|
1
|
Xie P, Yang L, Wei L, Ma H, Yang J. Jaundice as a Rare Presentation of Neuroblastoma in a Pediatric Patient. Clin Nucl Med 2024; 49:1033-1035. [PMID: 39325504 DOI: 10.1097/rlu.0000000000005432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
ABSTRACT Neuroblastoma presenting as obstructive jaundice due to compression of the extrahepatic bile duct is very rare. An 11-month-old girl had sudden onset of jaundice. Initial imaging suggested a dilated biliary system caused by hepatic hilum mass. 18 F-FDG PET/CT showed a lesion with increased 18 F-FDG accumulation associated with surrounding enlarged lymph nodes. Surgical pathology confirmed the diagnosis of a poorly differentiated neuroblastoma associated with multiple lymph node metastases.
Collapse
Affiliation(s)
- Peng Xie
- From the Department of Nuclear Medicine, The Third Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lan Yang
- From the Department of Nuclear Medicine, The Third Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lingge Wei
- From the Department of Nuclear Medicine, The Third Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Huan Ma
- Department of Nuclear Medicine, Beijing Friendship Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Jigang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Affiliated to Capital Medical University, Beijing, China
| |
Collapse
|
|
2
|
Madison K, Morgan Z, Kabbani W. Burkitt Lymphoma Presenting as Obstructive Jaundice: A Case Report and Literature Review. Cureus 2023; 15:e46215. [PMID: 37905254 PMCID: PMC10613480 DOI: 10.7759/cureus.46215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Burkitt lymphoma (BL) is an aggressive, high-grade B-cell lymphoma common in children and young adults. Despite being frequently discovered in extranodal sites, BL rarely occurs in the pancreas. We present a case of a patient with BL presenting as obstructive jaundice.
Collapse
Affiliation(s)
- Kyle Madison
- Internal Medicine, Methodist Health System, Dallas, USA
| | - Zack Morgan
- Internal Medicine, Methodist Health System, Dallas, USA
| | - Wareef Kabbani
- Surgical Pathology, Methodist Health System, Dallas, USA
| |
Collapse
|
|
3
|
Devarapalli UV, Sarma MS, Mathiyazhagan G. Gut and liver involvement in pediatric hematolymphoid malignancies. World J Gastrointest Oncol 2022; 14:587-606. [PMID: 35321282 PMCID: PMC8919016 DOI: 10.4251/wjgo.v14.i3.587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/22/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
Hematolymphoid malignancies are common neoplasms in childhood. The involvement of the gastrointestinal (GI) tract, liver, biliary system, pancreas, and peritoneum are closely interlinked and commonly encountered. In leukemias, lymphomas, and Langerhans cell histiocytosis (LCH), the manifestations result from infiltration, compression, overwhelmed immune system, and chemotherapy-induced drug toxicities. In acute leukemias, major manifestations are infiltrative hepatitis, drug induced gastritis, neutropenic typhlitis and chemotherapy related pancreatitis. Chronic leukemias are rare. Additional presentation in lymphomas is cholestasis due to infiltration or biliary obstruction by lymph nodal masses. Presence of ascites needs a thorough workup for the underlying pathophysiology that may modify the therapy and affect the outcome. Uncommon hematolymphoid malignancies are primary hepatic, hepatosplenic, and GI lymphomas which have strict definitions. In advanced diseases with extensive spread, it may be impossible to distinguish these diseases from the primary site of origin. LCH produces biliary strictures that mimic as sclerosing cholangitis. Liver infiltration is associated with poor liver recovery even after chemotherapy. The heterogeneity of gut and liver manifestations in hematolymphoid malignancies has a clinical impact on their management. Though chemotherapy is the mainstay of therapy in all hematolymphoid malignancies, debulking surgery and radiotherapy have an adjuvant role in specific clinical scenarios. Rare situations presenting as liver failure or end-stage liver disease require liver transplantation. At their initial presentation to a primary care physician, given the ambiguity in clinical manifestations and the prognostic difference with time-bound management, it is vital to recognize them early for optimal outcomes. Pooled data from robust registries across the world is required for better understanding of these complications.
