Abstract
Abstract
Background
Primary lymphoma of the liver, gallbladder, and extrahepatic bile ducts or secondary involvement of these organs by leukemia is exceedingly rare. Patients with primary lymphoma or leukemic involvement of the biliary tract and liver often present with symptoms and signs of biliary tract obstruction or inflammation.
Case presentation
We present a case of a 24-year-old male with biliary tract symptoms who underwent laparoscopic cholecystectomy. His precholecystectomy complete blood count performed on the same morning showed 72% lymphocytes while peripheral blood smears showed approximately 15% blasts. Surgeon went ahead with the procedure. Imaging done prior to surgery showed thickened gallbladder, while the liver, biliary tract, and pancreas did not show any thickening or mass lesion. However, the liver was enlarged. Grossly, the gallbladder wall did not show any stones or discrete mass involving the wall. Instead, there was subtle thickening of the gallbladder wall due to diffuse infiltration by the leukemic infiltrate. This lymphoid population reacted with PAX-5 and TdT immunohistochemical antibodies in a diffuse manner confirming precursor B-cell origin. This patient was found to have B-lymphoblastic leukemia involving his bone marrow on further clinical and diagnostic workup. Patient responded well to chemotherapy and is currently on maintenance treatment. He is well 1.5 years after his diagnosis.
Conclusion
This case highlights a unique and rare scenario where a previously undiagnosed and unsuspected hematologic malignancy initially presented with clinical features of a chronic inflammatory condition involving an abdominal organ owing to secondary involvement by the malignant infiltrate.
Publisher
Springer Science and Business Media LLC
Reference43 articles.
1. Fidias P, Carey RW, Grossbard ML. Non-Hodgkin’s lymphoma presenting with biliary tract obstruction. A discussion of seven patients and a review of the literature. Cancer. 1995;75(7):1669–77.
2. Dellon ES, Morris SR, Tang W, Dunphy CH, Russo MW. Acute liver failure due to natural killer-like T-cell leukemia/lymphoma: a case report and review of the literature. World J Gastroenterol. 2006;12(25):4089–92.
3. Mani H, Climent F, Colomo L, Pittaluga S, Raffeld M, Jaffe ES. Gall bladder and extrahepatic bile duct lymphomas: clinicopathological observations and biological implications. Am J Surg Pathol. 2010;34(9):1277–86.
4. Hwang DW, Lim CS, Jang JY, Lee SE, Yoon SO, Jeon YK, et al. Primary hematolymphoid malignancies involving the extrahepatic bile duct or gallbladder. Leuk Lymphoma. 2010;51(7):1278–87.
5. Psarras K, Symeonidis N, Vlachaki E, Baltatzis M, Papatolios G, Pavlidis E, et al. Primary gallbladder small lymphocytic lymphoma as a rare postcholecystectomy finding. Case Rep Hematol. 2014;2014:716071.
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献