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Chen XY, Yang JY, Chen YH, Liu AN, Wu SS, Ji Zhi SN, Zheng SM. Primary duodenal T/histiocyte-rich large B-cell lymphoma complicated with obstructive jaundice: A case report and review of literature. World J Gastrointest Surg 2025; 17:99758. [PMID: 39872781 PMCID: PMC11757195 DOI: 10.4240/wjgs.v17.i1.99758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 10/07/2024] [Accepted: 10/31/2024] [Indexed: 12/27/2024] Open
Abstract
BACKGROUND T/histiocyte-rich large B-cell lymphoma (T/HRBCL) is a highly aggressive subtype of diffuse large B-cell lymphoma characterized histologically by the presence of a few neoplastic large B cells amidst an abundant background of reactive T lymphocytes and/or histiocytes. T/HRBCL commonly affects the lymph nodes, followed by extranodal sites, such as the spleen, liver, and bone marrow, with rare occurrences in the gastrointestinal tract. Primary gastrointestinal T/HRBCL lacks specific clinical and endoscopic manifestations, and it is difficult to differentiate from inflammatory diseases, nodular lymphocyte predominant Hodgkin lymphoma, and other diseases on a histological basis, thereby hindering early diagnosis. CASE SUMMARY A 63-year-old man was hospitalized with a one-month history of jaundice and weight loss of approximately 3 kg. Laboratory tests revealed increased hepatic parameters in a cholestatic pattern and elevated carbohydrate antigen 19-9 levels. An abdominal computed tomography scan revealed a low-density mass within the descending duodenum and dilation of the bile and pancreatic ducts. He was clinically diagnosed with a duodenal tumor. During surgery, a 7.0 cm × 8.0 cm mass was identified within the descending duodenum, so pancreaticoduodenectomy and cholecystectomy were performed. Following operative biopsy, the tumor was diagnosed as primary duodenal T/HRBCL. The patient refused postoperative chemotherapy and died four months after surgery. CONCLUSION Primary duodenal T/HRBCL is an extremely rare and highly aggressive malignancy. The initial treatment strategies should be based on the original site of the tumor, the disease stage, and the patient's physical condition. Chemotherapy-based comprehensive treatment is still the main treatment method for primary gastrointestinal T/HRBCL.
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Affiliation(s)
- Xing-Yu Chen
- Department of Gastroenterology and Hepatology, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Jia-Yi Yang
- Department of Radiology, Wuxi People’s Hospital, Nanjing Medical University, Nanjing 214023, Jiangsu Province, China
| | - Yi-Hua Chen
- Department of Pathology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - A-Niu Liu
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Shan-Shan Wu
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Se-Niu Ji Zhi
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Shu-Mei Zheng
- Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
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Raza MH, Mustafa A, Amir M, Khurram Saleem M, Ishtiaq H, Akbar A, Saleem Khan M. Association of Liver Biomarkers With Jaundice in Patients With Gastrointestinal Complications: An Observational Retrospective Cohort Study. Cureus 2024; 16:e75583. [PMID: 39669649 PMCID: PMC11637320 DOI: 10.7759/cureus.75583] [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: 12/12/2024] [Indexed: 12/14/2024] Open
Abstract
INTRODUCTION Jaundice is a state of disease in liver function often along with gastrointestinal (GI) complications primarily characterized by hyperbilirubinemia. Other tests regarding liver function are often used besides bilirubin as during any liver complications biomarkers such as alanine aminotransferase (ALT), serum glutamic pyruvic transaminase (SGPT), aspartate aminotransferase (AST), serum glutamic-oxaloacetic transaminase (SGOT), alkaline phosphatase (ALP), and many other biomarkers even total protein metabolism might get disrupted and get released in the blood. However, no comparison or association among those biomarkers was determined in a cohort. Method: In this observational retrospective cohort study, we investigated the levels of different liver biomarkers and tried to compare their differences and correlations in jaundice patients with GI complications. We examined nine different biomarkers where, primarily, the jaundice was confirmed through the total bilirubin test and further categorized and analyzed them. RESULT Among the 91 patients of the study cohort after bilirubin (n=91) and conjugated bilirubin (n=88) levels, we found that enhanced globulin (n=79) levels were the most dominant among the cohort followed by unconjugated bilirubin (n=76), albumin (n=72), and total protein (n=71). On the other hand, a high ALP level was determined in the lowest number of the population (n=22). Regarding the category of men and women, similar findings were observed with a slight variation as the number of included female patients was approximately six times higher than that of male patients. In the case of age groups, similar observations were determined with some slight variation, as most of the patients were found to be over 40 years of age. CONCLUSION Besides bilirubin, globulin can be a promising biomarker to diagnose jaundice, especially in patients with GI complications. It may also help to indicate the presence of undiagnosed or unsuspected jaundice in patients with gastrointestinal problems.