Collapse
Affiliation(s)
- Umeshreddy V Devarapalli
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Moinak S Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Gopinathan Mathiyazhagan
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| |
Collapse
|
|
4
|
Facchinelli D, Boninsegna E, Visco C, Tecchio C. Primary Pancreatic Lymphoma: Recommendations for Diagnosis and Management. J Blood Med 2021; 12:257-267. [PMID: 33981170 PMCID: PMC8107008 DOI: 10.2147/jbm.s273095] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Primary pancreatic lymphoma (PPL) is a rare disease representing 0.1% of all malignant lymphomas, which lacks well-defined diagnostic and therapeutic protocols. We conducted a systematic review to analyze demographic, diagnostic and therapeutic features of PPL. METHODS This review identified small series and single case reports. Sources were MEDLINE, PubMed, and the Cochrane library from January 2001 to December 2020. Data were screened, extracted and the risk of bias analyzed by three independent reviewers. RESULTS A total of 107 eligible papers (17 small series, 90 single case reports) describing 266 patients were identified. Patients had a median age of 53.1 (range 3-86) years and were males in 64.6% of cases. Abdominal pain and jaundice were the most common presenting symptoms, affecting 75.3% and 41.8% of patients, respectively. PPL had a median size of 60.6 mm (range 16-200) and it was localized in the pancreatic head in 63.7% of cases. At diagnosis most patients underwent ultrasonography followed by computed tomography. PPL typically showed low echogenicity, and lower contrast enhancement than solid tumors. Histopathological specimens were obtained by percutaneous or endoscopic biopsies in 47.7% of patients; abdominal surgery was performed in 33.5% of cases. Overall, diffuse large B-cell lymphoma was the most frequent histological diagnosis (53.6%). However, patients aged <18 years were affected by Burkitt lymphoma in 52.4% of cases. Most patients (53.6%) received immunochemotherapy (IC) or IC plus radiotherapy (14%). Demolitive surgery appeared to be associated with impaired survival. Central nervous system (CNS) relapse or progression was observed in 20% of patients. CONCLUSION PPL is a rare entity, with some peculiar features at modern imaging. For diagnostic purposes percutaneous or endoscopic biopsies might be preferable, as opposed to surgery. No definite data is available about the optimal treatment, which should be tailored on the histological type and associated with CNS prophylaxis.
Collapse
Affiliation(s)
| | - Enrico Boninsegna
- Department of Radiology, Azienda Socio Sanitaria Territoriale, Mantova, Italy
| | - Carlo Visco
- Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Cristina Tecchio
- Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
|
5
|
Pawar VB, Surude R, Sonthalia N, Jain S, Contractor Q, Rathi P. An unusual case of obstructive jaundice: ampullary Burkitt lymphoma. J Gastrointest Oncol 2019; 10:379-383. [PMID: 31032110 PMCID: PMC6465488 DOI: 10.21037/jgo.2018.07.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/23/2018] [Indexed: 11/02/2023] Open
Abstract
Primary lymphomas of the digestive tract are uncommon heterogenous group of neoplasms that primarily affects stomach. Lymphomatous involvement of small intestine is amongst the rare lymphomas; ampullary involvement is even rarer. It is important to recognize this entity early as it mimics periampullary neoplasms and its management is different. We present the case of a 14-year-old male who presented with rapidly progressive obstructive jaundice and weight loss and ultimately was diagnosed to have ampullary Burkitt's lymphoma. Early diagnosis of this aggressive tumor and prompt induction of chemotherapy dramatically improved the patient's condition. It is crucial to consider Burkitt's lymphoma as a differential diagnosis of obstructive jaundice as both the treatment and prognosis are markedly different.
