstructive jaundice. J Comput Tomagr 10:89–92

    Article  CAS  Google Scholar 

  48. Kelly SB, Price P, Williamson RCN (1993) Non-Hodgkin’s lymphoma presenting with jaundice and hypercalcemia. Clin Oncol 5:122–123

    Article  CAS  Google Scholar 

  49. Swartz TR, Ritchie WGM (1983) Bile duct obstruction secondary to lymphomatous involvement of the pancreas. J Clin Ultrasound 11:391–394

    Article  PubMed  CAS  Google Scholar 

  50. Gillespie JJ, Ayala AG, MacKay B, Silliman YE (1977) Diagnosis of lymphoma from a cholecystectomy specimen: case report and review of the literature. South Med J 70:353–354

    PubMed  CAS  Google Scholar 

  51. Podbielski FJ, Pearsall GF Jr, Nelson DG, Unti JA, Connolly MM (1997) Lymphoma of the extrahepatic biliary ducts in acquired immunodeficiency syndrome. Am Surg 63(9):807–810

    PubMed  CAS  Google Scholar 

  52. Suzuki S, Tanaka S, Suzuki M, et al (2004) Mucosa-associated lymphoid tissue-type lymphoproliferative lesion of the common bile duct. Hepatogastroenterology 51(55):110–113

    PubMed  Google Scholar 

  53. Cappell MS, Yao F, Cho KC, Axiotis CA (1989) Lymphoma predominantly involving the pancreas. Dig Dis Sci 34:942–947

    Article  PubMed  CAS  Google Scholar 

  54. Ackerman NB, Aust JC, Bredenberg CE, Hanson VA, Rogers LS (1976) Problems in differentiating between pancreatic lymphoma and anaplastic carcinoma and their management. Ann Surg 184:705–708

    Article  PubMed  CAS  Google Scholar 

  55. Das K, Fisher A, Wilson DJ, et al (2003) Primary non-Hodgkin’s lymphoma of the bile ducts mimicking cholangiocarcinoma. Surgery 134(3):496–500

    Article  PubMed  Google Scholar 

  56. Andre SB, Farias AQ, Bittencourt PL, et al (1996) Primary extranodal non-Hodgkin lymphoma of the extrahepatic bile duct mimmicking Klatskin tumor. Rev Hosp Clin Fac Med Sao Paulo 51(5):192–194

    PubMed  CAS  Google Scholar 

  57. Teefey SA, Stephens DH, Sheedy PF (1986) CT appearance of primary pancreatic lymphoma. Gastrointest Radiol 11:41–43

    Article  PubMed  CAS  Google Scholar 

  58. Ferluga D, Luzar B, Gadzijev EM (2003) Follicular lymphoma of the gallbladder and extrahepatic bile ducts. Virchows Arch 442(2):136–140

    PubMed  Google Scholar 

  59. Hart MJ, White TT, Brown PC, Freeny PC (1987) Potentially curable masses in the pancreas. Am J Surg 154:134–136

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Sihhiye, Ankara, 06100, Turkey

    Bülent Ödemiş, Erkan Parlak, Ömer Başar, Osman Yüksel & Burhan Şahin

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  1. Bülent Ödemiş
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  2. Erkan Parlak
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  3. Ömer Başar
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Correspondence to Bülent Ödemiş.

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Ödemiş, B., Parlak, E., Başar, Ö. et al. Biliary Tract Obstruction Secondary to Malignant Lymphoma: Experience at a Referral Center. Dig Dis Sci 52, 2323–2332 (2007). https://doi.org/10.1007/s10620-007-9786-4

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  • DOI: https://doi.org/10.1007/s10620-007-9786-4

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