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Affiliation(s)
| | - Awais Mustafa
- Gastroenterology, Primary and Secondary Healthcare Department, Faisalabad, PAK
| | - Muhammad Amir
- Medicine, Midland Doctors Medical Institute, Muzaffarabad, PAK
| | - Muhammad Khurram Saleem
- General Internal Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, GBR
| | - Hifza Ishtiaq
- Medicine, Abbas Institute of Medical Sciences, Muzaffarabad, PAK
| | - Amna Akbar
- Emergency Medicine, Alexandra Hospital, Redditch, GBR
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Okamoto T. Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer. World J Gastroenterol 2022; 28:985-1008. [PMID: 35431494 PMCID: PMC8968522 DOI: 10.3748/wjg.v28.i10.985] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/03/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Malignant biliary obstruction generally results from primary malignancies of the pancreatic head, bile duct, gallbladder, liver, and ampulla of Vater. Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. They may be difficult to differentiate from primary hepato-pancreato-biliary cancer based on imaging studies, or even on biopsy. There is also no consensus on the optimal method of treatment, including the feasibility and effectiveness of endoscopic intervention or surgery. A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented. The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer. Different primaries also cause malignant biliary obstruction in different ways, including direct invasion, pancreatic or biliary metastasis, hilar lymph node metastasis, liver metastasis, and peritoneal carcinomatosis. Metastasectomy may hold promise for some types of pancreato-biliary metastases. This review aims to elucidate the current knowledge in this area, which has received sparse attention in the past. The aging population, advances in diagnostic imaging, and improved treatment options may lead to an increase in these rare occurrences going forward.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke’s International Hospital, Chuo-ku 104-8560, Tokyo, Japan
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Krupka M, Bartusik-Aebisher D, Strzelczyk N, Latos M, Sieroń A, Cieślar G, Aebisher D, Czarnecka M, Kawczyk-Krupka A, Latos W. The role of autofluorescence, photodynamic diagnosis and Photodynamic therapy in malignant tumors of the duodenum. Photodiagnosis Photodyn Ther 2020; 32:101981. [PMID: 32882405 DOI: 10.1016/j.pdpdt.2020.101981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/12/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
This article presents the current state of knowledge and a review of the literature in terms of the prevalence, etiopathogenesis, differential diagnosis, management, prognosis, and treatment of malignant tumors of the duodenum. The role of autofluorescence and photodynamic diagnosis as an emerging treatment method for rarely o ccurring duodenal malignant neoplasms .. We selected publications which can be found in databases such as The National Center for Biotechnology Information, U.S. National Library of Medicine (PubMed), The American Chemical Society, The American Association of Pharmaceutical Sciences and The American Society for Photobiology and The Canada Institute for Scientific and Technical Information.
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Affiliation(s)
- Magdalena Krupka
- Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15, 41-902, Bytom, Poland.
| | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Faculty of Medicine, University of Rzeszów, Kopisto 2A, 35-310, Rzeszów, Poland.
| | - Natalia Strzelczyk
- Department of Internal Medicine, 11 Listopada 5E, 42-100, Kłobuck, Poland.
| | - Magdalena Latos
- Silesian Centre for Heart Disease in Zabrze, Marii Curie Skłodowskiej 9, 41-800 Zabrze, Poland.
| | - Aleksander Sieroń
- Jan Długosz University in Częstochowa, Waszyngtona 4/8, 42-200, Częstochowa, Poland.
| | - Grzegorz Cieślar
- Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15, 41-902, Bytom, Poland.
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Faculty of Medicine, University of Rzeszów, Kopisto 2A, 35-310, Rzeszów, Poland.
| | - Magdalena Czarnecka
- Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15, 41-902, Bytom, Poland.
| | - Aleksandra Kawczyk-Krupka
- Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15, 41-902, Bytom, Poland.
| | - Wojciech Latos
- Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15, 41-902, Bytom, Poland.