Collapse
Affiliation(s)
- Vinay Balasaheb Pawar
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| | - Ravindra Surude
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| | - Nikhil Sonthalia
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| | - Samit Jain
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| | - Qais Contractor
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| | - Pravin Rathi
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| |
Collapse
|
|
6
|
[Pancreatitis as the initial manifestation and abdominal lymph node enlargement in a boy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018. [PMID: 30369361 PMCID: PMC7389050 DOI: 10.7499/j.issn.1008-8830.2018.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A boy aged 14 years had abdominal pain as the major manifestation, with elevated serum amylase and lipase. Abdominal ultrasound performed early after onset in another hospital showed enlargement of the pancreas and a reduction in echo. Magnetic resonance cholangiopancreatography (MRCP) showed pancreatic duct dilation and an unclear image of the head of the pancreas. Acute pancreatitis was considered. However, his symptoms were not relieved after fasting, fluid infusion, anti-acid therapy, and somatostatin therapy. Then, abdominal CT scan and MRCP found multiple low-density lesions of the pancreas and enlargement of the hilar and retroperitoneal lymph nodes. Exploratory laparotomy found pancreatic edema and multiple hilar nodules with unclear boundaries, and pathological biopsy showed anaplastic large-cell lymphoma. Since the liver, the spleen, bone marrow, and the central nervous system were not involved, he was diagnosed with stage III primary pancreatic lymphoma. After vindesine and dexamethasone were used to reduce tumor load, the patient underwent vindesine-pirarubicin-asparaginase-dexamethasone chemotherapy once and vinorelbine-dexamethasone chemotherapy 8 times. Imaging examination still showed multiple low-density lesions of the pancreas and retroperitoneal lymph node enlargement. His parents discontinued treatment. It is concluded that the rare causes of acute pancreatitis with poor response to conventional treatment should be considered, especially for patients with abdominal lymph node enlargement. Extranodal lymphoma should be considered, and lymph node biopsy should be performed as early as possible to confirm diagnosis. The prognosis of pancreatic lymphoma is associated with clinical stage and pathology.
Collapse
|
|
7
|
Pediatric cholangiopathies: diseases of the gallbladder and biliary tract. Abdom Radiol (NY) 2017; 42:69-85. [PMID: 27518785 DOI: 10.1007/s00261-016-0865-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pediatric gallbladder and bile duct disease encompasses a broad spectrum of processes, from congenital to developmental to neoplastic. We describe normal pediatric biliary anatomy and summarize the most common pathologic entities, with a focus on non-invasive imaging techniques and findings. Ultrasound is the first-line imaging modality in children with suspected biliary pathology based on its widespread availability, cost effectiveness, and lack of ionizing radiation. MRI and MRCP are often used for further evaluation in cases of diagnostic uncertainty and for surgical planning.
Collapse
|
|
8
|
Abstract
Biliary disease in infants and children frequently presents diagnostic and therapeutic challenges. Pediatric interventional radiologists are often involved in the multidisciplinary teams who care for these patients. This article reviews several notable causes of biliary disease in children who have not undergone liver transplantation, describes the role of percutaneous interventional procedures in managing these conditions, and details applicable biliary interventional techniques.
Collapse
Affiliation(s)
- Lisa H Kang
- Department of Radiology, University of Texas Southwestern Children's Health, Dallas, Texas
| | - Colin N Brown
- Department of Radiology, Texas Scottish Rite Hospital for Children, Dallas, Texas
| |
Collapse
|
|
9
|
Primary Pancreatic Lymphoma Simulating Acute Cholestatic Hepatitis in a 7-Year-Old Child. ACG Case Rep J 2015; 2:190-2. [PMID: 26157960 PMCID: PMC4435392 DOI: 10.14309/crj.2015.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 02/10/2015] [Indexed: 01/19/2023] Open
Abstract
Primary pancreatic lymphoma in children has been described infrequently in literature, and its acute presentation as cholestatic hepatitis is similarly rare. We report a case of a 7-year-old child with primary pancreatic lymphoma presenting as acute infective hepatitis, leading to delay in correct diagnosis and management.
Collapse
|
|
10
|
Imaging of pediatric pancreatic neoplasms with radiologic-histopathologic correlation. AJR Am J Roentgenol 2014; 202:1337-48. [PMID: 24848833 DOI: 10.2214/ajr.13.11513] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the imaging features of pediatric pancreatic tumors with pathologic correlation. Epithelial and nonepithelial lesions are described. Pancreatic imaging protocols, clinical presentation, and management are also detailed. CONCLUSION Pancreatic neoplasms are rare in children and vary widely between benign and malignant causes and between cystic and solid lesions. Epithelial tumors are most common and include solid pseudopapillary tumor, pancreatoblastoma, islet cell neoplasms, and cystic lesions.
