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(1): 99758 [DOI: 10.4240/wjgs.v17.i1.99758]
Corresponding Author of This Article
Shu-Mei Zheng, PhD, Associate Chief Physician, Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, No. 270 Rongdu Road, Chengdu 610083, Sichuan Province, China. zhengsm@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Xing-Yu Chen, Department of Gastroenterology and Hepatology, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Xing-Yu Chen, A-Niu Liu, Shan-Shan Wu, Se-Niu Ji Zhi, Shu-Mei Zheng, 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
Author contributions: Zheng SM designed the report; Chen XY and Liu AN collected the patient’s clinical data; Yang JY and Ji Zhi SN analyzed the radiological imaging; Chen YH and Wu SS analyzed the histological and immunohistochemical images; Chen XY and Zheng SM wrote the paper.
Informed consent statement: Written informed consent was obtained from the patient’s relatives for the publication of this report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu-Mei Zheng, PhD, Associate Chief Physician, Department of Gastroenterology and Hepatology, The General Hospital of Western Theater Command, No. 270 Rongdu Road, Chengdu 610083, Sichuan Province, China. zhengsm@163.com
Received: July 30, 2024 Revised: October 7, 2024 Accepted: October 31, 2024 Published online: January 27, 2025 Processing time: 150 Days and 8.9 Hours
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.
Core Tip: Primary duodenal T/histiocyte-rich large B-cell lymphoma (T/HRBCL) is an extremely rare and highly aggressive malignancy. It 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. 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. We report a case of primary duodenal T/HRBCL complicated with obstructive jaundice to improve the clinician’s understanding.