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Obstructive Jaundice Secondary to Primary Duodenal Lymphoma with CMV Duodenitis Causing Upper GI Bleed in Retro-Positive Patient: A Case Report. Indian J Surg 2012; 75:68-70. [PMID: 24426393 DOI: 10.1007/s12262-012-0731-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Accepted: 01/24/2010] [Indexed: 10/27/2022] Open
Abstract
Gastrointestinal (GI) tract is the most common site of extranodal lymphoma. Primary GI lymphoma constitutes a small amount of all lymphomas. Primary duodenal lymphoma presenting initially with obstructive jaundice is very rare. Primary B-cell lymphoma of the duodenum was shown to be the cause of biliary obstruction in a retropositive male, which was proved by endoscopic biopsy. Histopathology also showed cytomegalovirus inclusion bodies with duodenitis.
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Abstract
INTRODUCTION Primary lymphomas of the ampulla of Vater are extremely rare. Among these most frequent are follicular lymphomas followed by mucosa-associated lymphoid tissue-type lymphoma. CASE REPORT We report a case of a 36-year-old female diagnosed with diffuse large B-cell lymphoma (DLBCL) of the ampulla of Vater. Endoscopic biopsy was non-diagnostic. Whipple's resection was performed. The patient was given six cycles of chemotherapy. One year later, the patient developed recurrence at the anastomotic site and again treated with combination chemotherapy. Patient is doing well after 2 years of initial surgery. DISCUSSION Tumors of the ampulla of Vater are included in the pancreaticobiliary group of neoplasms; in some instances, it is almost impossible to ascertain the exact origin of the tumor anatomically. The patients of primary lymphoma of the ampulla of Vater may have a varied clinical presentation or may be completely asymptomatic and detected during routine medical check-ups for gastric cancer screening. CONCLUSION We present a rare case of primary DLBCL of the periampullary region. Due to the rarity of these lesions, their ability to masquerade as periampullary carcinomas, and the fact that these tumors show a good response to chemotherapy, an early diagnosis is desirable.
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Gupta N, Wright JG, Bowman CA. An unusual cause of acute obstructive jaundice in an HIV-infected patient. Int J STD AIDS 2011; 22:110-1. [PMID: 21427435 DOI: 10.1258/ijsa.2010.010290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe the case of an HIV-1-infected patient presenting with acute obstructive jaundice as the initial manifestation of primary small bowel Burkitt's lymphoma. The biliary obstruction resolved rapidly following chemotherapy without the need for surgical intervention. The prognosis is favourable with appropriate timely treatment.
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Affiliation(s)
- N Gupta
- Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield, UK.
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Ross WA, Egwim CI, Wallace MJ, Wang M, Madoff DC, Lee JH. Outcomes in lymphoma patients with obstructive jaundice: a cancer center experience. Dig Dis Sci 2010; 55:3271-7. [PMID: 20632106 DOI: 10.1007/s10620-010-1310-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 06/14/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Little information is available to guide clinicians on the optimal approach to managing obstructive jaundice in lymphoma patients. AIMS The aim of this study was to review our experience in treating lymphoma patients with obstructive jaundice in order to develop guidelines as to the best interventional approach. METHODS We reviewed the medical records of all lymphoma patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) and/or percutaneous biliary drainage (PBD) for obstructive jaundice between June 2002 and October 2008. RESULTS We identified 35 lymphoma patients who underwent ERCP and/or PBD for obstructive jaundice. The mean age was 57.6 years. Most patients (66%) had diffuse large B-cell lymphoma. Stents were placed by ERCP in 25 patients and PBD in nine. Serum bilirubin levels normalized following ERCP or PBD in 29 of 33 (85%) patients with stricture. Stricture resolution occurred in 12 cases. Patients who had obstructive jaundice at the time of their lymphoma diagnosis had significantly longer mean overall survival following intervention than patients in whom obstructive jaundice developed later in the course of their disease (21.3 months vs. 4.5 months, P = 0.0001). CONCLUSIONS ERCP and/or PBD effectively normalized serum bilirubin levels. Plastic stents should be used in patients who have obstructive jaundice at the time of lymphoma diagnosis because these strictures tend to resolve before stent exchanges are necessary. For patients in whom obstructive jaundice develops later in the course of their disease, the limited prognosis often makes a single intervention with insertion of a plastic stent sufficient to provide adequate biliary decompression.
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Affiliation(s)
- William A Ross
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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