Collapse
|
|
11
|
Abstract
A 10-year-old boy was referred to our clinic for tonsillectomy and was found to have a large mass within his oropharynx. Intraoperative biopsies confirmed Burkitt lymphoma. Further imaging and biopsy revealed pancreatic involvement. He was treated with multiagent chemotherapy. He remains disease-free 6 years later. Review of the literature demonstrates other cases of non-Hodgkin lymphoma with pancreatic involvement with good outcomes. Pancreatic involvement is a relatively rare occurrence in childhood lymphoma.
Collapse
|
|
12
|
|
|
13
|
Jaundice as a presenting manifestation of pediatric non-Hodgkin lymphoma: etiology, management, and outcome. J Pediatr Hematol Oncol 2010; 32:e131-5. [PMID: 20445407 DOI: 10.1097/mph.0b013e3181d640c5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES There are few data available on the management and outcome of pediatric patients with non-Hodgkin lymphoma (NHL) presenting with jaundice. Controversies exist on biliary drainage and chemotherapy dose modifications to be carried out in such patients. The aim of this study was to analyze the causes of jaundice in, the various modalities of treatment administered to, and outcome of patients aged 18 years or less, with de novo NHL and jaundice treated at our center. PATIENTS AND METHODS A retrospective analysis show 9 such cases (11.2% of all NHL cases), all of whom were treated by a uniform protocol. Chemotherapy dose modifications were based on serum bilirubin and clinical status of the patients. RESULTS Obstructive jaundice was the most common cause (7 of 9). Seven patients achieved normal serum bilirubin with chemotherapy alone. Only one had a biliary drainage procedure. Four patients were alive and disease-free at last follow-up. CONCLUSIONS Although biliary obstruction is the commonest most cause of jaundice in pediatric and adolescent NHL, biliary drainage may be unnecessary and chemotherapy alone may suffice as initial treatment for these patients.
Collapse
|
|
14
|
Childhood Burkitt lymphoma: abdominal and pelvic imaging findings. AJR Am J Roentgenol 2009; 192:1304-15. [PMID: 19380555 DOI: 10.2214/ajr.08.1476] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Burkitt lymphoma in children can be localized or disseminated and can involve various sites. Our objective is to review the clinical presentation and abdominopelvic imaging findings of Burkitt lymphoma in the pediatric population. CONCLUSION Numerous abdominal and pelvic imaging findings are seen in Burkitt lymphoma affecting the gastrointestinal tract and solid organs. Recognition of the common and uncommon imaging findings is essential in the diagnosis and treatment of patients with Burkitt lymphoma because prompt therapy is critical.
Collapse
|
|
15
|
|
|
16
|
Delarue A, Bergeron C, Mechinaud-Lacroix F, Coze C, Raphael M, Patte C, Patte C. Lymphome non-Hodgkinien de l’enfant : Prise en charge chirurgicale lors d’un tableau abdominal révélateur. ACTA ACUST UNITED AC 2008; 145:454-8. [DOI: 10.1016/s0021-7697(08)74655-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
|
17
|
Krishna RP, Lal R, Sikora SS, Yachha SK, Pal L. Unusual causes of extrahepatic biliary obstruction in children: a case series with review of literature. Pediatr Surg Int 2008; 24:183-90. [PMID: 18071716 DOI: 10.1007/s00383-007-2087-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2007] [Indexed: 11/25/2022]
Abstract
This paper highlights the etiology, diagnosis, management and outcome in nine unusual cases of extrahepatic biliary obstruction in children. Extrahepatic biliary atresia and choledochal cyst constituted 127 out of 136 (93%) cases of all pediatric surgical biliary disorders managed between March 2000 and February 2007 at the reporting centre. However, nine children (aged 1.5-15 years) presented with uncommon causes like (1) idiopathic benign non-traumatic inflammatory stricture (n = 3), (2) idiopathic fibrosing chronic pancreatitis (n = 2), (3) post-cholecystectomy type 4 benign biliary stricture (n = 1), (4) post-acute pancreatitis pseudo-cyst of pancreas (n = 1), (5) non-Hodgkin's lymphoma (NHL) with extramural common bile duct compression and gall bladder perforation (n = 1), and (6) Langerhan cell histiocytosis (LCH, n = 1). The clinical features and the diagnostic work up of each group are discussed. A preoperative endoscopic/percutaneous biliary drainage was required in four children because of cholangitis at presentation. A biliary-enteric anastomosis was performed for all seven children in groups (1)-(4). The patients with NHL and LCH were referred for chemotherapy after establishing tissue diagnosis at laparotomy. With a follow-up period of 3 months to 7 years, seven children (with the exception of patients with NHL and LCH) are currently anicteric. This paper draws attention to some infrequently discussed causes of extrahepatic biliary obstruction in children. The management entails a carefully planned combination of endoscopic interventions, interventional radiology and surgery. The outcome in benign cases is usually satisfactory.
