Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2021; 13(10): 1279-1284
Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1279
Hodgkin lymphoma masquerading as perforated gallbladder adenocarcinoma: A case report
Michelle Manesh, Reynold Henry, Shea Gallagher, Michael Greas, Mohd Raashid Sheikh, Shannon Zielsdorf
Michelle Manesh, Reynold Henry, Shea Gallagher, Mohd Raashid Sheikh, Shannon Zielsdorf, Department of Surgery, University of Southern California, Los Angeles, CA 90033, United States
Michael Greas, Department of Pathology, University of Southern California, Los Angeles, CA 90033, United States
Author contributions: Manesh M, Henry R, Gallagher S and Zielsdorf S were the patient’s surgeons, reviewed the literature and contributed to manuscript drafting; Greas M performed the pathologic analyses and interpretation and contributed to manuscript drafting; Sheikh MR was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Reynold Henry, MD, Surgeon, Department of Surgery, University of Southern California, 2051 Marengo Street IPT, C5L100, Los Angeles, CA 90033, United States. reyshenry@gmail.com
Received: April 20, 2021
Peer-review started: April 20, 2021
First decision: June 24, 2021
Revised: June 24, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 27, 2021
Processing time: 188 Days and 12.9 Hours
Abstract
BACKGROUND

There are several case reports of acute cholecystitis as the initial presentation of lymphoma of the gallbladder; all reports describe non-Hodgkin lymphoma or its subtypes on histopathology of the gallbladder tissue itself. Interestingly, there is no description in the literature of Hodgkin lymphoma causing hilar lymphadenopathy, inevitably presenting as ruptured cholecystitis with imaging mimicking gallbladder adenocarcinoma.

CASE SUMMARY

A 48-year-old man with a past medical history of diabetes mellitus presented with progressive abdominal pain, jaundice, night sweats, weakness, and unintended weight loss for one month. Work-up revealed a mass in the region of the porta hepatis causing obstructions of the cystic and common hepatic ducts, gallbladder rupture, as well as retroperitoneal lymphadenopathy. The clinical picture and imaging findings were suspicious for locally advanced gallbladder adenocarcinoma causing ruptured cholecystitis and cholangitis, with metastases to retroperitoneal lymph nodes. Minimally invasive techniques, including endoscopic duct brushings and percutaneous lymph node biopsy, were inadequate for tissue diagnosis. Therefore, this case required exploratory laparotomy, open cholecystectomy, and periaortic lymph node dissection for histopathological assessment and definitive diagnosis. Hodgkin lymphoma was present in the lymph nodes while the gallbladder specimen had no evidence of malignancy.

CONCLUSION

This clinical scenario highlights the importance of histopathological assessment in diagnosing gallbladder malignancy in a patient with gallbladder perforation and a grossly positive positron emission tomography/computed tomography scan. For both gallbladder adenocarcinoma and Hodgkin lymphoma, medical and surgical therapies must be tailored to the specific disease entity in order to achieve optimal long-term survival rates.

Keywords: Hodgkin lymphoma; Gallbladder perforation; Acute cholecystitis; Gallbladder adenocarcinoma; Case report

Core Tip: Here we present a case of Hodgkin lymphoma masquerading as gallbladder adenocarcinoma. In our patient, Hodgkin lymphadenopathy in the region of the porta hepatitis led to obstructions of the cystic and common hepatic ducts, causing acute cholecystitis and subsequent gallbladder perforation with associated cholangitis. Our case highlights the importance of histopathological assessment in diagnosing gallbladder malignancy when a patient presents with gallbladder perforation and a grossly positive positron emission tomography/computed tomography scan. For either gallbladder adenocarcinoma or Hodgkin lymphoma, chemotherapy tailored to the disease (and appropriate surgical intervention) are essential to achieve the best chance of cure and long-term survival.