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CT and MRI Findings of Primary Non-Hodgkin's Lymphoma of the Common Bile Duct Mimicking Cholangiocarcinoma

Chonnam National University Medical School Gwangju 501-757, South Korea

Primary lymphoma of the common bile duct is a rare disease. We describe primary non-Hodgkin's lymphoma of the common bile duct that mimicked the appearance of cholangiocarcinoma.

A 21-year-old woman was admitted with a 1-month history of progressive jaundice. Her peripheral blood level findings revealed aspartate aminotransferase 74 U/L, alanine aminotransferase 48 U/L, alkaline phosphatase 163 U/L, total bilirubin 8.48 mg/dL, and direct bilirubin 6.17 mg/dL. Abdominal sonography showed a hypoechoic mass in the common bile duct and dilatation of the intrahepatic bile ducts. CT showed diffuse circumferential thickening of the mid portion of the common bile duct and dilatation of proximal bile ducts (Fig. 6A). MRI depicted a well-defined mass that was hypointense to the hepatic parenchyma on T1-weighted images (Fig. 6B), and diffusely enhancing on gadolinium-enhanced T1-weighted images. MR cholangiopancreatography showed a mass obstructing the common bile duct and dilatation of the proximal bile ducts (Fig. 6C). ERCP revealed that the midportion of the common bile duct had an abruptly narrowed area with a smooth luminal surface (Fig. 6D).

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A. —21-year-old woman with progressive jaundice. Contrast-enhanced CT scan shows diffuse circumferential thickening of common bile duct with enhancement (arrows).

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B. —21-year-old woman with progressive jaundice. T1-weighted gradient-echo image (TR/TE, 120/4.2) shows hypointense mass (arrow) in common bile duct with dilatation of both intrahepatic bile ducts.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C. —21-year-old woman with progressive jaundice. Thin-section MR cholangiopancreatogram (96,000.0/185.6) shows mass (arrows) causing narrowing of mid portion of common bile duct and dilatation of proximal bile ducts.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D. —21-year-old woman with progressive jaundice. ERCP image shows abrupt narrowing of mid portion of common bile duct (arrows) with smooth luminal surface and dilatation of proximal bile ducts.

The patient had resection of the common bile duct and hepaticojejunostomy with the presumptive diagnosis of cholangiocarcinoma of the common bile duct. At the time of surgery, the common bile duct had a 2-cm–long mass at mid portion. Microscopically, the mass showed infiltration of lymphoid cells throughout a thickened wall and preservation of the epithelium. The mass proved to be non-Hodgkin's lymphoma, diffuse large B cell type. There were no enlarged lymph nodes in the abdominal cavity or in the retroperitoneal space and no other site of disease was identified on CT scans.

Primary malignant lymphoma of the common bile duct is rare. Several cases have been reported. In most cases, primary lymphoma of the common bile duct showed diffuse wall thickening without lymph node enlargement or wall thickening with adjacent lymph nodes [1–4].

It is not easy to differentiate lymphoma from cholangiocarcinoma either radiologically or clinically. In all cases previously reported, surgery was performed for a diagnosis of cholangiocarcinoma or sclerosing cholangitis [3–4]. Radiologically, primary lymphoma shows diffuse wall thickening of the common bile duct and proximal bile duct dilatation on CT, which is also shown in cholangiocarcinoma. To our knowledge, MRI in this context has not been reported previously. In this case, primary lymphoma of the common bile duct was revealed as hypointense to the hepatic parenchyma on T1-weighted images, hyperintense on T2-weighted images, and well-enhanced on gadolinium-enhanced T1-weighted images.

Although this disease is rare and radiologic findings are indistinguishable from cholangiocarcinoma, primary lymphoma of the common bile duct should be considered in the differential diagnosis when an obstructing mass with a smooth luminal surface is found in the common bile duct, especially in a young adult.

References

1. Chiu KW, Changchien CS, Chen L, Tai D, Chuah SK, Chen C. Primary malignant lymphoma of common bile duct presenting as acute obstructive jaundice: report of a case. J Clin Gastroenterol1995; 20:259 –261[Medline]
2. Maymind M, Mergelas JE, Seibert DG, Hostetter RB, Chang W. Primary non-Hodgkin's lymphoma of the common bile duct. Am J Gastroenterol 1997;92:1543 –1546[Medline]
3. Eliason SC, Grosso LE. Primary biliary malignant lymphoma clinically mimicking cholangiocarcinoma: a case report and review of the literature. Ann Diagn Pathol2001; 5:25 –33[Medline]
4. Nguyen GK. Primary extranodal non-Hodgkin's lymphoma of the extrahepatic bile ducts: report of a case. Cancer1982; 50:2218 –2222[Medline]

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lim, H. S. Articles by Cho, C. K. Search for Related Content PubMed PubMed Citation Articles by Lim, H. S. Articles by Cho, C. K. Social Bookmarking                      What's this?