Collapse
Affiliation(s)
- R Phani Krishna
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | | | | | | | | |
Collapse
|
|
18
|
Fernández-Plaza S, Sevilla J, Diaz MA, Madero L, Tamariz-Martel A. Dyspnea as the first manifestation of primary pancreatic lymphoma. Pediatr Blood Cancer 2008; 50:434. [PMID: 17437291 DOI: 10.1002/pbc.21242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
|
19
|
Papandreou E, Gentimi F, Baltogiannis N, Tzovaras A, Geroulanos-Christopoulos G, Karamolegou K, Stephanaki K, Moschovi M. Nonendemic Burkitt lymphoma presenting with an atypical clinical picture. J Pediatr Hematol Oncol 2007; 29:661-663. [PMID: 17805048 DOI: 10.1097/mph.0b013e3181468c7f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Primary appendiceal Burkitt lymphomas are rare occurring in 0.015% of all gastrointestinal lymphomas. Presentation of such lymphomas with peritonitis and obstructive jaundice owing to its subhepatic location is even more unusual. Burkitt lymphoma is very rare in children below 5 years old. We will present a 3-year-old boy with primary appendiceal lymphoma whose first symptom was obstructive jaundice caused by a ruptured retrocecal subhepatic appendix which in essence is a combination of all 3 mentioned occurrences complicated with acute abdomen.
Collapse
Affiliation(s)
- Evangelos Papandreou
- 2nd Department of Pediatric Surgery, Hematology-Oncology Unit, Athens University Medical School, Pathology Department, Aghia Sophia Children's Hospital, Athens, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
|
20
|
Abstract
Primary involvement of the pancreas in non-Hodgkin's lymphoma is extremely rare in children and adolescents. Indeed, we have only found three cases of primary pancreatic lymphoma in this population published in the English literature. We report the case of a 13-year-old girl diagnosed with primary pancreatic lymphoma. We describe the ultrasonography and computed tomography findings, discuss the differential diagnosis with other pancreatic tumors that affect pediatric patients, and review the literature.
Collapse
Affiliation(s)
- B R Arenas García
- Servicio de Radiodiagnóstico, Hospital de la Princesa, Madrid, España.
| |
Collapse
|
|
21
|
García de Andoin Barandiaran N, Lassaletta Atienza A, Scaglione Ríos C, Contra Martín T, Madero López L. [Neuroblastoma presenting as obstructive jaundice]. An Pediatr (Barc) 2006; 64:85-8. [PMID: 16539922 DOI: 10.1016/s1695-4033(06)70014-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Obstructive jaundice as a presentation of abdominal tumors in childhood is extremely rare. To date, only 4 cases of neuroblastoma causing obstructive jaundice at diagnosis have been reported in children. We report a 4-year-old boy who presented to the emergency department with abdominal pain, jaundice, choluria and acholia. A diagnosis of unresectable, nonmetastatic neuroblastoma was made. Chemotherapy reduced the size of the tumor and relieved the symptoms of obstructive jaundice without the need for decompressive surgery. Abdominal tumors should be included in the differential diagnoses of obstructive jaundice in childhood.
Collapse
|
|
22
|
Kessel B, Moisseiev E, Korin A, Soimu U, Ashkenazi I, Asquenasi A, Groissman G, Alfici R. Burkitt's lymphoma: an unusual cause of obstructive jaundice. Asian J Surg 2005; 28:301-304. [PMID: 16234085 DOI: 10.1016/s1015-9584(09)60366-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Biliary obstruction secondary to malignancy is a common clinical problem. Rarely, biliary obstruction is due to non-Hodgkin's lymphoma. Obstructive jaundice in these patients usually presents late in the course of the disease. Burkitt's lymphoma is a subtype of non-Hodgkin's lymphoma. Unlike other forms of non-Hodgkin's lymphoma, Burkitt's lymphoma presents as an extranodal disease. We present the case of a patient suffering from non-endemic Burkitt's lymphoma whose initial presenting symptom was obstructive jaundice.
Collapse
Affiliation(s)
- Boris Kessel
- Department of Surgery B, Hillel Yaffe Medical Center, Hadera, Israel.
| | | | | | | | | | | | | | | |
Collapse
|
|
23
|
Dhebri AR, Connor S, Campbell F, Ghaneh P, Sutton R, Neoptolemos JP. Diagnosis, treatment and outcome of pancreatoblastoma. Pancreatology 2004; 4:441-51; discussion 452-3. [PMID: 15256806 DOI: 10.1159/000079823] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2003] [Accepted: 12/10/2003] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatoblastoma is a rare tumour mainly presenting in childhood but also in adults. OBJECTIVES The aim was to determine the clinical course of pancreatoblastoma by an analysis of reported cases. METHODS Patients with pancreatoblastoma were identified from Medline and combined with patients identified from the Royal Liverpool University Hospital. RESULTS There were 153 patients with a median (range) age at presentation of 5 (0-68) years and a male:female ratio of 1.14:1. The most frequent site was the head of pancreas (48/123, 39%). The median and 5-year (95% CI) survival rates were 48 months and 50% (37-62%) respectively. At presentation there were 17 (17%) out of 101 patients with metastases, the liver being the commonest site (15/17, 88%). On univariate analysis, factors associated with a worse prognosis were synchronous (p = 0.05) or metachronous metastases (p < 0.001), non-resectable disease at presentation (p < 0.001) and age > 16 years at time of presentation (p = 0.02). On multivariate analysis, resection (p = 0.006) and metastases post-resection (p = 0.001) but not local recurrence influenced survival. CONCLUSIONS Pancreatoblastoma is one of the pancreatic tumours with a relatively good prognosis. The treatment of choice is complete resection with long-term follow-up aiming to treat any early local recurrence or metastasis.
Collapse
Affiliation(s)
- A R Dhebri
- Department of Surgery, University of Liverpool, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | | | | | | |
Collapse
|
|
24
|
Adsay NV, Andea A, Basturk O, Kilinc N, Nassar H, Cheng JD. Secondary tumors of the pancreas: an analysis of a surgical and autopsy database and review of the literature. Virchows Arch 2004; 444:527-35. [PMID: 15057558 DOI: 10.1007/s00428-004-0987-3] [Citation(s) in RCA: 234] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Accepted: 02/03/2004] [Indexed: 12/13/2022]
Abstract
The vast majority of pancreatic carcinomas are primary, and, among these, more than 90% are of ductal origin. However, a variety of extrapancreatic tumors may involve the pancreas secondarily and may manifest different clinicopathological characteristics and outcomes. In this study, pathology material from 973 surgical specimens and 4955 adult autopsy cases was reviewed to identify the tumors metastatic to or secondarily involving the pancreas. Biliary and periampullary neoplasms and tumors confined to peripancreatic soft tissue were excluded. In the autopsy series, the pancreas was involved by tumor in 190 cases, and 81 of these were secondary tumors. These were predominantly of epithelial origin, most commonly from lung (34), followed by GI tract (20), kidney (4), breast (3), liver (2), ovary (1), and urinary bladder (1). In addition, there were six tumors of hematopoietic origin, two melanomas, two sarcomas, and two mesotheliomas. Among the 973 surgical specimens, 38 cases contained metastatic tumors to the pancreas. Of these, 11 were lymphomas, and the others were carcinomas of stomach (7), kidney (6), lung (2), liver, prostate, ovary, uterus (1 case of each), and a Merkel cell carcinoma. In addition, there were three malignant gastrointestinal stromal tumors and one retroperitoneal leiomyosarcoma. In conclusion, lung cancer is the most common source of metastasis to pancreas, followed by gastrointestinal carcinomas and lymphomas. These tumors are usually seen in patients with disseminated disease and are detected mainly in autopsies. Secondary tumors constitute about 4% of pancreatic specimens in the authors' surgical database. Approximately one-third of them are clinically mistaken as primary tumors of the pancreas. These are predominantly hematopoietic malignancies or carcinomas of renal or gastric origin. Secondary tumors should be entertained in both the clinical and pathological differential diagnosis of pancreatic neoplasia.
Collapse
Affiliation(s)
- N Volkan Adsay
- Department of Pathology, The Karmanos Cancer Institute and Wayne State University, Harper Hospital, 3990 John R. Street, Detroit, MI 48201, USA.
| | | | | | | | | | | |
Collapse
|
|
25
|
Wammanda RD, Ali FU, Adama SJ, Idris HW, Abubakar U. Burkitt's lymphoma presenting as obstructive jaundice. ANNALS OF TROPICAL PAEDIATRICS 2004; 24:103-6. [PMID: 15005975 DOI: 10.1179/027249304225013376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A 12-year-old boy presented with a 5-month history of yellowness of the eyes, progressive painless abdominal swelling and weight loss. Physical examination revealed a grossly wasted child with marked jaundice and non-tender hepatomegaly. Liver function tests and abdominal ultrasound suggested obstructive liver disease. Tissue biopsy at laparotomy showed histological findings consistent with Burkitt's lymphoma. He was commenced on cytotoxic chemotherapy and, after two courses, the jaundice disappeared and he remained well. Although ante-mortem presentation of Burkitt's lymphoma as hepatic disease is rare, this condition should be included in the differential diagnosis of a child with obstructive jaundice.
Collapse
Affiliation(s)
- R D Wammanda
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
| | | | | | | | | |
Collapse
|
|
26
|
Ravindra KV, Stringer MD, Prasad KR, Kinsey SE, Lodge JPA. Non-Hodgkin lymphoma presenting with obstructive jaundice. Br J Surg 2003; 90:845-9. [PMID: 12854111 DOI: 10.1002/bjs.4119] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Obstructive jaundice is a rare presenting feature of non-Hodgkin lymphoma (NHL). Lymphomatous masses in the peripancreatic and hepatic hilar regions are potentially difficult to diagnose. METHODS A retrospective analysis was undertaken of patients presenting with obstructive jaundice secondary to NHL at a tertiary care hepatobiliary unit. RESULTS Over a 7-year period, six adults and three children with NHL were managed. The site of the lymphomatous mass was at the hepatic hilum in six patients and the peripancreatic area in three. Diagnostic procedures included a laparotomy and biopsy in four patients, hepatic trisectionectomy in two, percutaneous biopsy in two and lymph node biopsy in one patient. Percutaneous biopsy confirmed the diagnosis in both the patients in whom it was attempted. One patient died following liver resection. Chemotherapy was the mainstay of treatment and achieved complete remission in four patients, partial remission in three and no response in one patient. Two patients subsequently required operation for a benign biliary stricture after achieving complete remission. CONCLUSION NHL must be considered in the differential diagnosis of obstructive jaundice in adults and children. Attempts must be made to diagnose the condition using non-operative techniques. Chemotherapy is the mainstay of treatment. Late benign strictures of the bile duct requiring operation may develop.
Collapse
Affiliation(s)
- K V Ravindra
- Hepatobiliary Unit, St James's University Hospital, Leeds, UK
| | | | | | | | | |
Collapse
|